“There is a shock through generations,” Dr. Abdul Halim, a psychologist from Doctors Without Borders (MSF, Médecins sans frontières) at Dibaga camp for internally displaced persons (IDPs), told Rudaw.
“It is not only the current generation who will be affected by that trauma but the coming generation as well. It’s not affecting that person alone. It goes genetically to the other generations.”
According to MSF’s mental health activity manager, Bilal Budair, the majority of IDPs that MSF is currently treating those suffering from post-traumatic stress disorder (PTSD). Others have depression and severe depression disorder, adjustment disorder, mild and moderate depression, and anxiety disorder.
These patients are often treated with a combination of medication and behavioral therapy.
“When patients arrive they are complaining of their fears – severe nightmares, flashbacks, hypervigilance symptoms, starter responses. This is from the PTSD. For the depression, some have complained of lack of interest in activity, guilt, decreased concentration, sleeping problems, death wishes.”
A common nightmare consistent among their adult patients with PTSD, Budair explained, is the reliving of the experience of becoming displaced, moving from their homes uncertain of their future.
Children typically show incessant crying, night terrors and impulsive behavior. “They are crying a lot, waking up during the night suddenly shouting, they are impulsive,” Budair said.
In treating patients with PTSD, MSF mental health professionals like Halim apply rehabilitative methods such as cognitive therapy, prolonged exposure therapy, and meditation.
The goal in using these methods is to provide the patient with the appropriate coping mechanisms to deal with the trauma and minimize the impact it has on their day-to-day life.
“We gradually go through the details of the accident and we go on to repeat the accident itself until the patient reaches a point where he can discuss the event while remaining in control,” Halim explained. “In the beginning, they usually have a strong reaction because they remember. Usually we begin with less traumatic parts and gradually go to the ‘hot’ point of the trauma.”
Halim described one woman who he treated for PTSD from an occurrence when her 16-year-old son was badly injured in a bombing at his school. The boy’s arms and legs were severely burned with scrap metal from the bomb striking the face. In hearing the news of the attack while in her home, she collapsed due to shock. He described a series of steps where they first discussed her morning routine that day and are gradually working towards being able to discuss the actual experience without displaying negative side effects.
While cognitive and behavioral therapy and medication are common treatments for adults, with children, Halim resorts to what is referred to as “play therapy.”
“Usually the children don’t have the vocabulary to express their feelings. So they use toys,” Halim said.
“The first thing we do is to establish a safety zone, because they children usually don’t feel safe discussing it with their parents,” Halim explained. “Usually the parents deal with these cases in a very traditional way. They tell the children not to talk about the trauma. They suppress the pain they have experienced. For this, we bring in the family or the parents and we educate them about the trauma and how they can deal with that kind of trauma.”
Halim usually encourages the parents to play with their children, using a lot of physical communication to build a safe environment allowing for better communication between the child and the parents. “The most important thing is that the parents will listen more to the child,” he said.
MSF currently has 3 psychologists, 3 psychiatrists and 5 counselors as part of their mental health team for a population of 38,000 IDPs living in Dibaga. According Budair, this is horribly insufficient given the number of patients they have to care for.
“We are still receiving too many patients beyond our capacity at this point,” Budair said.
The main problem is not funding but the inability to find people with the proper qualifications and language skills. “The problem is not only with the language, the problem is finding a psychologist who’s trained and experienced in dealing with these issues,” he said.
