"Nothing could have prepared me for this moment"
The Emotional Scars of War
By Ibrahim Abou Khalil, Director of Mental Health and Psychosocial Support, International Medical Corps Iraq.
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.
Tragedies like this play out every day in Mosul.
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 western half 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 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. 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.
While caring for physical trauma from Mosul’s frontlines in 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.