Years after gas attack, the horror lingers in an Iranian town, EPH alumna finds

After every bombing, people in Sardasht, a small town at the foot of Iran’s Zagros Mountains, ran outside to help the injured. On June 28, 1987, they rushed into a world that smelled of garlic. The air burned like acid. Bodies were covered with blisters. Children were crying, beyond comfort. When the blindness came, the villagers had no reason to expect that it would be temporary. For many, it was not.

The physical effects of chemical weapons like the mustard gas that fell on this Iranian town during the 1980-1988 war between Iran and Iraq are well-documented: burns, respiratory problems and temporary or permanent blindness. A new Yale study now sheds light on the psychiatric effects. Farnoosh Hashemian, M.P.H. ’05, a research associate in the Department of Epidemiology and Public Health (EPH), has documented severe and long-term mental health problems in Sardasht residents who survived a chemical attack. Her data were so compelling that the Iranian government made a psychologist, a scarce resource in the country, available to the 4,000 chemical-attack survivors in Sardasht.

Hashemian’s team published their findings in the August 2 issue of JAMA: The Journal of the American Medical Association. They collected data in three Kurdish towns in rural Iran: one was bombed 10 times; another was bombed 75 times; and a third, Sardasht, was bombed 60 times and also was attacked with chemical weapons. Hashemian did not anticipate the magnitude of distress she found in Sardasht—59 percent of those exposed to chemical weapons had experienced post-traumatic stress disorder, and 33 percent were still suffering from the disorder. She found that 65 percent had major anxiety symptoms and 41 percent had severe depressive symptoms.

Growing up in Tehran during the war, Hashemian knew that Saddam Hussein had gassed civilians and Iranian troops. “Will he gas Tehran?” the adults whispered. Believing a chemical attack on the Iranian capital was imminent, her family fled the city, eventually settling in Canada.

Three years ago Hashemian returned to Iran as an EPH student on a Downs International Health Student Travel Fellowship. Although the program usually sends students to countries unfamiliar to them, Hashemian convinced the review committee that rural Kurdish areas would constitute a new culture for a woman raised in fast-paced Tehran. Her parents in Canada were a harder sell. The border region in northern Iran is known for smugglers and land mines. “They were very worried, but now they are proud of me,” she said.

Hashemian collected data along with Farahnaz Falahati, M.D., a physician with the Janbazan Medical and Engineering Research Center, the Iranian equivalent of the Veterans Administration. The women stayed in spartan quarters with no showers or kitchen. But Hashemian said their main challenge was hearing the dreadful and grim stories.

Survivors reported nightmares, inability to work and relationships broken under the weight of stress. They believed another attack would come at any moment. Their fear was heightened during Hashemian’s visit because the United States had just invaded Iraq. Many villagers expected that Saddam would gas them again in retaliation for the U.S. attack. Despite their fearfulness, they invited the researchers into their small houses, offered them special meals and willingly told their stories.

“They felt that they had been forgotten,” Hashemian explained, and she agrees. The international community was silent during and after the attacks, she said.

Hashemian would like to see her work used by international organizations seeking to eradicate chemical weapons. By documenting the suffering of civilians—who account for most war casualties—Hashemian said, public health professionals can raise discussions of war and peace above the realm of politics. “War is a serious public health issue.”