Just before 5 a.m., Dr. Saleem Al-Nuaimi enters his office at the University of Alberta Hospital in Edmonton, Canada. As the northern sky starts its shift from darkness to daybreak, most of his local patients remain in bed.
Saleem turns on his computer, and opens Skype. Half a world away in Syria, it’s 2 p.m., and the first patient of the day greets him from the pop-up window.
The psychiatrist regularly connects this way with 300 refugees and internally displaced people in northern Syria and the border town of Reyhanli, Turkey. Over the internet, he and doctors like him provide counseling and mental health assessments in a region where grief, mood disorders, depression, and trauma from war often go untreated. Saleem prescribes medications, too, though he’s not able to actually dispense them.
Shoddy electricity and connectivity in war-torn Syria often wreak havoc on this health care workaround. Jumpy words, intermittent flashes of people, sudden and total failure: all common side effects in places where IT infrastructure lacks or lags. It’s something neither doctors nor patients in need are immune to — no matter how many times they reset and reboot, or how many chairs they’ve stacked to get closer to a neighbor’s modem, or the severity of the issue at hand.
“Sometimes you just have to wait half an hour until it comes back,” Saleem says. “I’ve gotten used to it.”
When Skype won’t work, Saleem often turns to emails and phone calls to keep things moving. Occasionally, the internet connection in Syria returns just as Saleem’s Edmonton patients start to arrive. Prioritizing patients can get awkward, he says. To maximize efficiency — and take advantage of good connections — he’ll often hop back on Skype between Canadian visitors to get a quick update from Syria.
Saleem, who was born and raised in Edmonton and speaks Arabic, first visited the region in 2012 to treat Syrians seeking asylum in Turkey. He returned a year later to treat internally displaced people in tent cities throughout northern Syria. There, he saw that hospitals, homes, places of worship, and schools had all become targets in the bloody conflict between national forces, rebel armies, and insurgent groups.
War began in early 2011 following peaceful protests to oust Bashar al-Assad. The president refused to step down, sparking backlash. The death toll now tops 320,000, with millions more people forced to flee their homes.
Saleem says he initially feared the traumatized Syrians wouldn’t accept his help; seeking mental health care, as in many parts of the world, is often frowned upon. “But the problem is so big, it affects so many people, that it’s not really stigmatized anymore,” he explains. “Everybody’s been bombed and traumatized,” he adds, and many Syrians “don’t eat, don’t sleep, are irritable, and have huge amounts of anxiety.”
Over the internet, Saleem provides mental health care in a region where grief, mood disorders, depression, and trauma often go untreated.
The World Health Organization estimates nearly 600,000 Syrians suffer severe mental health disorders, while another 4 million are battling mild to moderate conditions — roughly 20 percent of the population.
Sitting in a windowless office in Edmonton, Saleem leans forward, shifting to recall his patient Nadia (not her real name) while people bustle in the background. Saleem treated Nadia in person shortly after his first visit. “She had a house, she had land, a husband who worked, she had kids,” Saleem says. “She had everything she wanted.” One morning, Nadia, in her mid-30s, was in the back of her house making bread. Her husband and five children were out at the market, or playing in the street.
A loud whooshing sound came just before a barrel-bomb smashed the front of Nadia’s house. She blacked out. Waking up, she realized what had happened. As the village evacuated in terror, she tried to collect the scattered body parts of her two slain children. She put those in a garbage bag to bury later. Her husband and eldest son, she later learned, died at the market.
“I remember her blank eyes. Very blank. No emotion,” Saleem recalls. On that trip, where he met with internally displaced Syrians to offer his free psychiatric services, he found many people like Nadia, suffering from post-traumatic stress disorder and depression.
With security concerns caused by militant groups like ISIS in northern Syria, camps like the one Nadia stayed in often disperse with-out a trace — yet another obstacle for effective care. Saleem has not been able to connect with Nadia in person or digitally since.
After recounting the story, Saleem’s cell phone alerts him to more work. He plans to expand his on-the-ground operations in Turkey and Syria through a partnership with the Union of Syrian Medical Relief Organizations, a non-governmental group. He’s also growing his Skype-based practice, training a team of psychiatrists in Canada to help treat Syrian patients over the internet.
“I never used to do this kind of work,” Saleem reflects. “And I’m not responsible for outcomes; I’m just responsible for what I can do. That’s a very frustrating thing for most people — that we do something and we expect an outcome, because our societies are driven that way.” He pauses. “But sometimes, you just need to do something because it’s the right thing.”