Dear Editor,

Unfortunately, as previously discussed, it was not logistically
possible for you to amend the paper version of my letter (although the
press release was amended) and i would therefore like to submit my
corrected version as a 'rapid update'. The main alteration is that the
reference has been corrected to a more up-to-date paper.

Rather alarmingly the media has widely misreported the term SHO, and
cited me as a 'leading doctor' - i am not a leading doctor or even a
senior doctor and my comments are my own personal reflections and do not
represent the opinion of the Oxford Radcliffe trust.

"Dr Rana makes a very valid point regarding the psyhological effects
on the Iraqi population stemming from their exposure to an apparent vast
increase in violent death as reported in the Lancet. Previous studies have
suggested that the risk of developing posttraumatic stress disorder
following a traumatic event ranges from 7.5% to 72.%, with the risk being
highest in those exposed to sustained combat trauma (1). With an excess of
over 500,000 violent deaths there will no doubt have been many more people
exposed to grave violence. It therefore seems likely that the nation of
Iraq may suffer a double blow, firstly by losing a sizebable proportion of
its working population and secondly by the significant consequences of
people suffering post-traumatic stress disorder. This may also be
compounded by cultural barriers which prevent people from seeking
pyschological help. The mainstay of the coalition's medical effort has
been understandably directed at assisting with basic medical help and
treating injured civilians in Iraqi or coalition hospitals. The medical
literature provides ample examples of rebuilding psychiatric facilities in
a post-war era, most notably the experiences of doctors in Croatia
following the invasion by coalition forces. We must learn the lessons of
history and expedite the psychiatric help for Iraqi civilians.

1. J Clin Psychiatry 2000;61[suppl 5]:4-12 Posttraumatic Stress
Disorder: The Burden to the Individual and to Society
2. Med Arh. 2001;55(1 Suppl 1):5-23 Reconstruction of mental health
services in Bosnia and Herzegovina"

Further to my letter i would add that although post-traumatic stress
disorder remains a somewhat controversial diagnosis, especially outside
the west, my letter was aimed at highlighting an aspect of the wellfare of
Iraqi civillians which I feel has thus far been underreported.

kind regards,

Michael Reschen

Competing interests:
None declared