Smiles and Nightmares: A Psychologist Works with Syrian Refugees in Iraq

MSF/Karem Issa


In March, clinical psychologist Charlotte Yence returned from a five-month mission with Doctors Without Borders/Médecins Sans Frontières (MSF) in northern Iraq, where MSF has worked in Syrian refugee camps since 2013. She set up mental health care programmes in the Kawargosk, Qushtapa, and Darashakran camps, and here she tells us about some of her encounters:

Winter is cold in Iraqi Kurdistan. The people give me human warmth, which compensates for the winter chill and the frozen wind that blows through the camp. Each morning I gather my courage to start my day’s work. Every day is a challenge, I have chills which never leave me anymore; I don’t dare to imagine what they have to bear in the tents, on top of the double exile they had to endure.

They first fled Damascus, then war-torn Aleppo to find refuge in Syrian Kurdistan, where they are originally from. And then when the bombing reached there, they fled again for Iraq. They lost everything twice, saw their families scattered, lost loved ones, and are now reduced to living in precarious conditions with an uncertain future.

It is hard, agonizing; they don’t feel welcomed by their Kurdish cousins, they don’t speak the same language, don’t have work or an income. Their distress is palpable, their demands for a better life are legitimate, but they are focused on survival and adapting to their new living conditions. Camping under the rain, the snow and in the mud is not easy, and when words are too difficult, their bodies express their deep malaise.

The patients’ smiles when they see me warm my heart, their calm and radiant faces at the end of a session – which are always intense and liberating – is the best encouragement to carry on. The men shake my hand shyly, then touch it to their heart or forehead, or both in quick succession. Daily I am blessed to the seventh generation with flurries of “saatchava saatroch,” which broadly means “under my watchful eyes.”

The women squeeze me like good bread, a kiss on the left cheek, three kisses pressed quickly on the right, an arm gripped around my neck and the other crushing my head. Their toughness is tender, their tenderness is tough. I take them in my arms when they cry; I speak to them in my kitchen-sink Franco-Kurdish-Arabic—“halas, ça va aller, bash?”—and they understand me because the language of emotion is stronger than words. We also laugh a lot; the complicity is there, the trust as well, to broach serious subjects with a certain triviality.

“Running Mama”—I nicknamed her this because she runs to see me every week, such is her haste to see me, and she laughs uproariously when I use the name. She is 47 and she looks 60, except when she smiles, and then she looks like a schoolgirl. She speaks eagerly, with urgency and detail, about her 11 children, including her seriously disabled 27-year-old who is not and never will be independent, and her two grandchildren. Her husband stayed in Syria; she curses him because he is overwhelmed and terrified far from her daily life, and at the same time she doesn’t want to tell him everything. It would be a burden rather than a support.

She leaves to rejoin her family after our meeting, not running but lighter, it seems, relieved from the overwhelming pains which make her old before her time. A strong relationship has developed between us, and it is heartbreaking to tell her, at the end of my mission, that I am leaving. For her, it is another loss, which revives all those that she has already suffered. Fat, silent tears run down her wrinkled cheeks, as she turns to the interpreter and asks, “What will become of me? The only blessing that I have had since I came to Iraq was meeting her!”   

She is reassured to meet my replacement, she can envisage continuity in the care that she receives, and, against all odds, she believes that she can break the cycles of disappointment that have marked her rough life.

Selma* is 10 years old. She survived a bombardment on her village but her cousin, whose head she saw rolling at her feet, did not. She has had a bald spot on top of her skull since, having lost a touch of hair, a little like what she pulled from her cousin’s scalp when she tried to recover what was left of him.  

At first she did magnificent, stunningly detailed drawings using only the black felt-tip from among all the available colors. Slowly she introduced other colors, and her final creation is a veritable rainbow. She draws Ali, the racoon hero from the workbook for traumatized children, who, once soothed, goes back to play with his friends.

Selma’s hair has started to grow again. She explained that she didn’t need to come and see me again, even if her jet black eyes were full of tears as she said it. I replied that even if we didn’t see each other anymore I would always carry her in my heart, which at that moment was very tight, I must admit. Her father, there with her in that meeting, explained sweetly how proud he was of her and her progress. They have since moved to Erbil; they don’t live in a tent anymore but in an actual house, and soon Selma will be able to go back to school, which was her greatest wish.

Mustafa is 27 and has been paralyzed from the waist down for two years, since he spent weeks being tortured in prison. He recounts his symbolic dreams of freedom, his first lost love, his perseverance doing his daily exercises in the muddy alleys of the camp, his pride in being sought out to sing at weddings. He also speaks to me about his suicidal thoughts; what is the point of living like this? “Nothing will ever be the same again.” His handsome face marked with an infinite sadness, he speaks as much about his legs as his homeland, but his stunning smile returns to illuminate his honey-colored eyes when I say, “see you next Tuesday.”

Gradually, over the course of several meetings, he seems to rediscover some hope in his future. One day he giddily announces that he has fallen in love again and wants to marry a young woman who he has met in the camp. He almost forgets his anger at never being able to walk again.

Jewan, 22, can’t sleep. He continuously lives and relives the torture he suffered in detention. He feels like he no longer belongs to the world of men since he lives in such close proximity to death. He is estranged from himself and others. Outside of the therapeutic space of our sessions he is incapable of sharing with his close friends and family what he went through, what he suffered, and his way to battle against his massive anguish is to start physical fights for no real reason.

His future prospects consist of returning to Syria, which he freely admits is a kind of suicide. I weave a restrained, soothing, maternal relationship with him, which allows him to abandon himself to sleep a little each night, and restart the search for his sister and his beloved nephews, who are displaced like him, rather than responding to the call of death.

There is also a group of children, all between 9 and 12 years old, who come happily to the peer support group meetings I organize weekly after school. It is their head teacher who introduces me to them, and who has identified them (justifiably) as suffering psychologically. Witnesses of war in Syria, these children have lost family members, have hastily fled the ruins of their homes. Sometimes they have nightmares. They can draw with great precision Kalashnikovs, bombers on fire, tanks and bodies lying in their own blood.

In our meetings, they share their harrowing experiences, become allies and friends with each other, and learn to express their feelings. Through the communal drawing exercises which I suggest, they discover that it is much more difficult to relate their experiences of peace than those of war. So, they understand, through many hands drawing, that they have lived through the same trauma, that they aren’t there for nothing, and that their revenge can be taking charge of their own rebuilding. And despite their differences, they can help each other.

I have confidence in the Syrian children of today, the adults of tomorrow. But the task ahead will be long and difficult for them.

*Names have been changed



Kawargosk Camp in Erbil, which hosts over 13,000 refugees. In Erbil, MSF also works in Darashakran Camp which hosts around 8,000 refugees, and in Dohuk province MSF works in Domeez Camp which hosts 58,000 refugees.
MSF/Karem Issa