#15 responsibility
Zeljko Crncic / Atran Youkhana

Facing the Horror - the Effect of Trauma in Northern Iraqi Society

The Kurdish region of Northern Iraq has been under heavy pressure in recent months. It has been subject to attacks on several occasions since Mosul was occupied by the so-called "Islamic State" (IS) in June 2014. Civilians have been raped, abducted and killed. A total of 2.5 million people have become internally displaced people (IDPs) since then. Of these, 1.2 million have fled to the Kurdish territories, where a local population of 5 million plus 300,000 Syrian refugees already lives. These events have had a physical, social, and psychological impact on children and adults. In the last issue, we took a look at the overall situation, and people who have been displaced in the region in particular. The focus of this article will be the psychological effects of war on the civilian population and initiatives working to cope with the difficult situation.

The political situation in the region remains highly charged and unstable. At the military level, the Iraqi Army and Shia militias are attempting to recapture the territories currently under IS control. While further IS attacks on northern areas cannot be ruled out in the near future, the region around Bagdad could be a more likely target for IS combatants. During their assaults on areas controlled by the Iraqi Military or the Kurdish Forces, IS has been responsible for acts which amount to crimes against humanity, including mass rapes and mass killings. But the forces fighting IS, such as the Iraqi Army and Shia militias, have also been involved in the displacement and killing of civilians, as several reports have indicated.

The violence and displacement that are common features of armed conflicts severely affects the mental health of hundreds of thousands of civilians.

In addition to these short-term developments on the ground, however, there are long-term effects, too often forgotten when the heaviest fighting is over, that must be considered as well. The violence and displacement that are common features of armed conflicts severely affects the mental health of hundreds of thousands of civilians. In many wars, the targeting of a certain segment of the population is not a side-effect from fighting, but rather a deliberate strategy by terrorists, militias or the military. As a result, the cognitive, emotional and physical health of civilians is negatively impacted. These effects have been observed over the past few decades and have intensified with the recent developments in the region. This also applies to Iraq, which has a long and sad history of attacks on civilians.

A bloody past, an uncertain present

For millions of people, growing up during Iraqi’s recent history has meant violence, flight and displacement. Different ethnic and religious groups of Iraqis experienced mass displacement and extreme violence in 1933, in the 1970s, during the war between Iraq and Iran from 1980 to 1988, in the aftermath of the Kuwait Invasion and the uprising against the central government by the Shia and Kurds, the war and invasion of Iraq in 2003, the Iraqi Civil War from 2006 to 2007, and most recently following the occupation and control of huge areas by the IS. The people affected are in need of psychosocial support and other forms of assistance because of the unimaginable trauma they have suffered.

The effects of this attack on the survivors are still visible today, and some of the population of Halabja are in need of psychosocial support.

The Northern parts of Iraq have repeatedly seen a great deal of violence over the decades. In the 1980s, Iraqi dictator Saddam Hussein started the vicious Anfal Campaign against the Kurdish insurrection. Bombardments, displacements, and the killing of civilians were part of the strategy. The most drastic attack took place in March of 1988 in the town of Halabja when the Iraqi army used poison gas against the city which was home to some 25,0000 people. Around 5,000 people lost their lives in just a few days; many more were left with lifelong impairments. Furthermore, the effects of this attack on the survivors are still visible today, and some of the population of Halabja are in need of psychosocial support.

In the 1990s, inner Kurdish fighting between the PUK (Patriotic Union of Kurdistan) and the KDP (Kurdish Democratic Party) was responsible for many civilian deaths. The region only achieved relative stability after a peace accord between the rival factions was signed 1997. After 2003, almost all of Iraq was again thrown into unrest when US Forces invaded the country. In the aftermath of the invasion, the northern, Kurdish controlled parts of Iraq were not involved in the violence. Today, the Kurdish region enjoys autonomous status and the Kurdish forces, the Peshmerga, recently managed to protect the region under its control against further attacks by the IS.

Widespread "ethnic cleansing" campaigns during the bloody factional war between Shia and Sunni militias added to the suffering of ordinary Iraqis of all religious and ethnic backgrounds.

What is true for the Kurdish north does not apply to the rest of the country. Human rights abuses by American forces, attacks by terrorists, militias, and violations of human rights by the Iraqi Army have plagued huge parts of the country. In 2006 and 2007, widespread "ethnic cleansing" campaigns during the bloody factional war between Shia and Sunni militias added to the suffering of ordinary Iraqis of all religious and ethnic backgrounds.

Effects of violence and displacement

Though the northern part of the country was relatively peaceful until recently, long-term effects of this long, ongoing period of war and violence still resonate in society even in times of peace. One specific effect is trauma. Trauma occurs as the result of severely distressing events which overwhelm a person and exceed his or her ability to cope with the emotions evoked by that experience. Flight and displacement are severely distressing events and as such always traumatic experiences. People who have undergone such trauma often exhibit a number of symptoms that include severe distress, fear, anger, nightmares and sleeplessness. Many have suicidal thoughts.

These effects are generally caused by physical and psychological torture, long-term detention under poor conditions, organized military attacks against civilian populations, displacement and flight, terrorist attacks, kidnappings, targeted killings, religious, ethnic or political persecution, rape and domestic and gender-specific violence, among others.

Many of those who endure torture suffer from post-traumatic stress syndrome and exhibit a variety of symptoms like flashbacks, severe anxiety, and memory lapses.

Along with flight and displacement, torture has also been a major phenomenon inside Iraq and was carried out by several actors. It was a crucial element of Iraqi state policy under the Saddam regime. Torture continued after the US invasion, was used by US forces, and remains a feature of policy inside the Iraqi state today. Torture as a physical form of violence also has psychological effects on the victims, of course. Many of those who endure torture suffer from post-traumatic stress syndrome and exhibit a variety of symptoms like flashbacks, severe anxiety, and memory lapses.

Post-traumatic stress disorder and the resulting problems can be treated effectively in resource-orientated and trauma-centred work. On an additional note, since war and violence are man-made disasters, we often observe that they have a bigger effect on those who experience them than natural disasters, because they undercut victims’ belief in humanity and the innate goodness of human beings. This applies here in particular because many experienced violence and trauma at the hands of people they knew. The perpetrations were often former neighbours of the victims, which intensifies the impact.

Systematic rape of Yezidi women and girls

IS has carried out the systematic rape of Yezidi women and girls. Many Yezidi – some as young as 12 – were raped repeatedly and by several IS combatants. Hundreds and perhaps even thousands of Yezidi women and girls were subjected to slavery and sold to men, not only inside Iraq and Syria, but also in other Middle Eastern countries. These acts are war crimes. Additionally, many Yezidi women who manage to escape find themselves alone because their families were either killed or remain in IS captivity. Moreover, hundreds of Yezidi men – thousands according to some estimates – were executed by IS combatants. In a recent study, Human Rights Watch reported that over 5,300 Yezidi had been killed, were missing, or remained in IS captivity by March 2015. The Kurdish Regional Government (KRG) is organising efforts to provide health care services to Yezidi women and girls who were able to escape their enslavement and are now in Kurdish controlled areas.

A difficult life in freedom

The victims are faced with a number of challenges after being exposed to traumatic experiences. They have to deal with all the symptoms and learn how to live and survive in a new environment. Adults and parents must somehow take responsibility for their families, care for their children, and re-build their daily lives. Children have been catapulted out of their familiar environment in their former homes. They are often unable to attend school and their daily lives lack routine and structure, which is a further injury to their already fragile psyches. Children are a particularly vulnerable group in the aftermath of disasters. Traumatized children and adults find themselves in a new environment with limited resources and opportunities and have to find ways of dealing with the experiences they endured during their flight. This is tremendously difficult and overburdens those affected. But there are ways to help.

Some groups and individuals are trying to deal with the above-mentioned effects of armed conflict and violence. Jiyan, Kurdish for life, is one such organization.

Along with the medical care provided by governmental and non-governmental actors, psychosocial support is also available. Some hospitals have psychotherapists who offer support to those who were traumatized. Furthermore, several international and local organizations offer psychosocial support in the Kurdish region, both outside and inside the refugee camps, and in many cases integrated into a more general emergency programme. In a society that – in the north – is subject to the constant threat witnessed in recent months after a long period of relative calm, some groups and individuals are trying to deal with the above-mentioned effects of armed conflict and violence. Jiyan, Kurdish for life, is one such organization. Founded in 2005, the group was the first institution to assist torture victims in Iraq. It cooperates closely with the Berlin Center for Torture Victims and maintains staff in the main northern cities that offers medical, psychological and psychosocial rehabilitation. Jiyan works with war victims of all religions and ethnic backgrounds and campaigns for the rights of women and children.

Because of the huge number of IDPs, however, psychosocial support must be expanded to cover more of the affected people. The tasks that lay ahead are not just limited to psychosocial support. Society and the authorities are responsible for providing a safe environment for those affected and encouraging and facilitating their re-integration into the community.

Obstacles to rehabilitation

Several hundred organizations work in the Kurdish region of Iraq. Their relief and psychosocial work is usually facilitated by the local authorities and obstacles are rare. Organisations working in the field sometimes have to go through complicated procedures to offer help though. In some cases, coordination and cooperation between the different parties involved remain sub-optimal. Additionally, the quality of the psychosocial support offered differs significantly in some cases.

It is increasingly understood and accepted that psychosocial work is essential in societies that have experienced traumatic events.

On a general level, support is facilitated by acceptance on the community level. The refugee communities, local populations and local authorities are all strongly in favour of psychosocial support. It is increasingly understood and accepted that psychosocial work is essential in societies that have experienced traumatic events. In some cases though, families, and male family members in particular, of clients who have experienced domestic violence exhibit resistance to this work. This situation forces women to seek out psychosocial support secretly.

Some cases of women being isolated and refused re-integration into their communities because they were enslaved and raped by IS combatants have also been reported. Community leaders are spearheading ongoing efforts to appeal to the community members who reject the traumatised women. Such as Baba Sheikh, a Yezidi religious leader, who issued a statement welcoming escaped women back into the community and stating that no one should harm them. He also called for support for these Yezidi women so they could return to their normal lives.

There are also some legal hurdles to medical and psychosocial help. Abortion, for instance, is illegal in Iraq including in the autonomous Kurdish region. An abortion is only permitted as a medical necessity and not for cases of rape. This presents a serious problem for many women who were raped.

A hard job

Therapists working with the victims of recent violence have reported several cases that overwhelmed the therapists and were much more intense than of all the cases they had dealt with before. This applies especially to the cases of Yezidi women and girls. We were able to talk to the therapists currently working with them, who say that after a session, they often sit in their offices alone and cry because the dramatic trauma experienced by their clients is so overwhelming. It is clear that they too need support and assistance if they are to remain able to help these women.

There are a number of ways to support the traumatized. Different initiatives aim to offer support outside the region. The German federal state of Baden-Württemberg, for instance, agreed to accept 1,000 Yezidi women severely affected by the events for treatment by the end of 2014, and there have been calls for other federal states to follow their lead. While this is an admirable example of supportive measures for a group of women who experienced severe violence, local NGOs working in the psychosocial field and providing trauma-therapeutic services for those affected argue that supporting local organizations and institutions with experience and expertise in this field would help a much greater number of traumatized people.

Besides the psychosocial support in the region as described above, there are other initiatives like "Child Friendly Spaces", developed by UNICEF and Save the Children and being implemented by other organizations as well. It gives children from refugee families an opportunity to participate in educational and recreational activities organized by facilitators with psychosocial training in how to address the stress experienced by children and help them recover emotionally.

Many organisations and institutions agree that there are not enough therapists who can offer psychosocial support in the region.

Many organisations and institutions agree that there are not enough therapists who can offer psychosocial support in the region. In an April report, Human Rights Watch emphasised that local psychologists and social workers needed training in trauma therapy. An additional approach for dealing with the overwhelming situation is to offer group therapy sessions along with individual therapy so as to help as many people as possible.

In April 2015, the Jiyan Foundation for Human Rights and the German Wings of Hope Foundation concluded the first three-year training programme for 20 specialized trauma therapists in Northern Iraq. The training also dealt with acute trauma, early interventions, and the basics of emergency care – concepts that are especially important in the immediate aftermath of the recent events. They were also offered further training in group therapy.

Iraqi society is facing a huge task in the coming years. On different national levels, but also internationally, and as much attention as possible should be paid to the possible victims of war crimes. Not just to fulfil the humanitarian responsibilities of the global community, but also to prevent a repetition of those brutal acts seen in the past.

Further Informations

If you would like to support Jiyan’s therapeutic work, please visit:

Photo by Alberto Hugo Rojas (flickr)

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