Psychological scars of war take toll in Misrata
The Libyan city of Misrata, scene of the bloodiest fighting during the revolution that toppled Colonel Gaddafi last year, is facing an acute crisis of psychiatric care for former fighters traumatised by the conflict and frustrated by the aftermath.
The battle of Misrata became known as Libya's Stalingrad.
In the three months the city was under siege, Misratans say 2,000 died and 14,000 were wounded.
Many young men are now struggling to cope with the psychological fallout, and doctors say there is a desperate shortage of qualified mental healthcare practitioners to treat them.
Mental illness is traditionally a taboo subject in much of the Arab world, and in the highly conservative city of Misrata conventional attitudes prevent many young men coming forward to seek the help they need.
But a high number of them are thought to be suffering from problems including psychosis, acute depression and post-traumatic stress disorder.
Some who have lived through the fighting also share a deep sense of depression and disillusionment at the lack of change they feel in the post-Gaddafi Libya.
Dr Khaled al Madani, head of the psychology department of Misrata University, has been trying to establish proper mental healthcare services in the city for more than a year.
He says at present there is only one part-time psychiatrist from Tripoli available to hold a regular but limited clinic in Misrata.
In a recent sample he conducted, among 200 local people who had lost their homes during the fighting, 17% were discovered to be suffering from post-traumatic stress disorder.
"This concept is new in Libya, but we now have a high number of people who are suffering from this high level of PTSD," he says.
At the Al Wazrak Medical Centre in Misrata one former fighter has come to see Dr Isa Asalini, the sole psychiatrist, who has just arrived from Tripoli.
The fighter, Ahmed (not his real name), who was studying at law college with a part-time job before the revolution, is suffering from acute depression.
This is the first time he has been to discuss his condition with a doctor. He has hollowed-out and listless eyes and conveys an overwhelming sense of despair.
"I lost many friends during the fighting," he says. "Many guys died. Many lost body parts, became amputees, or lost their sight."
Talk to Ahmed for a few minutes and the profound sense of disillusion he has regarding the revolution and its achievements is unmistakable. He cuts a harrowing figure in the clinic.
"In general I feel always sad and unable to sleep well. Mostly I feel isolated from the community, not like before.
"I feel that those people who died in the war died for nothing. For sure they are martyrs according to our religion, but I think they died for nothing and that's what drove me to depression. For me personally, I feel my life was better before the revolution."
Before the war, Ahmed used to do some trading abroad. Today he says he can't even get a visa to leave Libya and sees no future. In his bleakest moments, he has even contemplated suicide, an action that is fiercely condemned by Islam.
"Before the revolution I had ambitions but now I'm really depressed and I don't have the ambitions I had before. Nothing is stable in the country.
"I feel it will take a long time for the country to get stable again and this drives me to depression, and sometimes to think about killing myself to get rid of that feeling."
Questioning the revolution in a city like Misrata, which has developed a powerful cult of heroism and victimhood after experiencing the brunt of the fighting and casualties, brings its own dangers in the new Libya.
"Of course there is no freedom of speech at the moment. I am Misratan, my father is Misratan, my grandfather the same, but I cannot criticise the revolution, even on Facebook," Ahmed says.
"The question that keeps coming to my mind, is 'What did we gain?' I feel we gained nothing, but I can't say that in public because some katiba [brigade] may harm me or my family or even arrest me."
Dr al Madani notes that while young men represent the great majority of those suffering from mental health conditions, some women have also been seeking help.
One of his female patients suffers repeated flashbacks in which she thinks she is going to be raped or killed. "She has tried to kill herself three times," he says.
Misratans allege that soldiers from the neighbouring town of Tawergha fighting for Gaddafi committed numerous rapes of Misratan women and perpetrated other atrocities including the castration of Misratan men during the fighting in the city.
Tawerghans, who have not been allowed to return to their town and are now scattered across makeshift camps across the country, deny most of the charges and say they are being punished for the crimes of a small minority.
The war may be over, but cases like Ahmed are all too common in Misrata, says Dr al Madani.
"We have many of them, they're very disappointed and have depression because actually they need medicine, they need people to work with, and we don't have it. They thought previously that if they changed the Gaddafi regime everything would be fine. And, of course, this is not logically right."
Almost two years after he first started fighting, Ahmed is at last beginning treatment. His road to recovery will be a long one.
"I fought hard during the revolution, from Tripoli Street in Misrata to Bab al Aziziya [Gaddafi's compound in Tripoli] and Sirte," he says.
"I lost my business, I lost my friends and now I don't have anything left. My dreams are completely broken."