'The level of trauma inflicted by Daesh on women, girls, children, everyone under their control, is unlike anything you could imagine'
LONDON - “She couldn’t say a word. She couldn’t make a single sound. She sat in my office and stared at the wall. She simply couldn’t come to terms with what she had been through.” Dr Taib pauses, his face reddening. “I’m sorry, it just makes me so angry. The level of trauma inflicted by Daesh on women, girls, children, everyone under their control, is unlike anything you could imagine.”
Dr Nezar Ismet Taib, the director general of the northern Iraqi city of Dohuk’s health directorate and a trained psychiatrist, is usually a quiet man. But when he starts to talk about his work with those who have escaped or fled from the Islamic State (IS) group, and the deep psychological scars he is encountering, he becomes angry, his face transforming as despair overcomes him.
The mother was so terrified that she contemplated throwing her [daughter] out of a window, hoping the girl would at least find peace in death.
“She and her mother were kidnapped in 2014,” he explains after a few moments. “The girl looked like she was only seven or eight years old, so Daesh kept them together. The mother was raped repeatedly, each time in front of her little girl. When they discovered the girl was actually twelve, they threatened to rape her too. The mother was so terrified that she contemplated throwing her [daughter] out of a window, hoping the girl would at least find peace in death. Can you imagine? Somehow they managed to escape their captors, but they are both deeply haunted by their experiences.”
Dr Taib pulls out his phone, and scrolls through his photos. “This is the girl. She’s thirteen now.” It’s not surprising that her mother managed to persuade her captors that she was younger. She is tiny. “She’s doing a bit better now, and she and her mother want me to tell the world about what happened to them. They worry no-one will realise how dangerous Daesh are, otherwise.”
Skyrocketing rates of trauma
But there is little danger of the world forgetting the extent of IS barbarity. Genocidal violence against minorities such as the Yazidis, cinematic scenes of butchery and testimonies from those who have managed to escape captivity have made headlines worldwide.
"When girls who had been kidnapped by Daesh began to arrive in Dohuk, and I first heard about their treatment at the hands of their captors, it was almost too dreadful to believe," says Dr Taib. "I was so angry. As a father, no, as a human being, I couldn’t comprehend how anyone could do this.”
But it is the repercussions of this violence which tend to go unmentioned. “There was initially very little psychiatric support for those fleeing Daesh,” explains Dr Taib. “Girls who had been held as sex slaves returned home like ghosts to find no trauma support. Thankfully there are now charities working to address this problem.” Dr Taib himself also orchestrated the establishment of a women’s centre in Dohuk to help the women and girl victims of IS. They now have 778 patients and every new escapee passes through the centre for screening and referrals.
On top of 120,000 Syrian refugees, over 680,000 Iraqis have fled to Iraq’s most northernmost governorate
And it is not just trauma among women and girl survivors of sexual slavery that Dr Taib and his team are encountering. The strain of life in exile, the loss of friends and relatives and the constant fear of what is coming next has seen rates of trauma skyrocket in the past two years – and today, those in need of help look set to rise.
“With the battle to liberate Mosul now underway, we are anticipating the arrival of a huge number of adults and children in urgent need of trauma therapy,” warns Dr Taib. “We are not equipped for this. We are about to be overwhelmed by yet another crisis.”
Dohuk’s population has more than doubled in the past two years. On top of 120,000 Syrian refugees, over 680,000 Iraqis have fled to Iraq’s most northernmost governorate. Displaced by IS, they have become refugees in their own country, forced to eke out an existence in sprawling camps, abandoned buildings and makeshift centres.
Displaced Yazidis in makeshift shelter Khanke (Photo courtesy of the AMAR Foundation)
Living in overcrowded communities, often with insufficient access to clean water and exposed to both unbearably hot summers and surprisingly icy winters, displaced families are especially vulnerable to the spread of disease. At one healthcare clinic in Khanke camp, run by the British charity the AMAR foundation, doctors deliver over 450 medical services a day, so great is the demand.
But as displaced Iraqis swell Dohuk’s population and authorities face a worsening economic outlook, key health services are struggling to cope.
“The reign of Saddam Hussein, sanctions and wars resulted in our healthcare services disintegrating over the past few decades. But now we are at breaking point. There is a huge need for medical assistance, and yet there are just 4.5 doctors per 10,000 people. We have even fewer psychiatrists.”
'there are just 4.5 doctors per 10,000 people. We have even fewer psychiatrists'
Many critical services such as primary healthcare in displacement camps, the provision of mobile health clinics for those outside the camps, and the availability of mental health care are now only being delivered thanks to the support of charities.
“Without aid agencies, our healthcare system would have completely collapsed,” laments Dr Taib. “But even with their support, we can’t rest. We can’t stop. There’s too much for our teams to do. None of my colleagues have taken a day off for two years, they are absolutely exhausted.”
Internally Displaced Persons Camp in Dohuk (Photo courtesy of the AMAR Foundation)
And the situation is only set to get worse. As Iraqi and U.S.-led coalition forces intensify their efforts to liberate Mosul from Islamic State control, the U.N. is warning of an impending humanitarian crisis.
Since the campaign began on October 17th, over 17,000 have fled from towns and villages surrounding Mosul. But this is just the beginning. According to Stephen O’Brien, the U.N.’s undersecretary general for humanitarian affairs, the fighting is likely to force up to 1.5 million civilians to flee the area, most of them on foot and with just the clothes on their backs.
Since IS swept across the Ninevah Plain to enter Mosul, seizing the streets and marking the city as the star prize within their so-called caliphate, Dr Taib and his colleagues have desperately awaited the city’s liberation. “We’ve been waiting for this for two years, but our emotions are tinged with very real fear. We know that the operation will result in yet another humanitarian crisis for Iraq, and we are not equipped for this.”
'We’ve been waiting for this for two years, but our emotions are tinged with very real fear. We know that the operation will result in yet another humanitarian crisis for Iraq'
Whilst half of those fleeing the city are expected to move south towards Salah-al-Din, it is predicted that the rest will move north, to territory controlled by the Kurdish Regional Government. Of these, roughly 290,000 are expected to arrive in Dohuk province.
Actively involved in Dohuk’s response plan for the upcoming crisis, Dr Taib is attempting to ensure plans are in place to prevent the spread of disease amongst displaced communities. “Families will be arriving in Dohuk hungry, thirsty, exhausted and in need of medical assistance. Insufficient healthcare services could spell disaster,” he says. “This is a classic time of year for measles and cholera, and reports indicate that children living in Mosul have not been vaccinated. We need to immediately roll out a vaccination programme to protect these communities.”
The psychological toll of IS occupation, meanwhile, is of particular concern to Dr Taib. “For two years, residents have lived in constant fear. Many of them will have witnessed public punishments and executions. We’ve all seen it in the news, but this has been the daily reality for the people of Mosul. Now, they are about to find themselves caught in the crossfire, too.”
“What a lot of people forget is that the residents of Mosul have had no choice but to live under Daesh. People may think they are Daesh sympathisers, and of course there will be some, but the majority of residents either couldn’t escape in time in 2014, or they simply hoped that the occupation would be short-lived. These are innocent civilians who have been forced to live in what can only be described as a hellish prison.”
'These are innocent civilians who have been forced to live in what can only be described as a hellish prison'
'We need international support'
Despite the scale of the operation required to help those fleeing Mosul, there are still major shortfalls in funding. When, in June, it became clear that a Mosul offensive was inevitable, a UN flash appeal called for $280m to prepare for the expected crisis. They have since increased this to $365m, but have received just a small proportion of this. Charities such as AMAR are scaling up their emergency response work and launching public appeals for assistance, but there is a long way to go.
As viewers watch the battle for Mosul unfold live on TV and social media, and hopes rise that the defeat of IS in the city will mark the start of an endgame for the group in Iraq, it is clear that for Dr Nezar and his team, this is just the beginning.
*Dr Nezar is currently in the UK, working alongside the AMAR Foundation to highlight Iraq’s growing humanitarian needs
This article is available in French on Middle East Eye French edition.