Iraq
Patient receives consultation from her case manager and psychiatrist at the MHPSS clinic in Sinjar General Hospital. Photo: A.C. Robinson
SHINGAL, Iraq – Fatima was in her home on August 3, 2014, now referred to as “The Black Day” by the Yezidis of Shingal. She and her 13-year-old disabled daughter were alone and scared, trying to hide when Islamic State (ISIS) members stormed into her house.
Her daughter was so hungry that she began to whimper, alerting the ISIS fighters to their hiding place. Fatima and her daughter were kidnapped.
“They [ISIS] pretended to be friendly at first, saying that they would find some food and get medical treatment for my daughter,” Fatima, age 52, said. She would soon find out that the men were lying.
The real horror of her trauma began when her daughter was taken from her and put into a different room.
Fatima explained in detail how the men used cables to tie her arms and legs. She was then beaten, stripped and raped repeatedly until she lost consciousness.
“When I finally woke up, I saw that I was covered in blood. No one was around. I knew I had to find my daughter and escape,” she tearfully recalled. “I grabbed my daughter and began running into the mountains.”
The physical disabilities of her daughter prevented her from being able to walk, so her mother, bruised and in dreadful pain from the severity of her injuries, was forced to carry her.
They had no food or water, and Fatima was becoming exhausted from carrying the weight of her teenage daughter. She was forced to make the painstaking decision to leave her daughter behind.
“I don’t know what happened to me,” Fatima said with tears flowing down her cheeks. “I was almost dead and in pain and just wasn’t able to carry her any longer with my injuries.”
She continued running alone until she again lost consciousness. When she awoke this time, she was surrounded by several people from her village and other villages. The helped her, giving her food and water until she regained her strength to keep going.
Eventually, Fatima arrived at a camp in the Kurdistan Region where she was reunited with her husband, her daughter and son-in-law, and her 13-year-old son, the twin of her daughter who is now gone forever.
Fatima and her family returned to Shingal in 2017, but she suffers from depression and Post Traumatic Stress Disorder (PTSD), and is still unable to come to terms with the loss of her daughter.
However, at the beginning of 2019, a Mental Health and Psychosocial Support (MHPSS) clinic opened inside Sinjar General Hospital. The clinic, which is the first of its kind, is run by Access Aid Foundation (AAF) and receives funding from Cordaid organization.
It was April 2019 when Fatima was first taken in to the MHPSS clinic to see a psychiatrist. She was able to tell her story to trusted medical professionals, and she began treatment, receiving a prescription for medication to help her manage her depression and PTSD.
Speaking to Fatima in her Shingal home last month, she said that the treatment helped her return to a normal life where she remains active and takes care of her family as well as day-to-day house duties. She also enjoys sewing traditional dresses in her spare time.
“This program is important, especially for our people,” she said. “I had seen a doctor at the camp we were in, but we couldn’t afford medicine so it didn’t help me. The clinic [in Shingal] provides medicine for free.”
Since the clinic opened in March 2019, well over 200 patients have been received and treated. The most severe cases receive free medicine as needed and follow up with a psychiatrist on a weekly basis. The less severe cases are referred to the MHPSS Center, also operated by AAF, which provides a child-friendly space as well as several recreational activities for psychosocial support and treatment.
Noor is one such patient who takes part in the recreational activities at the MHPSS Center.
Although Noor escaped ISIS captivity, where she was frequently beaten, she became anxious, depressed and disassociated from her family. She often contemplated suicide.
Noor had stopped communicating with anyone and only wanted to be left alone in a dark room without eating or drinking. This led to her becoming comatose at one point.
She first visited the MHPSS clinic in April and is now able to manage her anxiety with the help of medication. She enjoys taking a knitting course at the MHPSS Center, which has helped her to begin socializing again. She is once again able to function on a day-to-day basis and take care of her family.
“I would be dead now if it weren’t for the treatment that I’ve received,” she said.
Before the MHPSS clinic was established at Sinjar General Hospital, there were reports of at least 3-4 suicides each month from the Iraqi Ministry of Health.
Organizations like AAF and Cordaid hope that with the expansion of their MHPSS program to other areas, people suffering from mental illness or suicidal thoughts will be able to access the specialized care that is now available to them.
To let people know about the new programming, AAF carries out regular awareness campaigns around Shingal city to notify the public of their services and tell people where they can go to receive treatment. Additionally, the local community is being educated on how to detect mental illness in family members or friends so that they may refer them for treatment if necessary.
Medecins Sans Frontieres (MSF), otherwise known as Doctors Without Borders, runs a hospital in Sinune, Shingal Region. They published a report in October indicating that their hospital has received a high number of cases involving suicide or attempted suicide.
“The Yazidi community in Sinjar [Shingal] district, northwestern Iraq, is grappling with a severe and debilitating mental health crisis, including a high number of suicides and suicide attempts,” reports MSF.
Between April and August of this year, 24 patients who had attempted suicide were brought into their emergency room. Approximately half of them were female and under the age of 18.
Of the 24 patients received, six of those died. The youngest death was a 13-year-old girl who had hung herself.
MSF states in the report that, “mental health services are overwhelmed.”
During a seminar that Fatima attended in early December presented by AAF at Sinjar General Hospital on Gender Based Violence, another local woman began wailing and rocking back and forth in her chair, remembering the pain she had endured under ISIS captivity.
Fatima was there by her side, with one arm around her shoulders, comforting the woman until she calmed down. Fatima’s strength in that moment was the result of the mental health treatment she herself has been receiving.
Although Fatima’s story is one of success, there still remains a substantial gap in MHPSS services across Iraq, particularly within the Shingal Yezidi community. Until this gap is filled, mental illness will remain a crisis in the country and chances of suicide or attempted suicide will remain commonplace.
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