{"id":8693,"date":"2019-05-29T08:51:00","date_gmt":"2019-05-29T08:51:00","guid":{"rendered":"https:\/\/www.cordaid.org\/en\/?p=8693"},"modified":"2024-12-30T09:27:18","modified_gmt":"2024-12-30T09:27:18","slug":"psychosocial-support-and-mental-health-care-in-iraq","status":"publish","type":"post","link":"https:\/\/www.cordaid.org\/en\/news\/psychosocial-support-and-mental-health-care-in-iraq\/","title":{"rendered":"Psychosocial Support and Mental Health Care in Iraq"},"content":{"rendered":"
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Two years after the military defeat of ISIS in Northern Iraq, traumas of the terror years rise to the surface on a scale that far overstretches the health system. This is why Cordaid has scaled up its mental health services and psychosocial support in different locations. The needs are overwhelming, as a journey to several health facilities shows.<\/strong><\/p>\n\n\n\n

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Women waiting in front of one of the health houses in Ba\u2019ashiqa, Ninewa Province. They returned to their village after ISIS was driven out of Ba\u2019ashiqa. May, 2019. Image: Cordaid \/ Mickael Franci<\/em><\/figcaption><\/figure>\n\n\n\n

The health system in Iraq is facing major challenges and gaps due to local humanitarian and economic crises. All healthcare services are overloaded: their capacity is exhausted, and there is a huge and immediate need to provide essential life-saving services. Since 2017, Cordaid has supported basic healthcare services in North Iraq for the most vulnerable populations, such as returned minorities, internally displaced people, and host communities, encouraging safe and voluntary return.<\/p>\n\n\n\n

Sinjar Hospital, on any weekday, is a crowded place. Especially on the first floor, where Cordaid runs a mental health and psychosocial support (MHPSS) department. Especially this day, when the psychiatrist organizes a weekly group session and has individual consultations. Several psychosocial workers assist him. Suddenly, in the busy hallway, one of the patients collapses. In no time, she is gently and professionally assisted by one of the social workers. And by another patient. \u201cShe relives the nightmare\u201d, explains one of the staff as the collapsed woman is being assisted. \u201cWe see this a lot.\u201d<\/p>\n\n\n\n

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“A lot of people say ISIS is still there, under the radar, in sleeping cells, biding their time. Hence, the checkpoints. And the unwillingness to return.”<\/p>\n<\/blockquote>\n\n\n\n

So far, only 6000 people have returned to Sinjar. This Yazidi \u2018capital\u2019 in Ninewa province, close to Syria, used to have more than 80,000 inhabitants. ISIS attacked and took the town in August 2014, only to be expelled in November 2015 by Kurdish forces. 15 months of utter horror.<\/p>\n\n\n\n

Setting Up a Mental Health Department in Former ISIS Territory<\/h2>\n\n\n\n

The number of returnees may be small, but all are scarred for life and need whatever support they can get. Yet the whole province of Ninewa, with its millions of inhabitants, has no more than a handful of psychiatrists. No wonder people are queuing for Dr. Muhazim Muhammed, the department\u2019s psychiatrist.<\/p>\n\n\n\n

\"Dr.
Dr Hala Sabah Jameel set up and coordinated Cordaid\u2019s MHPSS programme in Iraq between 2017 and 2020. Image: Cordaid\/Mickael Franci<\/figcaption><\/figure>\n\n\n\n

\u201cThis department is the only facility that provides mental health care and psychosocial support at the hospital level in the whole of Sinjar\u201d, explains Hala Saba Jameel, who coordinates Cordaid\u2019s health program in Iraq. \u201cWe trained social workers and mobile teams, especially in recognizing and addressing gender-based violence. We pay their salaries, provide the equipment, and offer incentives to the psychiatrist. The mobile staff goes out to the surrounding villages daily, talks to the families tries to find those most urgently in need of support and informs them of our psychosocial and mental health care activities. We ensure there\u2019s always someone there for them to listen to them and provide professional care. The department has been up and running for 5 months.\u201d<\/p>\n\n\n\n

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“We slept in a mountain shed. There was no food, no water. One moment, ISIS was near; they saw us and shot at us. We escaped.”<\/p>\n<\/blockquote>\n\n\n\n

ISIS rule and the ensuing war traumatised all communities in Iraq, whether Shia, Sunni, Kurdish, Christian or other groups. Nevertheless, the extent of targeted and organized brutalities against the Yazidis is unprecedented. Yazidi history knows many persecutions. This one stands out. Thousands of women and girls were raped, kidnapped, enslaved and sold. Thousands of men and boys were killed. So far, over 70 mass graves in and around Sinjar have been unearthed.<\/p>\n\n\n\n

Fear Never Left the Area<\/h2>\n\n\n\n

It is reckoned that of the 550,000 Yazidis in Northern Iraq, 100,000 have fled abroad, 350,000 still live a life in limbo in IDP camps, and many thousands sought refuge with relatives or in unfinished houses. 3000 people are still missing. To survive as a people, the Yazidi pray, sing and gather in their temples and other places of worship. They adapt age-old baptism rituals to \u2018cleanse\u2019 ISIS rape victims of stigma and shame and to welcome them back into the closed Yazidi community. It is not enough to heal wounds. Nothing ever is.<\/p>\n\n\n\n

\"A
Sinjar (near the border with Syria), Ba\u2019ashiqa (east of Mosul) and Seje (north of Duhok): 3 important locations of Cordaid\u2019s (mental) health and psychosocial program in Iraq.<\/figcaption><\/figure>\n\n\n\n

ISIS\u2019 evil nature is still omnipresent wherever you go in this part of Iraq. It\u2019s in the faces, hearts and souls of their survivors. It\u2019s in the black graffiti on the ruins of the houses they occupied. It\u2019s in the iron sniper cages hidden in trees, not yet dismantled, years after they left. A lot of people say ISIS is still there, under the radar, in sleeping cells, biding their time. Fear never left this area. Hence, the checkpoints. And the unwillingness to return.<\/p>\n\n\n\n

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“I am 52 years old, and I have never seen trauma on this scale.”<\/p>\n<\/blockquote>\n\n\n\n

One of the more gruesome illustrations of evil is the story of Sinjar’s old hospital. It\u2019s in the heart of the ghost part of town, a landscape of ruins. \u201cISIS turned this hospital into their rape centre\u201d, says Cordaid\u2019s Hala Saba Jameel. \u201cToday, people do not wish to go there, even though it has been rehabilitated and partly functioning. That\u2019s why health authorities turned a primary health centre in another part of town into a hospital. That\u2019s where we decided to have our MHPSS department\u201d, she explains.<\/p>\n\n\n\n

Baran Omer is one of the regular patients at the MHPSS department in the new Sinjar hospital. Her story is one among many. She and her family fled on the sinister day ISIS fighters took the town of Sinjar on August 3, 2014. \u201cLike the others, we walked towards the mountain\u201d, she recalls. Of the ones that stayed behind, some of them Baran\u2019s relatives, many were killed. \u201cFor a couple of days, we kept together as a family. We slept in a mountain shed. There was no food, no water. One moment, ISIS was near, saw us and shot at us. We escaped\u201d, Baran continues. \u201cMy husband and some of our children moved fast. At one point, I lagged behind as I carried my teenage daughter. She has been paralysed since birth. She also has mental problems and needs special, liquid food. Only I could take care of her. I told my husband to move on with the other children. Me and my daughter were too exhausted. We decided to hide under an abandoned tractor.\u201d<\/p>\n\n\n\n

Soon after, Baran and her daughter are caught and taken away by ISIS, together with other women and children. \u201cBefore they locked us up, they executed eight men right in front of us.\u201d<\/p>\n\n\n\n

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Baran Omer. Image: Cordaid\/Mickael Franci<\/figcaption><\/figure>\n\n\n\n

\u201cWe were kept inside a room. The first days, we were beaten and flogged. I did my utmost to feed my daughter. Often they came to rape me, but each time I cried and begged them not to, explaining the hardship of my daughter. This worked for a while. Until that evening, after 13 days. I knew they were going to rape me. Somehow, I managed to run away back to the mountain. I had to leave my daughter behind. It was horrible. I could not think any longer. I ran the whole night and saw a lot of dead bodies. I was like an animal. I didn\u2019t feel anything. I ate the leaves from the trees.\u201d<\/p>\n\n\n\n

Baran survives. She even manages to join her husband and other children. But up to today, she hasn\u2019t heard about the daughter she had carried up the mountain and cared for in captivity five years ago. She received a letter from the Iraqi authorities telling her they presumed her daughter had died.<\/p>\n\n\n\n

Today, Baran receives psychosocial support and psychiatric treatment. \u201cMedication helps me to live\u201d, she says. \u201cAnd to work. My husband is diabetic and has no job.\u201d<\/p>\n\n\n\n

Every Survivor Needs Treatment<\/h2>\n\n\n\n

As the psychiatrist Dr Muhazim Muhammed explains, every single survivor requires treatment. But with so few psychiatrists and psychotherapists around, only a few can get it. \u201cBeing kidnapped, having a family that is or was kidnapped, being raped or abused, losing your house, losing a family member\u2026 These are all deeply traumatising experiences\u201d, says Dr Muhammed. \u201cI am 52 years old, and I have never seen trauma on this scale.\u201d<\/p>\n\n\n\n

Luckily, the Sinjar MHPSS department manages to provide psychotropic medication for free. So far, with Cordaid support, they have not run out of stock. With all the checkpoints in this part of Iraq and safety procedures changing daily, this is a logistical and administrative triumph.<\/p>\n\n\n\n

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“We couldn\u2019t wash ourselves, we were beaten constantly. In the presence of all the others. My kids saw a lot of things. They still have nightmares.”<\/p>\n<\/blockquote>\n\n\n\n

Not being able to do enough is the most frustrating feeling for all health professionals. \u201cIn times of crisis, we work with whatever we have\u201d, says Dr Muhammed. \u201cAll patients are being taken care of by our nurses. Some are then referred to our psychosocial workers for extra support. The most severe cases, the ones who are suicidal and the ones with severe mental disorders, are treated by me individually. But the reality is that we should do a lot more than we are doing now.\u201d<\/p>\n\n\n\n

\"Dr.
Sinjar hospital. Dr Muhazim Muhammed, a patient, her child, and a Cordaid social worker. Image: Cordaid\/Mickael Franci<\/figcaption><\/figure>\n\n\n\n

In the Sinjar hospital entrance hall, some kids are having fun in a small playground under the caring attention of a Cordaid social worker. Their mother came to the hospital to meet the psychiatrist. She has a harrowing tale to tell but doesn\u2019t want her name or her picture to be published. Like so many, she carries a weight no one should be forced to carry.<\/p>\n\n\n\n

Escaping ISIS<\/h2>\n\n\n\n

The day ISIS came, she and her three youngest kids were dragged out of the house and taken away. At that time, her husband was at the market. Like cattle, they were being moved from place to place and lived in makeshift prisons for months. \u201cNow and again, fighters came and raped the most beautiful girls\u201d, she says. \u201cAfter a while, they also took the older women.\u201d<\/p>\n\n\n\n

This is how they survive for a year: she and her kids, the youngest at the time, are a year old. \u201cWe only had rice, water and bread. We couldn\u2019t wash, and we were beaten constantly. In the presence of all the others. My kids saw a lot of things. They still have nightmares.\u201d<\/p>\n\n\n\n

Once, she and a few other mothers try to escape. They fail. \u201cWe were beaten badly.\u201d\u00a0 They try a second time, showing amazing courage and cunning. \u201cOne of the girls had a mobile hidden in a sock. She called a man she knew outside. He was ready to pick us up with a van at a certain time and place \u2013 the nearest hospital. He also told us how to escape.\u201d<\/p>\n\n\n\n

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Sinjar hospital. Mother and her three youngest children. All four were kidnapped by ISIS. Image: Cordaid\/Frank van Lierde<\/figcaption><\/figure>\n\n\n\n

So, one night, six mothers and their children wear whatever black clothes they can find. It\u2019s the best ISIS outfit they can think of. At one point, in the dead of night, the door of their prison stays open for a short while. They sneak out in silence. And make it to the hospital, where a van is signalling with its headlights. Off they go, 20 km to the nearest Kurdish peshmerga checkpoint. They make it, and they are alive. Each of these mothers\u2019 relatives had paid the driver 15,000 US dollars. It was the price he had asked.<\/p>\n\n\n\n

Years later, she and her family keep on paying for what happened. \u201cMy kids have lost years of school. They are depressed, like me\u201d, says the mother. \u201cMyself, I keep having these epileptic fits. I have bad dreams; I am full of fear and anger. My husband is thankful that we are all together. But he is frustrated. Full of things inside. Much angrier than he was when we first met. People tell me to look ahead. I can\u2019t. I can only look back.\u201d<\/p>\n\n\n\n

The family used to live in the centre of Sinjar. \u201cWe decided to go back to Sinjar. But since our house in the centre was destroyed, we now live in a suburb, in a house that was only partly burnt down. Now and again, my husband has odd jobs in building and construction. It\u2019s hardly enough to make ends meet.\u201d<\/p>\n\n\n\n

Mornings are the worst. \u201cMy three youngest go to school\u201d, the mother says. \u201cIt\u2019s an hour\u2019s walk to get there. Every time I watch them go, I am terrified that I will never see them again. Without the psychiatrist, the mental support and the medication, I would not be able to keep on going the way I do.\u201d<\/p>\n\n\n\n

Heavily Armed Checkpoints<\/h2>\n\n\n\n

Some 200 kilometres to the east, following a string of heavily armed checkpoints and passing several IDP camps under a blazing sun, lies the town of Ba\u2019ashiqa. It used to be known as a place where Muslim, Christian and Yazidi communities lived side by side in peace.<\/p>\n\n\n\n

Amar Qassar, a pharmacist and part of the Cordaid health team in Iraq, grew up in Mosul. He guesses that about half of Ba\u2019ashiqa\u2019s population has returned. \u201cBefore ISIS got here, everybody had left the place\u201d, he says.<\/p>\n\n\n\n

One of the reasons for people to return and to stay \u2013 apart from basic safety, housing, job opportunities and schooling for kids \u2013 is the presence of healthcare facilities. \u201cThere were none here\u201d, Amar explains. \u201cISIS looted and destroyed all facilities before they were pushed out\u201d, he explains.<\/p>\n\n\n\n

In the past year, Cordaid staff in Iraq rehabilitated four basic but essential health facilities in the rural outskirts of Ba\u2019ashiqa. All of the \u2018health houses\u2019 are located near a school and near or inside a village. \u201cThey are smaller than the primary health care centre in town. Cordaid wanted to restore them because so many people can\u2019t afford transportation to the centre. And sometimes, in urgent cases, it takes too long to get there. And by revitalizing these rural health facilities, we unclog overburdened health services inside the town\u201d, Amar explains.<\/p>\n\n\n\n

Turning Empty Lots into Health Facilities<\/h2>\n\n\n\n

Cordaid staff purchased prefab housing units\u2014several for each health facility\u2014generators and medical equipment. We supply essential drugs. We pay the salaries of the nurses, pharmacist assistants, and social workers who run the facilities and treat the patients\u2014more than 30 on average a day. We pay an incentive for the psychiatrist who visits the health houses once a week.<\/p>\n\n\n\n

So, in a couple of months, four empty lots were turned into primary health and mental health units people can rely on. They are essential because apart from dealing with a post-war situation\u2014fear, sectarian tensions, damaged houses, and joblessness\u2014people have to deal with daily life, with common things like diarrhoea, diabetes, infections, hypertension, and depression.<\/p>\n\n\n\n

\u201cOnly last week, we saved a baby\u2019s life. It had an acute chest infection. Luckily, we had a vaporizer and the right drugs\u201d, says the nurse in the health house of Baybokht village. Like all staff, he was displaced for years. \u201cI returned from the south after ISIS was driven away and the electricity was re-installed in this area.\u201d<\/p>\n\n\n\n

Struggle within a Struggle: Women\u2019s Fight for Freedom and Basic Rights<\/h2>\n\n\n\n

Hanin Rafa is the social worker in Baybokht. She\u2019s a young woman who \u2013 despite the war and with an interval of several years \u2013 graduated in psychology at Mosul University. She does what all Cordaid-supported social workers do. \u201cI want girls and women here to stand up for themselves\u201d, she explains. \u201cIt\u2019s very delicate. Most women are not allowed to go out of the house. If they do, sometimes their husbands want to divorce. They have no rights at all. They are stuck. At least 50% of them cannot read and write\u201d, she says. On top of the big war and ISIS rule that all of them have survived, women, especially in the more conservative rural areas, have another battle to fight for: the one for freedom and basic rights. The one against domestic restraint and violence.<\/p>\n\n\n\n

Hanin\u2019s work, like any trust-building work, asks for patience. \u201cThe first step is to invite them to come to my sessions. If one woman comes, others may follow more easily. I encourage them to discuss things with their husbands. And here, in my separate room in the health facility, we do several things. I teach them to read and write. That opens a world. We talk about the problems they have and how to overcome them. They support each other. Some girls drop out, some stay.\u201d<\/p>\n\n\n\n

10 km down the dusty road, at the health house in Dar Awash village, women and kids have come in such numbers they almost block the entrance. Wasila Mohammad, a Muslim mother who lives nearby, is one of them. \u201cIt\u2019s good this place has reopened. We come here often, including my six children and me. It\u2019s too expensive to go to the health centre in Ba\u2019ashiqa town\u201d, she says. \u201cWhen I was bitten by a snake while working in the field, I ran to this place\u201d, says Ghazal Brahim. \u201cThey took out the venom and gave me the right drugs.\u201d Another young woman, Sosen Ali, would like the health centre to have a gynaecologist. \u201cFor 10 years, I\u2019ve been trying to have a child. I can\u2019t afford to go to a hospital for a sonar check. I wish they could help me here\u201d, she says.<\/p>\n\n\n\n

\"Four
Sosen Ali (in the middle) and other women waiting for the Cordaid psychosocial session in Dar Awash. Image: Cordaid\/Mickael Franci<\/figcaption><\/figure>\n\n\n\n

All the women and their kids are waiting for the group session with the psychosocial worker. It has started recently. \u201cWe come here to clear our hearts and to learn new things. Like sewing, making clothes, and reading. Soon, we can sell the things we make\u201d, Sosen says. \u201cWe feel lighter after the sessions. And we know more. We are less afraid to share our psychological problems. Even with the psychiatrist, who comes here once a week\u201d, says another woman. \u201cIf only they had this for men too. It would help them to vent their frustrations. To be more open and less violent\u201d, she continues.<\/p>\n\n\n\n

So eager are women to come to the sessions\u2014with their smaller kids at their side\u2014that new problems arise. \u201cThe room is too crowded, too small, and too hot,\u201d Sosen says. A facility nurse explains that this is why they are thinking of creating a separate and safe playground for the children on the small compound.<\/p>\n\n\n\n

Mechanic, Farmer, and Mother<\/h2>\n\n\n\n

Wasila shares part of her story. She spent a few years in an IDP camp after ISIS took her village and occupied her house. \u201cWe fled in time. We ended up in an IDP camp in the Kurdistan Region. Life there was hard. The heat and cold were unbearable.\u201d<\/p>\n\n\n\n

\"Wasila
Dar Awash village. Wasila Mohammad with her youngest son. Image: Cordaid\/Mickael Franci<\/figcaption><\/figure>\n\n\n\n

Like others, Wasila decided to come back once she knew Iraqi militias had come back to Ba\u2019ashiqa. \u201cOur house was partly damaged. And the water well was destroyed. Still, life here is better than inside the camps\u201d, she says. Her husband is jobless. \u00a0He used to be a truck driver but lost an arm in an accident. Now, it\u2019s Wasila who raises an income. She sells the vegetables she grows herself. And she works as a mechanic. \u201cI repair generators and water pumps in the village.\u201d Wasila is still angry when she shows the damage ISIS did to her house years ago. \u201cIf they ever return, I will defend my house. I am stronger than my husband. With one ar,m he cannot fight.\u201d<\/p>\n\n\n\n

Seje<\/h2>\n\n\n\n

We leave Ba\u2019ashiqa. We cross the river Tigris, leave the Ninewa Plains and pass the heavily guarded border with the Kurdistan Region in Iraq. This autonomous part of Iraq was never invaded by ISIS,\u00a0 thanks to fierce resistance by Kurdish fighters, the Peshmerga. Here, in the Christian village of Seje, near the city of Dohuk, Cordaid decided to start its healthcare intervention at a time when the war with ISIS was still undecided more than two years ago. \u201cThis was the right spot to start\u201d, says Albert van Hal, Cordaid\u2019s Health program manager based in The Hague. \u201cAt the time, we couldn\u2019t enter Ninewa province because of the war. Kurdistan welcomed hundreds of thousands of IDPs back then. Most of them are still waiting to go back. Many reside in camps. Some stay in unfinished houses inside and around villages like Seje. So we decided to expand, re-equip and re-staff a very basic health centre in Seje, in collaboration with the Dohuk District of Health. Not only to provide health care for the displaced, mostly Yazidi families. Also for the host communities who were outnumbered and could hardly cope with the situation\u201d, van Hal continues. \u201cThe idea was that if we do well in Seje, we can later expand to other locations.\u201d<\/p>\n\n\n\n

\"Children,
Patients queuing at Seje Primary Health Care Centre. Image: Cordaid\/Mickael Franci<\/figcaption><\/figure>\n\n\n\n

Two years later, the primary health care centre of Seje is the main health facility for many miles around. It has a doctor\u2019s room; two nurses have their unit; there\u2019s a pharmacy, clean toilets, a waiting room, and a room for psychosocial support. \u201cAll chronic and common diseases are treated here\u201d, says Amar Qasar from Cordaid. \u201cUnfortunately, we do not have the means for an emergency room and a maternity ward. We provide first aid care, but people must go to Dohuk Hospital for serious injuries or emergencies, which is half an hour\u2019s drive. Sometimes, if people cannot pay for transportation, we use the Cordaid vehicle as an ambulance. Recently, we did this for an older man who was in shock. And for a woman who was about to give birth\u201d, Amar continues.<\/p>\n\n\n\n

Mobile Clinics<\/h2>\n\n\n\n

From morning till afternoon, Seje Health Centre receives patients from Seje and the surrounding villages. Half of them are displaced Yazidi people; half are residents. \u201cThe Seje centre also has a well-equipped and staffed mobile clinic\u201d, Amar Qasar explains. \u201cThe Cordaid vehicle is packed with medical equipment and drugs. Every day, the driver, pharmacist and doctor visit families in the surrounding villages.\u201d<\/p>\n\n\n\n

About a year ago, Cordaid decided to add mental health and psychosocial support to its project in Seje. Months before Sinjar and Ba\u2019ashiqa, this is where we started our MHPSS program. \u201cThe reason was simple\u201d, says Hala Saba Jameel. \u201cDuring and immediately after the war, the focus was on emergency health care. On survival. After people had escaped ISIS, joined their families, had found some sort of shelter, their traumas came to the surface. Issues of mental health and post-traumatic disorders became much more prominent. That is why Cordaid decided to recruit and train a psychosocial worker. For a year now, she has been part of Seje’s team. We also did our utmost to add a psychiatrist to the team. As you know, they are hard to find in Iraq.\u201d<\/p>\n\n\n\n

Tahireh Sadiq, the psychiatrist, visits the Seje health centre twice a month. It\u2019s only one of the locations where she treats patients.<\/p>\n\n\n\n

Psychiatrist and Social Worker Team Up<\/h2>\n\n\n\n

\u201cCurrently, I have about 15 patients in Seje, all women from Sinjar. They all have trauma-related disorders. Sonita Khalil, the Cordaid social worker at the centre, referred them to me. We work well together. We exchange files, discuss cases and decide how I, as a psychiatrist, and she, as a social worker, can best treat and support women. Sonita provides psychosocial care to Yazidi IDPs, mainly women and girls. As a young Yazidi woman herself, she knows their world and speaks their language. She does a terrific job\u201d, Dr Sadiq explains.<\/p>\n\n\n\n

\"Dr.
Dr. Tahireh Sadiq in Seje Primary Health Care Centre. Image: Cordaid\/Mickael Franci<\/figcaption><\/figure>\n\n\n\n

\u201cDisplacement is a hugely traumatic experience. It deteriorates and aggravates any existing mental issue or disorder and can cause new ones. The ISIS crisis itself, even before people ended up being displaced, caused a massive peak in sleeping, eating and other disorders. Displacement and the bad socio-economic conditions that come with it cause new forms of suffering. The stress and poverty, on top of the loss of relatives and loss of homes, cause extra anxiety and more domestic violence. In a way, the suffering of displaced people increases with the years. After years of continuous trauma, treatment not only becomes more urgent but also more difficult.\u201d<\/p>\n\n\n\n

According to Dr Sadiq, the scope of mental needs and suffering is far bigger than health data can even start to depict. \u201cUntil now, no proper mental health assessments have been done in the whole of Northern Iraq. We know that every single person who was attacked and displaced by ISIS has had at least one and probably several deeply traumatic experiences. All of them need to be assessed and given the care they need. This takes time and a lot of patience. Traumatised persons, especially kids and adolescents, tend to become silent and withdrawn. Their signs of suffering and mental disorder are often not obvious. Only if we go from house to house, from camp to camp, and properly assess each person will we know the extent and the vastness of mental suffering caused by ISIS and the violent events\u201d, says Dr Sadiq.<\/p>\n\n\n\n

Mental Health Gap<\/h2>\n\n\n\n

Given this scale of suffering, the lack of psychiatrists in Iraq is staggering. But there\u2019s more than that, according to Dr Sadiq. \u201cMental health work is teamwork. It consists of social work, psychosocial counselling, psychotherapy and psychiatric care. Here in Seje, there\u2019s only a social worker and a psychiatrist due to a lack of funds and trained staff. That\u2019s all. The middle part of the pyramid, counselling and therapy, which is the most important part, is lacking completely. Proper therapy can prevent people from falling into a deep depression. Or to commit suicide. I also do therapeutic work by necessity and have a background as a therapist. But it\u2019s not how we should work\u201d, Dr Sadiq explains.<\/p>\n\n\n\n

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“Never tell women who survived ISIS and displacement and who cope with domestic violence and gender injustice, what to do. Never give advice. Never push.”<\/p>\n<\/blockquote>\n\n\n\n

Another gap, and an aching frustration, is that, due to budget limitations, the centre in Seje does not have the psychotropic drugs patients need. Contrary to the Cordaid-supported MHPSS department in Sinjar, where all drugs, psychotropic medication included, are provided for free.<\/p>\n\n\n\n

\u201cAll services in Seje are free of charge. Even antibiotics, painkillers and other essential drugs. But we lack the means to provide psychotropic drugs to treat anxiety, depression and other forms of mental suffering\u201d, Dr Sadiq concludes. \u201cPeople have to go to Dohuk for that. But the fare is too expensive for most patients, let alone the drugs.\u201d<\/p>\n\n\n\n

What we do may not be enough. It never will be. But it is essential. Sonita Khalil, Cordaid\u2019s social worker in Seje, works at the bottom of the mental health care pyramid. Being a young Yazidi woman herself, she is a person other displaced and traumatized Yazidi women and girls can confide in. In group sessions and individual chats, in training, she creates a setting of trust and personal safety. Safe enough for girls and young women to speak out, share the pain and dream.<\/p>\n\n\n\n

Watch this mini-documentary about Sonita and Cordaid\u2019s mental health programme in Iraq<\/em>:<\/p>\n\n\n\n

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