The first thing that hits me every single time I visit the refugee camps in northern Iraq is their sheer size. Great sprawling masses of tents stretch as far as the eye can see. Just 18 months ago these vast pieces of land were home to no one except a handful of farmers and their sheep. Now, thousands upon thousands of people are forced to call these grim places home.
There are now 16 of these monstrous canvas cities in the Kurdish region alone. It is a statistic made all the more shocking when you consider that the total population of the camps make up a tiny proportion of Iraq’s 3.2 million internally displaced people (IDPs). Today, I’m on a regular visit to Khanke Camp, half an hour’s drive from the city of Dohuk.
More than 18,500 people live here, half of them under the age of 18. They are all Yazidis who fled here from cities and towns only a few miles away when Islamic State (Isis) invaded the summer before last. The lives of these gentle people were destroyed virtually overnight. Loved ones, friends and neighbours were killed or disappeared.
More than 5,000 young girls were kidnapped, sold on as sex slaves and horribly abused. Those more fortunate managed to escape, but left behind their homes, their jobs, and their worldly possessions. Their lives were reduced to the clothes on their backs and whatever else they could carry. Khanke looks very much like all the other camps.
The management building at the front is always buzzing with activity. Staff from the scores of NGOs here come and go every few minutes, camp residents arrive with suggestions, questions, and requests, and teenagers and young children hang around hoping to see something to relieve their boredom.
Today, it’s bitterly cold. A wicked wind blows across Mosul Lake nearby and whips up mini dust-storms. The few people who are out and about have their heads bowed, scarves and hats pulled over their heads as they struggle to walk on the muddy pot-holed roads. Not for the first time, I imagine what it must be like to live here.
Spending your days living under canvas, trying to keep warm in front of little portable heaters, no escape from the awful monotony. I suppose I have a better idea than most about how tough this life can be. I was forced to flee Saddam Hussein’s murderous henchman 25 years ago when he attacked his own people in the south of Iraq. I spent many years in an IDP camp in Iran before deeming it safe enough to return home.
In Khanke, NGOs and the Kurdish government are doing their very best to make life as reasonable as possible. My own charity has built a health clinic and a training centre here. We have tried, wherever possible, to employ staff who already live in the camp. It’s always a bit of a shock to discover just how many skilled people there here, but why would there not be?
Entire urban populations now live here. Our clinic currently sees around 450 patients a day and our training centre bustles with those keen to learn new skills that will hopefully stand them in good stead once they are able to leave. Inside the clinic, it’s the usual organised chaos. People get sick very quickly here and the weather – freezing winters and baking summers – does little to help.
Doctors, nurses and pharmacists work flat out. Elderly people and the young suffer the most. There’s an old man with a horrible cut on his leg, and a small child stands quietly while his mother holds a bloodied bandage to his head. Elsewhere, there are lots of mums with their babies – the usual childhood complaints made all the more serious by the living conditions.
In another room, pregnant women wait excitedly for a scan that will show them their babies for the first time. It’s a heart-warming moment. For the most part, thanks to super-human efforts by the Dohuk health department and support from NGOs, the physical medical needs of IDPs are being looked after. Their mental health, however, is a different story.
Those 5,000 young Yazidi women and girls abducted by Isis suffered horrific and prolonged sexual abuse. They were imprisoned for months on end, beaten and burnt and exposed to daily rape and torture. Horrifyingly, some of those victims were as young as nine. Sadly, some girls have taken their own lives in desperate attempts to escape the horrors of captivity.
The 500 or so girls who have managed to escape are not doing well. On top of the horrors of war and sexual enslavement, they now live an uncomfortable and difficult life in exile – far from their homes, in unfamiliar surroundings and without the traditional support structures of their local communities. With so many sources of trauma, complex post traumatic stress disorder is on the rise.
All too often we see cases of girls suffering from severe depression, crippling anxiety, panic attacks, headaches and nausea. Some self-harm, and many struggle to maintain relationships. Children frequently suffer from terrifying nightmares and struggle to communicate and concentrate – signs that their subconscious is grappling with memories of brutal violence.
Iraq’s healthcare system is struggling to deal with this crisis. Decades of war and instability have seen the mental health care system crumble, and the desperate financial situation is preventing Iraq’s ministry of health from investing in its recovery. Infrastructure and training have been neglected, and many mental health care professionals have fled the country.
Today, in the northern Kurdish region alone, there are just 17 general psychiatrists, and only four are trained to work with child and adolescent patients. Today, and every time I visit an IDP camp, I meet women and young girls who are struggling to cope with the enormity of what they have suffered. This is why we are battling to develop the infrastructure for mental health care here.
We are establishing new care centres, training local GPs in conflict-related trauma therapy, working with community workers to address stigma surrounding mental health issues and are training teachers to spot post-traumatic stress disorder symptoms among their students. Our current appeal is to raise funds so we can provide urgent counselling to Yazidi women and girls.
It will likely take years for victims to overcome the traumas they have suffered at the hands of Isis. But I, and all of my colleagues, will not stop until their needs are met.
Dr Ali Muthanna is regional director, Iraq at AMAR International Charitable Foundation.