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, which 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. In 2016, with the escalation in population displacements in Ninewa governorate and the launch in mid-October of the battle to retake Mosul, MSF teams have been seeing patients suffering from even more severe mental health disorders.
Since November, patients consulting our services are much more badly affected. Many tell us they witnessed public executions in the market and saw corpses strung up and left for days. Death by stoning, beheadings, torture and corporal punishment; the level of violence has left many deeply traumatised.
As they listen to what some of their patients have to say, MSF 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 swore. But the facts are inescapable when different people recount the same story.
Another root of suffering for those displaced in recent months, is the fighting they have witnessed in their home villages or neighbourhoods. They have watched friends or relatives die.
Video: Elisabeth Jaussaud, MSF's emergency coordinator, gives an overview on the situation and on OCP activities: the Qayyarah hospital and the provision of specialised mental health care to internally displaced person (IDPs).
These displaced people have fled Mosul or nearby villages for the safety of the camps. Patients who would never before have considered consulting a psychiatrist are now seeking help, but they're still terrified and live in fear of being exposed yet again to IS violence.
The MSF teams providing mental health care in the camps in Hassansham and Khazer offer consultations to patients suffering from severe depression, anxiety, acute stress reactions or post-traumatic stress disorder. They also see patients suffering from chronic diseases such as epilepsy, who need to resume treatment. Other organisations delivering primary healthcare or psychological support services in the camps refer patients to us who are suffering from disturbed sleep or more acute disorders that are negatively impacting their daily life.
"We treat all cases, moderate as well as severe", explains 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."
A man in his 50s who lives in Khazer 1 explains that all his shops in Mosul were destroyed and on arrival in the camp he couldn't make himself enter his tent. "I cried. I wanted them to come and kill me, and everyone in my family. It is like being in a prison. It took me 20 years to build my home. Now it’s all gone. I’ve got nothing left. Not a single dinar in my pocket."
After several weeks, most of the displaced people start to get used to life in the camps, but others will go on to develop more lasting mental health disorders. They think their lives are finished and they want to die. We need to step in quickly and offer them the services of a psychologist or psychiatrist to help them adapt and cope.
Find out more about MSF's work in Iraq.