Zakho, Iraq – Haji Umar, a former Iraqi army sergeant and a member of the Yazidi religious minority, lay down on the scorching sand. He picked up his phone and with a parched mouth spoke to his 19-year-old daughter Wanza.
The suffering around him had become too much. He told Wanza goodbye, hung up the phone and raised his gun to his head.
A month later, Wanza lies grief-stricken in a hospital bed. Her eyes search the face of Dr Haitham Abdalrazak, the hospital psychiatrist standing next to her, but her body remains rigid.
Her family fled their village near Mount Sinjar at the beginning of August with the Islamic State of Iraq and the Levant’s advance into the region.
After his eight children were delivered to safety in Iraqi Kurdistan, Wanza’s father Umar went back to Mount Sinjar to try and fend off ISIL.
“He was good hearted but hurried in making decisions,” says Ilyas Alman, Umar’s younger brother and Wanza’s uncle. He wipes his tears with an orange scarf. “He couldn’t stand the pain of the people around him.”
Umar was buried where he died, near Mount Sinjar, but his funeral took place in the crowded school where the family now lives.
In August, ISIL fighters carried out the massacre of hundreds of Yazidis with the belief that Yazidis worship the devil. Up to 2,500 mainly women and children were abducted, with tens of thousands fleeing the area, according to a UN report.
Since the crisis, cases of post-traumatic stress disorder (PTSD) and depression like Wanza’s have ripped through the Yazidi community.
Her family is part of around 300,000 displaced Yazidis living in the Kurdistan region, many of whom are now sheltering in camps, abandoned buildings and schools.
It’s mid-morning in the hospital and patients crowd the narrow corridors outside Dr Abdalrazak’s office in Zakho General Hospital.
He estimates that over 70 percent of Yazidi IDPs in Zakho, a small city in Dohuk Province near the Turkish border, are suffering from trauma.
Abdalrazak has a kind, serious expression. He says about 20 percent of his patients have considered suicide and about five percent have attempted it.
“When you feel that your whole people are targeted, when they [ISIL] want to kill all of your people, you feel afraid. You don’t feel safe any more,” he says.
Abdalrazak looks over Wanza once again, bending her forearm at the elbow to test her responses before letting the arm drop back to her side.
Twenty-one-year-old Nahla Haji is the next patient. She sits hunched over a chair in Abdalrazak’s office, eyes peering out from behind a thin pale scarf. Yesterday she was in the emergency room suffering from flashbacks.
want to kill all of your people, you feel afraid. You don’t feel safe any more.”]
“I was so nervous and agitated. It is the second time I felt like this,” she says. “All my thoughts are about missing friends and villages taken by ISIL. We try to cope but even at night when we sleep we see many things in our dreams.”
Amr Yousif is her cousin by marriage and accompanies her today. He still has vivid memories of ISIL fighters discarding his cousin’s bullet-ridden body just before they left town. His cousin had refused to convert to Islam.
Nahla and Yousif live in a crowded and dirty school building where fights between families break out regularly.
“Thank God for our living situation,” Yousif says, chuckling ironically.
Both Wanza and Nahla will need therapy and to learn anti-anxiety techniques to face their memories gradually, according to Abdalrazak.
Wanza’s family can’t afford regular visits to the hospital and is fearful of a repeat attack.
Abdalrazak gives Nahla a prescription for anti-depressants but not long after she returns, the pharmacy runs out of free medication. Abdalrazak prescribes another, less effective drug.
Dr Nazar Amin, a consultant psychiatrist working in Sulaymaniyah, says the concept of psychotherapy didn’t exist in Iraq until recently. Years ago, patients would visit his clinic in Erbil after sunset to avoid being seen.
“Now people are realising what trauma is and what mental health is. The stigma is fading,” Amin says.
Even though there is now more awareness about mental illness, Amin says there still is not enough expertise to deal with this mass trauma.
“We can’t import [psychiatrists],” he says. “They must have the language and the familiarity with the culture.”
Years of war have not only increased cases of trauma in Iraq, but have also negatively impacted the country’s health infrastructure.
Although health spending in Iraq has been rising, spending on health and other development areas last year was still “insufficient” compared to needs, according to the UN Joint Analysis Policy Unit.
Meanwhile, Doctors Without Borders warns that PTSD, anxiety and depression are now also affecting displaced children.
The organisation has been offering psychological support to displaced people in their Dohuk mobile clinics since August, but do not have any psychiatrists working with them in the area.
Not long ago a young woman who had escaped Sinjar, entered Abdalrazak’s clinic with her fiance. She told Abdalrazak she didn’t know where her family had ended up after ISIL attacked her town in early August, and that her younger sister had been kidnapped by the group.
She couldn’t stand not knowing what had happened to them and wanted to kill herself. She was suffering from PTSD, but her fiance helped her.
“When she felt stressed or upset he would bring his mobile phone and make her listen to beautiful songs, love songs. He told her it would all be OK and he would say, ‘I will marry you very soon,'” Abdalrazak says.
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She regularly visited Abdalrazak, who prescribed anti-depressants.
“I saw her for a couple of weeks and she became better and better, and they decided to run away to Turkey. Last week they came to my clinic and said thank you,” Abdalrazak says.
The couple left in mid-September and he hasn’t heard from them since.
At the hospital entrance large glass doors bathe the reception with light. A group of four young psychologists in colourful hijabs linger as patients filter through the swinging doors.
Outside the hospital, the mountains that line the Iraq-Turkey border are lit up with the midday sun. Inside, Nahla is finally starting to talk.
Amid stories of lost loved ones and trampled villages, Abdalrazak also sees glimmers of hope, like the couple’s love story.
Abdalrazak and Amin will continue to treat patients like Wanza and Nahla with the resources they have, but say it could also be the strong sense of community among the Yazidis that finally brings them through the trauma of war.