Action Against Hunger has been working with internally displaced people since ISIS took control of parts of Iraq in 2014. More than 10 million people need humanitarian assistance, and access to the most vulnerable populations remains a major challenge. Our programs in Mosul and surrounding areas include providing food, water, sanitation and hygiene, as well as mental health care for the people most heavily affected by the war. Iraqi government forces have regained control of Mosul, but the humanitarian needs of its people are immense, especially when it comes to mental health after the trauma of living under ISIS rule.
Below is an interview with Action Against Hunger’s Mental Health Director in Iraq, Lisa Peyre, who is also a clinical psychologist. Originally published by Action Against Hunger’s operations in France, it has been translated and edited slightly.
What is the psychological impact of the crisis in Iraq?
From a psychological point of view, the impact of the crisis is enormous. Some people have lived for more than two years under ISIS control and are now experiencing the violence in Mosul. They are being exposed to a great deal of violence and threats, and to the virtual impossibility of having a real social life. The consequences are severe for individuals, families, and communities. Individuals feel a great deal of distress—many families have been separated because some members are in Mosul, others in camps, or have been killed. At the community level, there is a great sense of mistrust between people.
What psychological symptoms do you see in people?
Mainly high levels of anxiety and fear, and symptoms similar to post-traumatic stress syndrome, including sleep problems, behavior changes. We meet people with signs of depression, others with suicidal thoughts. There were some cases of suicide in the displacement camps, when depression and the feeling of hopelessness became too strong.
A girl draws during a group mental health support session for teenagers in Khazer Camp, which hosts 30,000 people displaced from Mosul and surrounding areas. Action Against Hunger has been working in the displacement camps since the beginning of the crisis.
Photo: Lys Arango for Action Against Hunger, Iraq.
Action Against Hunger incorporates mental health interventions into its programs in Mosul and elsewhere. Why are these types of programs important in times of crisis?
Psychological support is necessary in a context of crisis because the level of suffering of the populations is very high. However, these populations ask for help and do not know how to manage their symptoms: anxiety, anger, etc. Some people may become very violent and this obviously affects the well-being of families. We also work with mothers and their babies because we believe that activities that improve mental health can contribute to building better relationships between parents and children—and thus improve our efforts to prevent malnutrition.
What was the strategy of Action Against Hunger in Mental Health and Care Practices in Mosul and its surrounding areas?
Our strategy is to provide support to the people who fled Mosul as soon as possible. This is why we work in Khazer camp, the first destination for displaced people. We have organized group psychological support activities for women, men, adolescents, and children, as well as individual sessions with our psychologists for people with very high levels of anxiety. When we encounter cases of psychiatric problems, we direct them to psychiatrists who work with Doctors Without Borders. We also work in the villages north of Mosul. We were the first NGO to intervene in this area and provided the first mental health response for many of these people. Now, our strategy is to intervene inside Mosul, where we’ve gained access.
How many people have benefited from Action Against Hunger’s mental health programs in and around Mosul so far?
Since the beginning of our emergency response last November, more than 22,000 people have received initial psychological help in the camps and villages north of Mosul. 7000 people participated in psychological support sessions in groups, 600 in individual sessions.
Tell us more about Action Against Hunger’s mental health programs in Iraq.
We put in place three main activities: individual psychological support for people suffering high levels of distress, which include between 7 and 8 sessions with our psychologists. We also set up psychological support groups for adults, teenagers, and children between 4 and 5 sessions depending on the age groups. Finally, we developed care practice activities for pregnant, lactating or mothers of children under 2 years of age—these activities help strengthen the connection between mothers and children and to spot the signs of undernutrition in order to prevent it.
What challenges does Action Against Hunger face when it comes to providing mental health and other emergency services in this crisis?
Challenges vary from place to place. In the camps, access is safer and easier, but in the northern villages of Mosul there are still mines, bodies of former ISIS combatants, and bombs fall very close to where we work and where our patients live. The first challenge for our teams is access. Another problem we face: finding psychologists. The level of distress of the populations is very high, and it’s difficult to find people who are well trained to handle these cases. Another challenge is, of course, to find funds.
What impact has the crisis had on your life?
When I arrived in Iraq last October, I was part of the emergency team at the Paris headquarters. I came on the spot to design the emergency response and for the implementation of the strategy. I was supposed to stay only six weeks, but I finally decided to stay longer. It is the first time in my entire career that I have witnessed such a level of mental health suffering.