The recent launch of the military offensive to retake Mosul has forced people who have lived through extremely traumatic times to flee the town and nearby villages. "These people have endured two years of occupation of their town or villages by the so-called Islamic State (IS), airstrikes, Iraqi forces fighting IS, and have fled for their lives", says Bilal Budair, MSF's mental health manager in Erbil.
"They had to leave very quickly, taking nothing with them, and now they find themselves in a displaced persons camp." Some 30,000 people are living in camps in Hassansham and Khazer, 35 kilometres east of Mosul. MSF's mental health teams see around 45 patients a day.
With the rise in the number of people displaced in Ninewa governorate in 2016 and the launch in mid-October of the battle to retake Mosul, our teams have been seeing patients suffering from severe mental health disorders.
The teams, which include a psychiatrist, a psychologist and a community worker, previously worked with Syrian refugees in northern Iraq in 2013. Then, in 2014 they began assisting displaced Iraqis who had fled Mosul when IS took control of the region.
People are deeply traumatised
Many people tell us they witnessed public executions in the market and saw corpses strung up and left for days. Death by stoning, beheadings, torture and corporal punishment; the level of violence has left many deeply traumatised. MSF psychiatrists are shocked by what they hear. Like the father who recalls how he was forced to kill his own child because he swore.
They find these accounts hard to believe, but the facts are inescapable when different people recount the same story. Another root of suffering for those displaced in recent months, is the fighting they have witnessed in their home villages or neighbourhoods. They have watched friends or relatives die.
These displaced people have fled Mosul or nearby villages for the safety of the camps. Patients who would never before have considered consulting a psychiatrist are now seeking help, but they're still terrified and live in fear of being exposed yet again to IS violence.
What MSF teams are doing in the camps
The MSF teams providing mental health care in the camps in Hassansham and Khazer offer consultations to patients suffering from severe depression, anxiety, acute stress reactions or post-traumatic stress disorder. They also see patients suffering from chronic diseases such as epilepsy, who need to resume treatment.
Other organisations delivering primary healthcare or psychological support services in the camps refer patients to us who are suffering from disturbed sleep or more acute disorders that are negatively impacting their daily life. "We treat all cases, moderate as well as severe", explains Bilal Budair.
"In fact, MSF is the only aid organisation treating severe cases and providing psychiatric care. We are on-hand to assist people and identify the most vulnerable. We're here to help them and anyone close to them experiencing difficulties in adapting to the situation."
A man in his 50s who lives in Khazer 1 explains that all his shops in Mosul were destroyed and on arrival in the camp he couldn't make himself enter his tent. "I cried. I wanted them to come and kill me, and everyone in my family. It is like being in a prison. It took me 20 years to build my home. Now it’s all gone. I’ve got nothing left. Not a single dinar in my pocket."
After several weeks, most of the displaced people start to get used to life in the camps, but others will go on to develop more lasting mental health disorders. They think their lives are finished and they want to die. We need to step in quickly and offer them the services of a psychologist or psychiatrist to help them adapt and cope.