I had been working at a trauma center in Baghdad for some time when an opportunity came up to transfer back to my old job — at a maternity hospital in Sadr City. But I backed out at the last minute.

I knew the transfer would be good for me: I’d be far away from the stress and drama of the E.R., where I had spent a lot of time. I told myself that getting away would let me process what I had seen and experienced. But I wondered if I had gotten so used to chaos that I wouldn’t function in a peaceful, stable environment.

When the transfer offer came, I was responsible for this hospital’s female medical ward. Men and women are treated separately in hospitals here. Even the E.R. is segregated. When I worked there I preferred the male side, where you get mostly trauma cases with some uncomplicated surgeries thrown in. But on the female side, you get internal cases as well as serious psychological ones. The worst of these are suicide attempts. And there are a lot of them.

During one of my E.R. shifts, a 16-year-old girl was brought in by her aunt and brother, who were both terrified. They asked us not to tell her father that she had tried to kill herself because he would kill her if he knew. She had swallowed 25 diabetes pills. We discovered that her father and her stepmother had subjected her to constant verbal and physical abuse, which is why she wanted to end her life. She arrived in critical condition with very low blood sugar. But with our care she recovered. Then, we discharged her — back to the abuse she had tried to flee.

I’ve also seen quite a few women who’ve burned themselves. They’re of a type: young, married and very poor. Their families, fearing disgrace, always deny that the women have tried to commit suicide. But as we press them, the story gradually changes. Burns, which often cover most of their bodies, are one of the toughest aspects of my E.R. work — along with blast victims. I never really get over these things.

But what angers me most is that, if they survive, these women almost never get any counseling or psychiatric help — though they are often abused, deeply angry and severely damaged even before they come to the emergency room.

These women are especially at risk in a health care system in which overworked doctors like me focus only on saving their lives; healing their invisible wounds is another story. Even though Iraqis have been living in a violent, unstable environment for years, there is still no culture of mental health care here. It has little to no support from the state or health authorities, and people who do seek psychiatric help are stigmatized by their families and society: these two truths reinforce each other. Even blast victims, if they recover, don’t get counseling.

But women’s mental health in particular has no place in a tribal, male-dominated society like Iraq, where women still struggle to own our own lives. You don’t get to decide what’s best for you. There always has to be a man in your life who decides that, and then makes sure you put up with the consequences.

I’m a successful professional, but my second-class status came home to me again recently when I applied for an Iraqi passport. I was told that wasn’t possible: I don’t have first-degree male relatives (a husband, father, or brother) who would prevent me from traveling outside of Iraq, embracing a liberal lifestyle and committing ”sin.” With a lot of help from an insider — paid help — I got the passport. But not until officials asked me a series of humiliating and insulting questions about just what I intended to do if I traveled.

As a female doctor, I’ve had to develop a tough exterior to earn the respect of others and to get things done. I’m not easily intimidated now. But if a woman like me, with an education, a profession and a good job, still has trouble being heard in Iraqi society, it’s hard to imagine how these desperate women in the E.R. — and at the bottom of the social ladder — will ever get the care they need.

Lubna Naji is a 25-year-old junior doctor who works in the countryside in Iraq’s Wasit Province. She qualified in 2010 and worked for a time in a major trauma center in Baghdad. Her first post was about the Dec. 22 bombings in Baghdad in which more than 60 Iraqis were killed.

The New York Times