The recent launch of the military offensive to retake Mosul has forced people who have lived through extremely traumatic times to flee the town and nearby villages. “They have endured two years of the so-called Islamic State (IS) occupation of their town or villages, airstrikes, Iraqi forces fighting IS, fleeing for their lives and arriving in a displaced persons camp”, says Bilal Budair, MSF mental health manager in Erbil. “These people had to leave very quickly, taking nothing with them. And now they find themselves confined in a camp.”
Some 30,000 people are living in camps in Hassansham and Khazer, 35 kilometres east of Mosul. MSF’s mental health teams see around 45 patients a day. The teams, who include a psychiatrist, a psychologist and a community worker, worked with Syrian refugees in northern Iraq back in 2013. Then, in 2014, they began assisting displaced Iraqis who fled Mosul when IS took control of the region. This year, with the escalation in population displacements in Ninewa Governorate and the launch in mid-October of the battle to retake Mosul, MSF’s teams have been seeing patients suffering from even more severe disorders.
Since November, patients consulting our services are much more badly affected. Many tell us they were witness to public executions in the market and had seen corpses of murder victims strung up and left for days on end on bridges over the river. Death by stoning, beheadings, torture and corporal punishment — all so much violence that has left many deeply traumatised.
As they listen to what some of their patients have to say, MSF’s psychiatrists are shocked by what they hear and find their accounts hard to believe. Like the parent forced to kill his own child because he used a swearword. But the facts are inescapable when different people recount the same story. The psychiatrists are also seeing patients who would never have considered consulting a psychiatrist before now seeking help.
There is yet another cause of suffering for those displaced in recent months, as they have been first-hand witnesses to fighting in their villages or neighbourhoods. They’ve watched friends or relatives die, like a woman who came to us with her 10-year old son. Her friend’s little girl was killed when a mortar shell fell on their house. She saw the child’s body, and so did her son, who was her friend. These displaced people have fled Mosul or nearby villages for the safety of the camps. But they’re still terrified and live in fear of being exposed yet again to Islamic State violence.
The MSF team providing mental health care in the camps in Hassansham and Khazer give consultations to patients suffering with severe depression, anxiety, acute stress reaction or post-traumatic stress disorder. They also see patients already ill with chronic diseases such as epilepsy and psychoses before they had to flee and who need to resume treatment. What’s more, other organisations delivering primary health care or psychological support services in the camps refer to the MSF team patients who are handicapped in their everyday lives because of disturbed sleep or more acute disorders.
“We treat all cases, moderate as well as severe”, continues Bilal Budair. “In fact, MSF is the only aid organisation treating severe cases and providing psychiatric care. We are on-hand to assist people and identify the most vulnerable. We’re here to help them and anyone close to them experiencing difficulties in adapting to the situation.” Like this man in his fifties who lives in Khazer 1 camp. All his shops in Mosul have been destroyed. He said, “I couldn’t make myself get into the tent. I cried. I’d like them to come and kill me, and everyone in my family. This is like being in a prison. It took me 20 years to build my home. It’s all gone. I’ve got nothing left. Not a single dinar in my pocket.”
After several weeks, most of the displaced start to get used to life in the camps, but others will go on to develop more lasting disorders. They think their lives are done for and they want to die, so we need to step in quickly and offer them the services of a psychologist or psychiatrist.