The trauma haunting Mosul's survivors

“They were my best friends as well as work colleagues, we had known each other as boys from primary school age,” he continues.

For almost half an hour I listened as he recounted his story of the day when armed jihadists from the Islamic State group came to his office at the Iraq election commission in Mosul looking for his two friends, Layth and Marwan. Like Moqtaz both were only in their early twenties.

“They had their names on a list, I don’t know why but they took them away,” he recalls. It was some hours later when the IS fighters returned with the decapitated corpses, dumping them in front of Moqtaz and a few of the young victims’ family members who had gathered at the office to await news about the fate of their loved ones. Since that moment Moqtaz has suffered nightmares.

“I see their bodies, the blood, my friends now unrecognisable,” he tells me. It’s a story his psychiatrist has listened to many times before during the series of therapy sessions Moqtaz has undergone to help him cope with the Post Traumatic Stress Disorder (PTSD) with which he has been diagnosed.

Outside the clinic in Mosul’s old city and western neighbourhoods, chasms of bomb blasted buildings, severed electricity cables and phone lines, lie mangled in stark testimony to the destruction of life at a physical and material level. The degree of destruction is staggering.

But Mosul has other scars too that defy comprehension, less visible perhaps but no less gaping in terms of the holes they puncture in people’s lives and way they disconnect their mental anchoring.

The United Nations estimates that that among the near million civilians displaced during the battle for Mosul alone, about 80 per cent suffered psychological trauma, with 15-20 per cent reporting “mild or moderate” symptoms and 3-4 per cent “severe” symptoms.

At the Muhabareen clinic, funded by the European Commission’s Civil Protection and Humanitarian Aid Operation (ECHO), there are many others like Moqtaz.

The very idea of closure from the horrific experiences many have had carved into their psyche remains elusive. In some cases those experiences will haunt them for the rest of their lives.

For Zaman a petite twenty-eight-year-old woman I also met at Muhabareen clinic, the loss of all four brothers, Ali, Ahmed, Idriss and Fadi, has left her with major depression and anxiety attacks.

Having gunned down Ali in the street as he worked as a taxi driver, IS later came to Zaman’s family home at midnight and seized Ahmed and Idriss. The body of Ahmed was returned a month later, while Idriss whereabouts remain unknown, even though Zaman’s father went to the IS prison where they were taken, to enquire about the fate of his son.

According to Zaman, the body of Idriss has most likely been dumped along with hundreds of other victims of IS death squads in one of the many mass graves that lie around Mosul.

As if all this was not trauma enough for Zaman, her lone surviving brother Fadi, is now out of reach too, he being inconsolable and unable to communicate after a breakdown that has left him in hospital for seven months.

For those like Zaman and Fadi, rarely can they travel through a day without crossing the emotional and traumatic intersection of past and present.

“I often hear my son’s voice,” Khiarya tells me, as we sit in her tent at the Hajj Ali camp for those displaced by the war. The camp is located on a dry dusty plain south of Mosul and the oil town of Qayyarah.

It was here last year during the course of the campaign by the Iraqi Army and Kurdish peshmerga fighters to retake Mosul, that I first encountered those who had fled the fighting and brought with them their accounts of the horrors unfolding.

Khiarya’s arrival at Hajj Ali is more recent though after she and thousands of others escaped the town of Hawija over the past few months, one of the last IS strongholds to be taken back from the jihadists.

As Khiarya speaks I can’t help noticing that the sunlight streaming through the bright blue tarpaulin of the tent in which we sit, has cast a strange and melancholy light across her lined face.

Her eyes are glazed with moisture, it’s the stifling heat maybe or tears, perhaps, I can’t tell for sure, but something is wrong. I give an enquiring look across at Doctor Abdulhalim Hasan sitting opposite, concerned that my chat with Khiarya is proving too painful for her and it’s time to stop. He nods discreetly in agreement and gently we change the subject before taking our leave.

Outside in the dust we walk though the ranks of tents crammed with the tens of thousands of civilians who fled here to Hajj Ali from the battles that turned swathes of Iraq’s second largest city Mosul and others into canyons of ruins.

Doctor Hasan has personal experience of the toll war takes. Originally from the Syrian capital Damascus, he was a psychiatrist at a mental health centre in Douma, six miles northeast of the city. It was during this time that his daughter suffered from the trauma of surviving a mortar attack at her school in which five of her classmates were killed.

As a result of the experience the family fled Damascus, heading first to northern Syria, and from there to Turkey, before eventually settling in Jordan. Today Dr Hasan works as a psychiatrist with the International Organisation for Migration (IOM) in Iraq as part of its Mental Health Psychosocial Support Programme for those affected by the war there.

“There are so many cases of trauma here in Hajj Ali camp, the most recent from Hawija,” he explains as we walk and he talks me once again through the tragic experiences that led to Khiarya’s mental meltdown.

He tells how she was a survivor of an abusive marriage before war came to her doorstep. How her son who had gone over to the ranks of IS and shamed their tribe, family and neighbourhood was then himself murdered by relatives for doing so.

No sooner had the horrors of the jihadists’ rule taken her son, than those who came to liberate Khiarya’s town of Hawija in the shape of Iraqi Shi’ite militiamen, who fight alongside the Iraqi Army, abducted her 17-year-old daughter who has never been seen or heard of since.

Since that time Khiarya has wrestled with her own demons struggling to prevent them from consuming what remains of her life that until now has survived near unimaginable horrors.

Like so many and through no fault of their own, the war has gone by and the monsters it unleashed has scythed the happiness, hope and everything held dearest out of the lives of those like Khiarya. In its wake it has left behind a visceral sense of despair, loneliness, confusion and uncertainty.

“Khiarya seemed to be making some progress, but after what I have seen today, there are delusionary patterns beginning to manifest themselves in her behaviour and I’m becoming more concerned for her,” Dr Hasan tells me.

According to those psychiatrist and psychologists tasked with treating patients like Khiarya, many people, especially children, are experiencing what is known as “toxic stress,” a severe form of psychological trauma that can cause lifelong damage.

In toxic stress cases the mind is often constantly in fight or flight mode. Left untreated, it can damage the brain’s architecture and have a lifelong impact on mental and physical health.

Children are a major cause for concern. According to research by Save the Children, the loss of loved ones was their biggest cause for distress. As many as ninety per cent of children from Mosul reported the loss of at least one family member through death, separation during their escape, or abduction.

Some mention fear of an unidentified “thing”, “person” or “monster”. Their mental images of traumatic experiences, and subsequent nightmares, appear to be so vivid they are haunted by them during the day.

When children were asked to play a game where they could put anything they didn’t want into a ‘magic bag’, either an item or an aspect of themselves, they most frequently chose war, weapons, sadness and IS. When they were asked to take an item out of the bag to make them feel better, they often had difficulty answering. Of those that did, most chose happiness and lost loved ones.

According to Dr Hasan, among adults the main symptoms treated are anxiety, depression, and psychosomatic reactions such as nightmares, loss of sleep or sight.

He explains too how some women have lost the capacity to empathise with their children’s needs, while relatives of those who joined or cooperated with ISm, as did Khiarya’s son, often show vindictive impulses.

Just before I left Hajj Ali camp, Dr Hasan introduced me to another of his patients, a woman called Mardya who now finds it difficult to relate to or look after her children.

“I felt I must break my relationship with the children as I might lose them too,” she explained as we talked in the quiet of a hut about the loss of her husband and its impact. “I was numb and could not get rid of the shock,” she told me.

Mardya keeps a photograph of her husband, Yusef, in a little plastic bag that never leaves her person night or day.

In the now fading thumbnail size passport photo is the face of a handsome, clean-shaven man in dark blue suit, white shirt and striped tie.

The picture was taken just before Mardya witnessed Yusef being blown to pieces by an IS bomb that hit his car outside their home on the outskirts of Mosul.

What Mardya saw that day has played on her mental health since. If that moment was the worst in her life then the day she married Yusef, she says was the happiest.

“He was an honest man and very kind, a man who liked nothing more than staying at home with his family,” she told me.

Today for those like Mardya, what began as grief has morphed into something else.

Anxiety and post-traumatic stress disorders, depression, guilt, thoughts of suicide and periods of intense loneliness, are all taking their toll on the survivors of Mosul’s cataclysm.

Last week as the tremor of the earthquake that struck Iraq and Iran shook the ground at Hajj Ali camp, Mardya was alone in her tent.

“At that moment, I felt I was about to join Yusef,” she later told me, smiling for the first time since we spoke.

The world’s headlines might have moved on, but for many the struggle to survive the psychological aftermath of the battle for Mosul is almost as desperate as those months during the physical battle itself.

For people like Moqtaz, Zaman, Khiarya and Mardya, the guns, bombs and cries have never completely fallen silent even if the fighting with IS is all but over.

For so many survivors the images of dead or maimed loved ones remain indelibly etched in their mind’s eye. The darkness of bedrooms, the slam of a door or a baby’s cry - this is how their new war haunts them and lingers painfully on.