Refugees wait for aid at a camp in Iraq. Photo by Melih Cevdet Teksen/Shutterstock
Nihad Barakat Shamo Alawsi was just 15 when Islamic State fighters invaded her village in Sinjar, northern Iraq. She was kidnapped, along with 29 members of her extended family, all members of the Yazidi religious and ethnic group that was targeted by IS from August 2014 onward.
"They were hard days. The Daesh fighters raped us and attacked us, took our children and our women and killed our men," Nihad said, using the Arabic name for the IS group.
She held back tears as she related the story of her 15 months in captivity.
"They took us to Syria for a week, converted us to Islam then brought us back to Mosul. The worst torture we experienced was in Mosul. They gathered all the girls, raped them and then distributed them to senior Daesh fighters. They took the children away," she said.
Nihad was handed over to a fighter called Salam Hamdu Ubaid, who regularly beat and raped her. A month later, she was pregnant.
"I felt that a Daesh criminal was in my body," she said. "I tried many times to abort the fetus but that wasn't my fate."
Shortly after giving birth she managed to contact her family, who organized a smuggler to help her escape Mosul, a city in northern Iraq that has been held by IS since June 2014. Two of her brothers, their families and two sisters are still trapped in the city.
Nihad was one of an estimated 5,000 Yazidi women and girls kidnapped by IS – the largest single mass kidnap of women this century. Based on Yazidi officials' estimates, the United Nations has cited allegations that as many as 3,500 people remained in IS captivity as of October 2015. Human Rights Watch says IS's systematic abductions and rapes constitute war crimes, and may be crimes against humanity.
While some of these women, like Nihad, managed to escape, reaching safety has not ended their suffering. The horrors have left many deeply traumatized, suffering both mental and physical reactions to their harrowing ordeals. Some could not live with their memories and have committed suicide.
Years of brutal dictatorship, followed by foreign invasion and ever more brutal sectarian violence have left millions of Iraqis psychologically scarred. The cumulative impact is of staggering proportions. More than 3 million Iraqis are internally displaced, with many having fled unimaginable violence. Syria, next door, hosts more than twice that figure.
In northern Iraq, which hosts more than 1 million people who have fled from other parts of the country, there are just 17 psychologists and psychiatrists on the ground. The local government, U.N. agencies and nongovernmental organizations have set up a range of pyscho-social programs, but the need is vast.
"These camps are more in need of psychological support than anything else, because of this pressure. Every family, if not half, three-quarters of them [still] are in the hands of Daesh," said Ruwaq Fadil, who runs programs on women's empowerment for a British charity, Amar.
Amar runs group sessions, clinics and social centers for women in the camps, along with courses in sewing, hairdressing and handicrafts. There also have health volunteers who visit people in their tented homes to provide psychological support and health education. "The idea is to take away the pressure they are living through in the camps," Fadil said.
Yet a lack of understanding about psycho-social support, along with the stigma attached to rape in a largely conservative Yazidi society means that few Yazidi women actually access any sustained psycho-social support or mental health care, according to a recent report by Human Rights Watch.
Rezhna Mohammed shares this view. As director of psychological services for SEED Foundation, a local NGO in the Kurdish region of north and northeastern Iraq, she works in the Mamilyan Camp that houses more than 13,000 IDPs. She and two colleagues provide deeply traumatized Yazidi women with psychological support. But she would not use that phrase in front of them. She says the experiences of rape that often result in psychological disorders – both considered taboo subjects in the community – mean that many Yazidi women face a double stigma and consequently a multifold trauma.
"If you offer them psychological support, they'll say, 'I'm not mad,'" explains Mohammed. "They can't eat, they sleep only two hours a night, they have nightmares, and they'll say, 'Yes i was raped, Daesh put me in prison, my son is still with them, but I'm not mad.'"
The 30-year-old psychiatrist holds weeks-long informal group activities to build trust with internally displaced people before moving to one-on-one counseling sessions. But professionals with such cultural sensitivity who can perceive the individual context and need of each person are not easy to find. Mohammed, who manages two junior psychiatrists and takes on particularly challenging cases herself, says some of the major international NGOs have only one social worker in a camp of 10,000 people.
"The real problem is there are no specialists," she says. "There's no effort in education, higher education, or in the health service to focus on this. It's very weird because in Iraq, in one century we've had seven wars."
Amar also launched a new project in March to train local doctors to deliver quality psychological care, establish 10 new psychological support centers and deliver counseling and psychological support directly into homes.
The charity has been working with Iraqi IDPs since former Iraqi President Saddam Hussein's extermination campaigns against the Marsh Arabs of south and east Iraq in the early 1990s, and recently launched a new program to support women in the camps of northern Iraq.
"The great need lurking in the shadows is the psychological one," said Baroness Nicholson of Winterbourne, the British peer who founded Amar. She says it has helped some of the most traumatized people on earth. Today the NGO provides health services to hundreds of thousands of people like Nihad.
"They left their houses, their money, lost people who died in the hills as they escaped, or were killed by Daesh and now they're in mass graves. All that [suffering] needs psychological support," says Fadil.
What is being provided right now is a drop in an ocean of need, she said.
Paul Raymond is a freelance journalist based in London. This article originally appeared on Refugees Deeply, and you can find the original here. For important news about the global migration crisis, you can sign up to the Refugees Deeply email list.