What follows are testimonies from displaced people in Iraq, where violence continues to drive thousands upon thousands from their home and prevent the delivery of desperately needed assistance:
Since the beginning of August, schools in Dohuk governorate have been closed and are instead being used as temporary shelters for the thousands who have fled violence in neighboring areas. Kandala refugee camp, on the border with Syria, is the only camp currently ready to accept new people. Another camp in Sharya, south of Dohuk, is to be completed soon. In the interim, over 3,000 people are living in the town’s schools and non-residential buildings.
Since the beginning of the crisis, Doctors Without Borders/Médecins Sans Frontières (MSF) has been running a primary health care service from a classroom in Sharya high school. Ten-year-old Malican has been living there with her family as well. In the morning, they wake and store their blankets and personal items in the corner while the MSF team brings in medical equipment. After the clinic closes at 4 in the afternoon, the classroom once again becomes Malican’s home.
She and her family fled from Hatare, a small town southwest of al Qosh. Sitting on the floor of the school’s corridor she is playing a game called knucklebones with a friend while a crowd of people bustle around her.
“Life has got much harder since we came here," she says. "I have to tidy up, wash clothes, and I have a lot of chores." Malican’s mother is very ill. She has been in and out of Dohuk general hospital for the past few months. "I worry about her and miss her very much," Malican says, but “today is a good day. I am going to the hospital to visit her.”
There are only four toilets in the school and these are used by both the residents of the school and by the 350 patients that visit the medical facility each week. “Every morning as I wake up, the first thing I do is go and wash my face and hands in the toilet," Malican says. "The restroom is always disgusting. Despite cleaning it every day it is still dirty because everybody uses our bathroom."
“Back at home we used to have a shrine in the corner of the house," she adds. "Here we don’t pray anymore, it is too dirty, it would be a sin.”
Water and sanitation is a problem throughout the displaced communities. To address the gap, MSF has been installing temporary latrines and showers and distributing hygiene kits in refugee camps across Dohuk.
An enthusiastic student, Malican's favorite subjects are English, Kurdish, and gym class. She misses going to school: “My teacher came by a few days ago and I asked him when we would restart school. He told me they are not going to open the schools in Hatare soon because it is too dangerous."
In spite of the fighting in the north of Mosul, some, including Malican’s uncle, have chosen to return to their homes rather than face the appalling living conditions in Sharya. “I think he hated this place," Malican says of her relative. "I don’t think he will come back. I miss him so much and I wish he would call us more often.”
“What I miss the most is my friends, Madeline most of all," Malican says. "I don’t know where she is. I miss playing dolls with her. I don’t have a doll here, I had to leave them all behind."
“All I want is for my mother to get better and to go back home," she adds. "And I want a doll too”.
Property developers in Northern Iraq were not expecting to see their newly constructed cinderblock housing complexes become home to thousands of displaced people who have recently fled from Sinjar. This may explain why construction continues at Dabin City, a seven-building housing project in Zakho in spite of 6,500 people having settled in some of the half-completed structures.
While heavy construction materials are unloaded from trucks, children run around the site as if it were a playground, groups of men gather to chat, and women wash clothes and fill up buckets and jerrycans at crowded water points.
Dalal is the second wife of Ahmed, a teacher from Sinjar. The 30 members of her extended family share four rooms on the sixth floor of an unfinished building. She speaks facing a flock of children quietly sitting on the bare cement floor. “Where do I begin? My life here is a daily struggle,” she declares quietly. “There is not enough room here. We have so many young children and they have nowhere to play."
Dalal and her family are among the many people living without electricity or running water. There are a few stoves, but fuel is expensive for people who have nothing left. Some of the higher floors do not have external walls, but the biggest problem is sanitation.
“I cannot walk down the stairs because of the pain in my hips,” says Dalal, and her mother-in-law, who can barely stand, has been confined to one room ever since she arrived. "But the kids wake up at night and need to go to the toilet: it is very hard to take them all the way down to the latrines in the dark."
On the site grounds, the 20 latrines available often overflow and give off a wretched stench. Fifty more toilets are being installed, but the developers have already threatened legal action against anyone digging the property grounds.
“Our findings show that poor sanitation and overcrowding is increasingly affecting people’s health," says Dr. Zahra, who works at the primary health care unit MSF has set up next to the construction site. “Diarrhea, gastrointestinal problems, and skin diseases are on the rise," she adds. A cholera vaccination campaign was planned by the local health authorities and then dropped because the outbreak season is nearly over.
An MSF water-and-sanitation team is planning to build 100 latrines, 100 showers, and 50 washing areas. A team of 40 people will be hired to clean the site and manage the waste, and hygiene kits will be distributed to the people living on the site. MSF experts are also putting in place a water waste management system.
Standing by a gap where a window should be, Dalal hoists a rope tied to a heavy jerrycan filled with water all the way to their floor. “We use so much water and we don’t even know if it is good for drinking," she says. “We have no windows, it’s getting cold and we don’t have enough blankets. Winter is approaching. How will we survive without windows and heating when temperatures will drop below freezing?”
Upper respiratory infections are now the leading cause of morbidity. Queues at the clinic are long and people are growing restless. “The vast majority of patients are affected by diseases that are perfectly preventable and are directly related to their poor living conditions. The number of patients turning up at our clinic is rising and we have to turn down many patients every day, we cannot cope," says Dr. Zahra. MSF is preparing a distribution of over 10,000 blankets by November.
Back in her bare flat it is Dalal’s turn now to ask questions: “Please tell me, when will the camps be ready," she asks. “When will be allowed to move in? Does anybody care about us?”
Dalal is also the name of an ancient stone bridge in the border town of Zakho, in northern Iraqi Kurdistan. It means beautiful and unique and is the name of resort on a hill overlooking the river, where people used to celebrate weddings and take their children to play on a Ferris wheel.
Today, the grounds of this resort are lined with tents and dotted with latrines and water points. It is currently home to more than 5,000 people who have fled Sinjar. MSF has been running a mobile clinic offering primary health care and mental health services for the past month.
Aziz, a 10-year-old boy, has come to the MSF clinic for his last session with Dr. Shirine, an MSF psychologist from Dohuk. Wearing a worn orange Real Madrid t-shirt with Ronaldo written on the back, he wrings his hands and recalls that “one day MSF health promoters came to the tent to explain the services the clinic offered in the camp. They told my mother there was a psychologist.”
Aziz was having nightmares and problems going to the bathroom at night. His mother entrusted his older sister to take him to the MSF clinic. A doctor prescribed antibiotics for an urinary infection but also referred him to the psychologist who supports the team in the camp.
“So many people here are traumatized,” says Dr. Shirine. “They have suffered a lot. Many struggle to adapt their new living conditions and become depressed." MSF offers counseling in individual or group sessions. “We ask patients to share their feelings and describe any traumatic events that have affected them," she says.
Aziz is normally very brave but admits that his nightmares terrify him. He recalls how he reacted when fighting erupted in his neighborhood and the Islamic State (IS) forces approached: “The day before we fled, people had been fighting all night. I was at home with my little brothers, looking after them while they slept. I was not afraid. As the fighting came closer I woke them up and took them to a safer place. I even managed to put them to sleep again. Then in the morning, the Peshmerga withdrew so we escaped to the mountains."
“The time we spent in the mountains was hard,” he says. “We were walking a lot. Some had no shoes. I was wearing plastic slippers. We walked for four hours up the mountains but the worst part was walking down. It was very slippery and by then the little ones were too tired. I was carrying my five-year-old sister on my back. She was so heavy, but she wouldn’t walk, so we had to do it. Then my mother tripped and fell over. We had to stop for a while and then one of my uncles carried her."
Aziz’s mother was three months pregnant. When she finally got to the bottom of the mountain, soldiers drove her to the hospital in Kanishli. “She is okay now,” says Aziz, “but she lost the baby."
“I worry a lot about her; I fear I will lose my parents. Coming to see Dr. Shirine was a good idea. She helped me a lot. Now I don’t wet my bed anymore and the nightmares have gone. I took some medicine and she told me not to think too much at night. Now I just have a pee before going to sleep and think of nothing."
Dr. Shirine says that “most of the children complain of fear and nightmares. Aziz had been having these problems before coming here too; he use to dream of being choked or drowning. Fleeing from Sinjar and his mother’s poor health only made things worse."
Dr. Shirine had three individual sessions with Aziz. “I also spoke to the family because they need to be aware of these problems and supportive of the children. I asked his parents to be gentle with him and spend time with him before he goes to sleep."
“I have many friends in camp," says Aziz. “We play football together, and generally I am the goalkeeper. I am very popular,” he boasts. “Some of my friends could do with seeing a psychologist; my cousin is my age and has the same symptoms as me,” he says. “I told him to come but he doesn’t listen, maybe he is shy or maybe his mum doesn’t insist as much as mine did."