The Emotional Scars Of War: Mosul’s PTSD Mental Health Crisis

TRIGGER WARNING SENSITIVE MATERIAL

The father arrived at the clinic with one child in his arms and another in a stroller.

Obviously distraught, he would not let the stroller out of his sight.

It took a few moments for me to register the gravity of what had happened: the children had been hit in a crossfire — one of them fatally. The father, faced with the inconceivable decision of having to seek care for one wounded child and burying the other, had no choice but to bring both to the clinic. The sound of mortars crashed in the distance as he tried to navigate saving one child’s life, while mourning the loss of the other.

As a father of four, this scene will forever be seared in my memory. I have spent over eighteen months in Iraq as the director of mental health and psychosocial support for the humanitarian organisation International Medical Corps. I have witnessed indescribable suffering and heard tragic stories of loss, but nothing could have prepared me for this moment. Seeds ripe for PTSD.

Tragedies like this play out every day in Mosul.

There is a little girl in the primary health clinic in Arkan, a neighborhood in eastern Mosul, which sees approximately 100 patients a day, according to its staff. The most common health issue the clinic sees, according to doctors working there, are skin diseases, likely the result of the persistent lack of water in Mosul. “We suffer from a shortage of everything, from staff to water and medicines,” one of the doctors said. International Medical Corps, with funding from the EU’s humanitarian aid budget, is making infrastructure repairs at the clinic and providing medicines, generator fuel, and other support.

Iraq’s second largest city was under control of ISIL for more than two years. In October 2016, the military operations to retake the city began in the city’s eastern suburbs as Iraqi Security Forces pushed further and further into the city. The eastern half of Mosul was reclaimed by Iraqi Security Forces early this year, but the fight for the western bank of the Tigris River grinds on. Families — like the man I saw outside the clinic — are caught in between.

International Medical Corps is providing medical care, mental health care, psychosocial support services and gender-based violence prevention and support to people seeking refuge in displacement camps east and south of the city. As areas in Mosul became accessible, our teams, with funding from the European Union’s humanitarian budget and USAID’s Office of U.S. Foreign Disaster Assistance (OFDA), started to help eight clinics get back on their feet caring for patients after more than two years of neglect under ISIL rule followed by conflict.

My focus was to assess how we could support primary health clinics in eastern Mosul to care for the psychological and emotional impact of the on-going conflict. How could we address the PTSD that was assailing this community. Across the eight primary health clinics, we heard from staff how they needed everything, from medicines to generator fuel. Some had been hit by car bombs and shells and sprayed with bullets. From a mental health care side, we heard again and again how people needed psychological support, but the infrastructure was heavily impacted and it could not be provided.

International Medical Corps’ community health team hosted an education event at a girls’ school in Gogjali, a neighborhood in eastern Mosul that has been under the control of the Iraqi army since late 2016. Under ISIL, girls were not allowed to go to school, which means most of them have just returned to the classroom after two years. The event covered common health issues as well as the importance of healthy habits, such as hand-washing.

While caring for physical trauma from Mosul’s front lines is essential, services have to be made available to help families with the psychological trauma of living under ISIL and war. Many people in Mosul have lost loves ones. Hundreds of thousands have fled with whatever they could carry to live in camps. All of them are uncertain of if and when peace will be restored and how they will begin to rebuild the lives they once knew.

The psychological toll can naturally lead to mental health problems like anxiety, depression and post-traumatic stress disorder. However, in my work responding to crises and conflicts, I have seen time and time again the tremendous impact relatively modest interventions can have to reduce psychological distress specifically on the longer term. This includes connecting people to information — like where to seek health care among other basic services and what they are entitled to when they arrive in a camp — as well as responding to their needs and concerns in a comforting, grounding way.

This approach, known as Psychological First Aid, is simple, but the impact can be very powerful. If first responders — from volunteers, youth, community members, doctors to camp managers — receive people who have just experienced a stressful event, they are fuelling chaos and uncertainty. Instead, if people are met in a calm, compassionate way and given information they need, we can subtly promote a sense of security and empower families to make decisions on their next steps.

International Medical Corps has been supporting this in camps and in east Mosul and other places by training case managers, volunteers, and health care providers in Psychological First Aid. We also provided them with basic training on common mental health issues so that they can quickly identify warning signs and symptoms and connect them to available care as needed. The hope is to expand the baseline services and referral networks so that communities can better take care of each other.

While the magnitude of suffering in Mosul is almost impossible to fully comprehend, I have witnessed incredible transformations that show the strength of the human spirit. In Mosul, people are engaged and committed to supporting their communities ― helping us create a network that will have a lasting legacy for families in need.

When I read this I just had to publish it on my blog. We are going to see a generation of refugee children severely afflicted by Complex PTSD and trauma.  This, of course, has always happened it is just it is being acknowledged now and is being addressed. There is hope for the little ones.

Written by Ibrahim Khali for the Contributor

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