The following view was espoused in a 1903 Lancet editorial describing psychiatric services in the East: ‘The treatment of lunatics in the East has not yet fully emerged from the clouds of ignorance and barbarism which have surrounded it for ages.’ One of the first reformers was ‘Mr. Theophilus Waldmeier, a gentleman resident in Syria, who commenced in the spring of 1896 the work of helping and providing for the numerous sufferers from mental disease in Syria and Palestine.’ He attempted to introduce the methods of humanity and science in this field. In 1939 Bernstein described his visit to the Maristan Arghoum, a psychiatric hospital, in the city of Aleppo. He observed the complete lack of medical supervision, ‘bad’ patients being chained and the despotic rule of the ‘keeper’ of the hospital.

Demographics

The Syrian Arab Republic has a total area of 185 180 km2, of which approximately 80 000 km2 is cultivable land; the remainder is desert and rocky mountains. The country's population in 2006 was estimated at 18.717 million. The population growth rate was 2.45%; 39.4% of the population were below 15 years of age and 3.3% above 65 years. In 2006, the crude death rate was estimated to be 4 per 1000 population per annum and the crude birth rate 30 per 1000 per annum. In the same year, life expectancy at birth was estimated at 72 years.

The socio-demographic correlates of psychiatric morbidity among lowincome women in Aleppo, Syria, were studied by Maziak et al (2002), who concluded that the prevalence of ‘psychiatric distress’ was 55.6%, but there was no categorisation of these psychiatric disorders. The study used a special questionnaire based on items not relating to psychosis from the 20-item Self-Reporting Questionnaire (SRQ–20), as well as questions about background information considered relevant to the mental health of women in the population studied. (The SRQ–20 was developed primarily as a psychiatric screening tool to suit primary care settings in low- and middle-income countries.) ‘Psychiatric distress’ was related to a number of factors, including women's illiteracy, polygamy and physical abuse, most of which are amenable to intervention.