Mental Health testimonies

Iraq: Yazidi survivors of violence are facing a mental health crisis

Thirty-one-year-old, Seve Mirza, is pictured in her house in Sinuni. "I have migraines and pain in all my body. I am always sweating. I feel like I cannot control myself. I start talking and cannot stop. I feel my body is heavy. I had some problems before the 2014 genocide, but it’s become worse since then. We were in IDP [internally displaced person] camps near Dohuk for three years. Because of the trauma of the genocide, my mother went blind, then she got cancer, then she died. And I got worse," she said.
Iraq 2019 © Emilienne Malfatto
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The massive violence suffered by the Yazidi religious minority in northwestern Iraq has led to a severe and debilitating mental health crisis, including many suicide attempts, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today, highlighting the need for mental health services in Iraq's conflict-affected communities.

In August 2014, the Islamic State group attacked the Yazidi religious minority in Sinjar district, conducting a sustained campaign of killing, rape, abduction, and enslavement and causing a mass migration to camps in the adjacent Kurdish region. The United Nations has acknowledged this as a genocide. Although Sinjar was retaken in 2015, many Yazidi families have not returned—not only because of the destruction of their homes and villages, but because of the trauma they now associate with their ancestral homelands.

Those who remain in Sinjar district experience a high level of mental health needs. Between April and August 2019, 24 patients arrived in the emergency room of Sinuni General Hospital following suicide attempts—six of whom died. Eleven of the patients were under 18 years old.

Mental Health testimonies
Sixteen-year-old Ayman Farouq is pictured in his house in Sinuni. "After the 2014 genocide we were living on the mountain. One day, in 2015, I was injured by a mine. I lost my left arm and got shrapnel in my feet and my legs. I have over 50 pieces of shrapnel in my legs and feet. I am in pain all the time, I can’t think about anything else, I can’t sleep because of the pain. I have what we call ‘tafkir’, overthinking. All because of the pain. I feel sad and nervous."
IRAQ 2019 © Emilienne Malfatto

"Our first mental health survey in 2018 in Sinuni revealed that 100 percent of the families we spoke with had at least one member who suffered either moderately or severely from mental illness," said Dr. Marc Forget, MSF head of mission in Iraq. "When we met with the medical director of the hospital in Sinjar, he told us that everyone needs mental health support in the district, including him. It matched what we realized at the beginning of our activities: that we were dealing with a major mental health crisis, and that it was linked to the collective trauma Yazidis endured recently."

MSF is currently providing mental health treatment to about 200 people in Sinjar district, with common diagnoses including depression, anxiety, and conversion disorder (when a patient experiences blindness, paralysis, or other symptoms not explained by medical examinations). Although MSF has increased mental health services—with group sessions and mental health clinics for displaced people on Sinjar mountain—the demand is overwhelming. Some patients are on a waiting list.

"Everyone here has lost at least one family member or friend, and all over the Sinjar region there is an overwhelming sense of hopelessness and loss," said Dr. Kate Goulding, who works in MSF's emergency room in Sinuni. "It is universal to be sad when your husband dies, when your child is sick, when you break up with your partner, or when you are forced to be away from your family. But the extent of loss in this community is incomprehensible and compounded by the trauma of extreme violence, humiliation, mass displacement, poverty, and neglect."

Halo Khalaf, 66, poses in her house in Sinuni on September 2nd, 2019.
Sixty-six-year-old Halo Khalaf is pictured in her house in Sinuni. "I wait for all the abducted ones to come back. So many people in my family have been kidnapped. Almost all my brother’s family has been kidnapped. Some came back, some didn’t . . . I always feel like ISIS is coming. When I sleep, I wake up with a start. I cannot see clearly because I cry a lot. I feel pain in my whole body. I am not happy."
IRAQ 2019 © Emilienne Malfatto

Dr. Goulding supported MSF's Yazidi staff in caring for psychiatric patients for two months when MSF was unable to recruit a psychiatrist in Iraq—a sign of the nationwide need for more psychiatrists, psychologists, and mental health counselors after years of violence.

"Despite the urgency of the situation in Sinjar, we are unable to find qualified psychiatrists and psychologists in Iraq to work with us," Forget said. "So as MSF we are forced to bring in international staff for support, which is not ideal, and also not sustainable in the long term. The Iraqi mental health system definitely needs more money and more medication, but the biggest need is for more qualified staff, and for them to be assigned to areas of greater need, especially in rural and conflict-affected areas of this country."