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 IRAQ: Trauma leaves an indelible mark

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تاريخ التسجيل : 07/10/2009
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مُساهمةموضوع: IRAQ: Trauma leaves an indelible mark    الجمعة 03 سبتمبر 2010, 21:25

IRAQ: Trauma leaves an indelible mark

US President Barack Obama may have hailed the end of US combat operations in Iraq, but the seven-year war has left an indelible mark on many ordinary people who are still traumatized by the horrific things they experienced.Whenever he sees a speeding car, Ammar Khalil Sadiq recalls the summer of 2006 when a suicide bomber drove his explosives-laden vehicle into a police patrol a few metres from his Baghdad music shop.

Seconds later Sadiq, 34, found himself lying underneath the shop shelves and shattered glass, the air heavy with smoke, dust and a strong smell of TNT. Ignoring his injuries, he knew he had to get out to check on his brother who was in the street just before the explosion.“The smell of burnt human flesh and the yells of the wounded are still in my nose and ears,” Sadiq said. “I can’t forget how I walked on pieces of human flesh until I recognized my brother’s dismembered body by the watch which was still on his left wrist.”

The Iraqi authorities have only recently begun to address the mental health issues and psychological scars resulting from three decades of war and social and economic turmoil, said Sabah Karkokli, a spokesman for the Iraqi Health Ministry.In 2009 the Health Ministry started to roll out a programme of psychological therapy, and train staff to meet the increasing need for such therapy nationwide, Karkokli said. Iraq has opened mental health units in each of its nearly 3,500 hospitals and health centres nationwide, he added.

The country has two psychiatric institutions - in Baghdad’s Al-Rashad and Ibin Rushid hospitals - and six other recently inaugurated trauma centres.“We started opening units in each of our health institutions and encouraging doctors to undertake training in psychiatric treatment… We are aiming to create an awareness of mental illness and encourage people to show up whenever they need to,” Karkokli said.

Mental health survey

In March 2009 Iraq released its first and only nationwide
mental health survey. Carried out by the World Health Organization (WHO) and the Health Ministry, it painted a grim picture.Of the 4,332 respondents aged 18 and above surveyed, nearly 17 percent had suffered from a mental health disorder in their lifetime, ranging from post-traumatic stress disorder to depression. A higher rate of severe depression and phobias, like fear of leaving the house, was observed among women.

The 102-page report said many of the cases documented related to the period during and after the 2003 US-led
invasion that toppled Saddam Hussein. It said nearly 70 percent of those with a mental health disorder said they had considered committing suicide.It also noted that there were only 437 psychiatric and social workers
nationwide in a country of nearly 30 million.

Success story in Basra

After receiving training in the USA on the diagnosis and treatment of trauma cases as part of a cooperation
programme with the US Health Department, psychiatrist Aqeel Al-Sabagh and three of his colleagues opened a
mental health centre in the southern province of Basra in December 2009.

Initially, demand for the services of was very low due to the stigma associated with mental illness and the lack of awareness among people who usually turn to clerics or quacks for help, al-Sabagh said.“We started a campaign in the local media to raise awareness about trauma and what the Sarah Centre could offer. We also held symposiums in the province’s universities and distributed leaflets with the help of community leaders,” he told IRIN.

Subsequently the number of people coming to what is Basra’s sole government-run centre has risen. “We are
now planning to expand the centre and increase the number of employees to cater for the increasing number of
visits.”Al-Sabagh said most of the cases they received were prisoners during Saddam Hussein’s regime or had
been deserters - some with their ears cut off as a punishment - and the survivors of torture, kidnappings, rape
and family violence.

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PTSD More Likely to Develop Dementia

Military veterans with post-traumatic stress disorder, or PTSD, are more likely to develop dementia than those without the disorder, according to researchers at a Veterans Affairs medical center in Texas.The results were significant even after accounting for other risk factors for dementia such as diabetes, high blood pressure, heart disease and stroke.

The researchers noted that further investigation is needed to learn the reasons behind their findings, published in the September issue of the Journal of the American Geriatrics Society."Although we cannot at this time determine the cause for this increased risk, it is essential to determine whether the risk of dementia can be reduced by effectively treating PTSD. This could have enormous implications for veterans now returning from Iraq and Afghanistan," senior author Dr. Mark Kunik, a psychiatrist at the Michael E. DeBakey VA Medical Center in Houston, said in a journal news release.

He and his colleagues studied 10,481 veterans, aged 65 and older, who had been seen at least twice at the medical center between 1997 and 1999. Outpatient data from the patients was gathered until 2008.Overall, 36.4 percent of the veterans had PTSD. Dementia occurred in 11.1 percent of patients who had PTSD but had not been injured during combat, and in 7.2 percent of those who had PTSD and had suffered combat injuries, the investigators found. Dementia rates for veterans without PTSD were 4.5 percent for those without combat injuries and 5.9 percent for those who'd suffered combat injuries.

The study authors suggested that there could be a number of explanations for the findings: cognitive impairment in PTSD may be an early marker of dementia; having PTSD may increase the risk of developing dementia; or PTSD and dementia may have some common characteristics.The findings about veterans may have wider significance, noted the author of an accompanying editorial.

"Confirmation of a causal link between PTSD and cognitive impairment in late life would have enormous global implications in a world facing a rising societal burden of dementia, a shrinking workforce to sustain its economies, and the difficulties of containing human violence," wrote Dr. Soo Borson of the University of Washington Medical Center in Seattle. "Soldiers and other U.S. war veterans are just one of many groups exposed to deeply traumatizing experiences with lifetime effect."

More information

The U.S. National Institute of Mental Health has more about

-- Robert Preidt

SOURCE: Journal of the American Geriatrics Society, news release, Sept. 2, 2010

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Dementia common in vets with PTSD

War veterans with post-traumatic stress disorder appear far more prone to dementia than other veterans, according to a new study.

The findings in Thursday's study could have implications for people suffering from other traumas such as rape, car crashes or the sudden death of loved ones, said an editorial published with the study in the Journal of the American Geriatrics Society."We found veterans with PTSD had twice the chance for later being diagnosed with dementia than veterans without PTSD," psychiatrist Mark Kunik of the Michael E. DeBakey Veterans Affairs Medical Center in Texas, said in a news release.

"Although we cannot at this time determine the cause for this increased risk, it is essential to determine whether the risk of dementia can be reduced by effectively treating PTSD. This could have enormous implications for veterans now returning from Iraq and Afghanistan."The study included medical records of 10,481 U.S. veterans aged 65 and older that had visited a VA medical centre at least twice between 1997-1999. It checked those records a decade later.The prevalence of PTSD in the group was 36.4 per cent.It found 11.1 per cent of those with PTSD who had not been injured had dementia, compared with 4.5 per cent of those without PTSD who had not been injured.

It said 7.2 per cent of those with PTSD who had been injured had dementia, compared with 5.9 per cent who had been injured, but had no PTSD diagnosis.The authors took other risk factors for dementia into account, such as diabetes, substance abuse and heart disease.Most of the subjects were men, so the findings cannot be generalized to women, the authors said.The editorial said a separate study of records turned up similar findings.The editorial by psychiatrist Soo Borson of the University of Washington Medical Center in Seattle cautioned that more research is required.

"Confirmation, in future research, of a causal link between PTSD and cognitive impairment in late life would have enormous global implications in a world facing a rising societal burden of dementia, a shrinking workforce to sustain its economies, and the difficulties of containing human violence," Borson wrote."Soldiers and other U.S. war veterans are just one of many groups exposed to deeply traumatizing experiences with lifetime effect."Among them are civilian survivors of genocidal and other mass violence, victims of rape and childhood physical abuse, first responders and individuals surviving severe medical illness.

© Copyright (c) Postmedia News

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Questions over drugs to sleepless vets

Andrew White returned from a nine-month tour in Iraq beset with signs of post-traumatic stress disorder: insomnia, nightmares, constant restlessness. Doctors tried to ease his symptoms using three psychiatric drugs, including a potent anti-psychotic called Seroquel.Thousands of soldiers suffering from PTSD have received the same medication over the last nine years, helping to make Seroquel one of the Veteran Affairs Department's top drug expenditures and the No. 5 best-selling drug in the nation.

Several soldiers and veterans have died while taking the pills, raising concerns among some military families that the government is not being up front about the drug's risks. They want Congress to investigate.In White's case, the nightmares persisted. So doctors recommended progressively larger doses of Seroquel. At one point, the 23-year-old Marine corporal was prescribed more than 1,600 milligrams per day — more than double the maximum dose recommended for schizophrenia patients.

A short time later, White died in his sleep."He was told if he had trouble sleeping he could take another (Seroquel) pill," said his father, Stan White, a retired high school principal.An investigation by the Veterans Affairs Department concluded that White died from a rare drug interaction. He was also taking an antidepressant and an anti-anxiety pill, as well as a painkiller for which he did not have a prescription. Inspectors concluded he received the "standard of care" for his condition.

It's unclear how many soldiers have died while taking Seroquel, or if the drug definitely contributed to the deaths. White has confirmed at least a half-dozen deaths among soldiers on Seroquel, and he believes there may be many others.Spending for Seroquel by the government's military medical systems has increased more than sevenfold since the start of the war in Afghanistan in 2001, according to documents obtained by The Associated Press under the Freedom of Information Act. That by far outpaces the growth in personnel who have gone through the system in that time.

Seroquel is approved to treat schizophrenia, bipolar disorder and depression, but it has not been endorsed by the Food and Drug Administration as a treatment for insomnia. However, psychiatrists are permitted to prescribe approved drugs for other uses in a common practice known as "off-label" prescribing.But the drug's potential side effects, including diabetes, weight gain and uncontrollable muscle spasms, have resulted in thousands of lawsuits. While on Seroquel, White gained 40 pounds and experienced slurred speech, disorientation and tremors — all known side effects.Last year, researchers at Vanderbilt University published a study suggesting a new risk: sudden heart failure.

The study in the January 2009 edition of the New England Journal of Medicine found that there were three cardiac deaths per year for every 1,000 patients taking anti-psychotic drugs like Seroquel. Seroquel's unique sedative effect sets it apart from others in its class as the top choice for treating insomnia and anxiety.AstraZeneca PLC, maker of the drug, said it is reviewing the study. The FDA is conducting its own review, citing the limited scope of the Vanderbilt study.According to the Veterans Affairs Department, Seroquel is only prescribed as a third or fourth option for patients with difficult-to-treat insomnia stemming from PTSD.

Marine Cpl. Chad Oligschlaeger, 21, was being treated for PTSD when he died in his sleep at Camp Pendleton, Calif., in May 2008. Oligschlaeger was taking six types of medication, including Seroquel, to deal with anxiety and nightmares that followed two tours of duty in Iraq.The military medical examiner attributed the death to "multiple drug toxicity," indicating that Oligschlaeger, too, died from a drug interaction. Because of the complex reactions between various drugs, medical examiners do not attribute such deaths to any one medication.After consulting with physicians, parents Eric and Julie Oligschlaeger now believe their son died of sudden cardiac arrest caused by Seroquel.

"Right now, I'm so angry, and I believe someone needs to be held accountable," said Julie Oligschlaeger, of Austin, Texas. "The protocol absolutely has to change."The Defense Department's deputy director for force health protection, Dr. Michael Kilpatrick, said the government has not seen any increase in dangerous side effects from Seroquel and other drugs.Physicians interviewed by the AP said they began prescribing Seroquel because it was the only drug that offered relief from the nightmares and anxiety of PTSD.

"By accident, some people were giving them Seroquel for anxiety or depression, and the veterans said, 'This is the first time I have slept six or seven hours straight all night. Please give me more of that.' And the word spread," said Dr. Henry Nasrallah of the University of Cincinnati, who has treated PTSD patients for more than 25 years.Most of the soldiers and veterans seeking treatment for PTSD do so at hospitals run by the VA or the Defense Department.

The VA's spending on Seroquel has increased more than 770 percent since 2001. In that same time frame, the number of patients covered by the VA increased just 34 percent.Seroquel has been the VA's second-biggest prescription drug expenditure since 2007, behind the blood-thinner Plavix. The agency spent $125.4 million last fiscal year on Seroquel, up from $14.4 million in 2001.Spending on Seroquel by the Department of Defense, has increased nearly 700 percent since 2001, to $8.6 million last year, according to purchase records.

Nasrallah and others said they use drugs like Seroquel off-label because so few treatments are approved for PTSD. The FDA has only cleared two drugs for the condition, the antidepressants Paxil and Zoloft, and they do not always work.The only published study on use of Seroquel for PTSD-related insomnia involved just 20 patients who were followed for six weeks at a VA medical center in South Carolina. The study, which showed moderate improvement in sleep, was funded by AstraZeneca at the request of VA psychiatrist Dr. Mark Hamner, who has studied the use of Seroquel for PTSD.

In his written conclusion, published in 2003, Hamner urged caution in interpreting the results because of the study's small size and short duration.Hamner is working on larger, federally funded studies of Seroquel. For now, he acknowledges, there is little published research on the use of the drug for PTSD."Clinical judgment is really the best we can use at this time because there isn't really a good database to facilitate decision-making," said Hamner, who works at the Ralph H. Johnson Medical Center in Charleston, S.C.

He stressed that VA guidelines require doctors to monitor patients for dangerous side effects with drugs like Seroquel.The drug, approved in 1997, is AstraZeneca's second-best-selling product, with U.S. sales of $4.2 billion last year. But that success has been marred by allegations that the company illegally marketed the drug and minimized its risks. AstraZeneca agreed to pay $520 million in April to settle federal allegations that its salespeople pitched Seroquel for numerous off-label uses, including insomnia.

Pharmaceutical companies are prohibited from marketing drugs for unapproved uses. AstraZeneca also faces an estimated 10,000 product liability lawsuits, most alleging that Seroquel caused diabetes.Since White died, his family has been searching for an explanation — and for a way to prevent other deaths."We trusted the knowledge of the physicians, that they weren't going to do any harm," White's father said. "And we also trusted the drug companies because that's who provides the research for the physicians. That's what our battle is now: trying to get changes made."

Copyright © 2010
The Associated Press.

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Contracting Out the Iraq Occupation

Another false ending to the Iraq war is being declared. Nearly seven years after George Bush's infamous "Mission Accomplished" speech on the USS Abraham Lincoln, President Obama has just given a major address to mark the withdrawal of all but 50,000 combat troops from Iraq. But while thousands of US troops are marching out, thousands of additional private military contractors (PMCs) are marching in. The number of armed security contractors in Iraq will more than double in the coming months.

While the mainstream media is debating whether Iraq can be declared a victory or not, there is virtually no discussion regarding this surge in contractors. Meanwhile, serious questions about the accountability of private military contractors remain.In the past decade, the United States has dramatically shifted the way in which it wages war - fewer soldiers and more contractors.Last month, the Congressional Research Service reported that the Department of Defense (DoD) workforce has 19 percent more contractors (207,600) than uniformed personnel (175,000) in Iraq and Afghanistan, making the wars in these two countries the most outsourced and privatized in US history.

According to a recent State Department briefing to Congress' Commission on Wartime Contracting, from now on, instead of soldiers, private military contractors will be disposing of improvised explosive devices, recovering killed and wounded personnel, downed aircraft and damaged vehicles, policing Baghdad's International Zone, providing convoy security and clearing travel routes, among other security-related duties.

Worse, the oversight of contractors will rest with other contractors. As has been the case in Afghanistan, contractors will be sought to provide "operations-center monitoring of private security contractors (PSCs)" as well as "PSC inspection and accountability services."The Commission on Wartime Contracting, a body established by Congress to study the trends in war contracting, raised fundamental questions in a July 12, 2010, "special report" about the troop drawdown and the increased use of contractors:

"An additional concern is presented by the nature of the functions that contractors might be supplying in place of US military personnel. What if an aircraft-recovery team or a supply convoy comes under fire? Who determines whether contract guards engage the assailants and whether a quick-reaction force is sent to assist them? What if the assailants are firing from an inhabited village or a hospital? Who weighs the risks of innocent casualties, directs the action and applies the rules for the use of force?

"Apart from raising questions about inherently governmental functions, such scenarios could require decisions related to the risk of innocent casualties, frayed relations with the Iraqi government and populace and broad undermining of US objectives."We'd like to pose an additional question to the ones listed above: when human rights abuses by private military contractors occur in the next phase of the occupation of Iraq, which certainly will happen, what is the plan for justice and accountability?This massive buildup of contractors in Iraq takes place at a time when the question of contractor immunity - or impunity - is at a critical point.

In one example, since 2004 our organization, the Center for Constitutional Rights (CCR), has been demanding - in US courts and through advocacy - that private military contractors who commit grave human rights abuses be held accountable. Contractors have responded by claiming something known as the "government contractor defense," arguing that because they were contracted by the US government to perform a duty, they shouldn't be able to be held liable for any alleged violations that occurred while purportedly performing those duties - even when the alleged violations are war crimes. Contractors also argue that the cases CCR has brought raise "political questions" that are inappropriate for the courts to consider. These technical legal arguments have been the focus of human rights lawsuits for years - and, so far, the question of the contractors' actual actions have not been reviewed by the federal courts.

One case that should be watched closely this fall is Saleh v. Titan, a case brought by CCR and private attorneys against CACI and L-3 Services (formerly Titan), two private military contractors, which military investigations implicated as having played a part in the torture at Abu Ghraib and other detention centers throughout Iraq.Saleh v. Titan was filed six years ago on behalf of Iraqis, who were tortured and otherwise seriously abused while detained, and currently includes hundreds of plaintiffs, including many individuals who were detained at the notorious "hard site" at Abu Ghraib. The plaintiffs in Saleh v. Titan, many of whom still suffer from physical and psychological harm, are simply seeking their day in court, to tell an American jury what happened to them.

The Court of Appeals for the District of Columbia dismissed the case last September, and the Supreme Court will be deciding whether or not to take the case this fall. This and a handful of other cases will signal how civil lawsuits on behalf of those injured or killed by contractors will be handled in US courts - and decide whether victims of egregious human rights violations will obtain some form of redress, and whether contractors who violate the law will be held accountable or be granted impunity.

And how will human rights abuse by contractors be handled by criminal prosecutors in the coming years? Given its track record, it is safe to say that Iraqi civilians cannot count on the Department of Justice (DOJ) to prosecute many contractor abuse cases. The DOJ was given an "F" by Human Rights First in their 2008 report "Ending Private Contractor Impunity: Report Cards on the US Government Response since Nisoor Square." The DOJ has never pursued criminal prosecutions for contractor involvement in the crimes of Abu Ghraib, something CCR still demands today.

Iraq's Parliament signed the Status of Forces Agreement (SOFA) in 2008, which gave it the power to prosecute some US contractors who commit crimes against Iraqi civilians. We can all hope Iraq's justice system will be able to overcome the political challenges involved in prosecuting US companies or US contractors and other foreigners in Iraq's courts. But even that will not stop the common practice of contractor companies simply pulling their employees out of the country when a crime happens.With these fundamental questions left unanswered and legal loopholes left open, thousands more armed contractors will soon be filing into Iraq, onto the streets where Iraqis work, study and go about their everyday lives.

As a senator, Obama called for less dependence on private military contractors and for accountability when they committed human rights abuses. He told Defense News in 2008 that he was "troubled by the use of private contractors when it comes to potential armed engagements." Senator Clinton co-sponsored legislation to phase out the use of security contractors in war zones.As president, Obama pretends the occupation of Iraq is ending with the withdrawal of combat troops while he and Secretary of State Clinton quietly hire a shadow Army to replace them.

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TRUTHOUT & For more information about Saleh v. Titan, please click here.

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A mosque as old as the Kingdom

Since its founding over eight decades ago, Al Husseini Mosque, the oldest mosque in Amman, Jordan, has been the nexus of the capital's downtown area and an important gathering place for people of all walks of life.The mosque, according to members of the committee running its affairs, which receives up to 1,500 worshipers for Duhr (noon) prayer, is not only a place of worship, but also a monument to the city's history as well as a place of many memories for Amman's older generation.

According to documents from the Amman Awqaf Department, Al Husseini Mosque was the Kingdom's first major architectural project, predating the city's major markets, the stately villas of Jabal Amman, and even Raghadan Palace, the oldest Royal palace.Located at the heart of downtown Amman, the mosque stands on the site of an earlier mosque that was built during the reign of Caliph Omar Ben Al Khattab's (634-644 AD) and renovated during the Umayyad era (661-750AD), the documents show.The original mosque consisted of a prayer hall and courtyard, where people prayed, and a single minaret, from which the muezzin called to the faithful to perform the five daily prayers.

In 1921, after His Majesty the late King Abdullah I decided to make Amman his capital, he ordered the old mosque rebuilt. The project was completed in 1924, and the King decided to name the new mosque after his late father Sharif Hussein, the leader of the Great Arab Revolt.The then-new mosque comprised a prayer hall, a courtyard and a domed fountain for worshipers to perform ablution, decorated with Koranic verses rendered in mosaics. Later on, the place of ablution was moved to another area.
One minaret was built in 1924, standing 13 metres tall, and a second minaret of matching size was added in 1952. Some renovations were made in 1987 during the reign of His Majesty the late King Hussein. Currently, the mosque has an area of 2,000 square metres and accommodates up to 2,600 worshipers.

A city’s nucleus

“Every single memory of our childhood is linked with the mosque,” 84-year-old merchant Manie Maaitah, better known as Abu Yahia, said.During its early years, when Amman was a small city, Al Husseini Mosque brought together everyone from menial labourers to the King himself, Mohammed Bukhari, the head of the mosque’s committee, told The Jordan Times.“There were no other mosques during the 1920s, so Al Husseini Mosque was the only option citizens had,” the 62-year-old Bukhari explained.

As such, he said, the mosque gave people the opportunity to meet prominent Jordanians, including King Abdullah I, who used to attend Friday prayers at the mosque every week.Bukhari said that the king wore white clothes and a white turban and travelled in a car surrounded by horsemen to the mosque, where the armed forces band received him with musical performances.Abu Yahia and other elderly residents of the area recalled waiting anxiously for Fridays to have a chance to see the King when he came to pray.

The late King Abdullah I’s devotion to Al Husseini Mosque was passed on to the later generations of the Hashemite monarchy. King Talal, his son, went on horseback to the mosque to pray and children used to follow the King and salute him, said 73-year-old Riad Assali, a tailor in downtown Amman.The late King Hussein, Bukhari recalled, preferred to pray in Al Husseini Mosque during Eid Al Fitr and Eid Al Adha.

During Ramadan, the mosque used to play host to many celebrations of the holy month, lending a spiritual atmosphere to the city centre, local residents explained.Abu Yahia recounted that Syrian bands used to hold concerts across the street from the mosque in front of Souk Al Bukhariyeh, the oldest market in Amman.Other bands used to chant Sufi songs in the mosque’s courtyard and the popular sweet, kenafeh, was served to worshipers after the Asr (afternoon) prayer on Islamic holidays, Assali told The Jordan Times.

Due to its location at the centre of the capital, Al Husseini Mosque attracted many traders to the area, and many markets were established there.“The presence of the mosque attracted traders, as they could work and pray in the same area,” Bukhari said.Bukhari recalled that shops in downtown Amman used to stay open all night during the final 10 days of Ramadan, when dealers would have iftar in their shops and perform Taraweeh, the special Ramadan evening prayers in the mosque.

Today, although the capital has grown and its downtown has been overshadowed by the cosmopolitan districts of West Amman, Al Husseini Mosque remains an important historical landmark as well as a place of worship for the still-vibrant neighbourhood.Bukhari and other members of the committee look after the mosque, maintaining it as well as preserving its history.“We did some renovations for the bathrooms and bought carpets for the mosque. We are planning to do some improvements in the future,” Bukhari said.

The committee chairman also noted that plans are in the pipeline to allow the public to borrow from the mosque’s 3,600-book library, which he said contains many valuable works of Islamic theology and scholarship.For older residents of downtown Amman like Bukhari, Assali, and Abu Yahia, Al Husseini Mosque is the setting of many memories of a time when life was simpler, its pace slower and the capital smaller.For their posterity, they hope, it will at least remain a symbol of the history both of their city and of their country, and a place where Jordanians rich and poor can meet as equals in prayer.

By Muath Freij, by the Jordan Times
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IRAQ: Trauma leaves an indelible mark
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