A decision by Iraqi authorities to close camps sheltering up to 100,000 displaced people will worsen a mental health crisis in which spiking suicide rates are disproportionately affecting women, experts and NGOs have warned.
Three years after the Iraqi government declared victory over the Islamic State terrorist group, the Ministry of Migration and Displaced People is eager to close camps for those displaced by the war, announcing in October a programme for the “safe and voluntary return” for hundreds of thousands of Iraqis.
But closing these camps will exacerbate a deepening mental health crisis, NGOs warn.
“Many of the people in these camps are widows and families that have been neglected and outcast by their families for their connection with ISIS,” said Ekhlas Mohammed Ali, a psychiatrist from Mosul.
Around Qayyarah, a hardscrabble town 40 miles south of Mosul in Ninewa province, camps house nearly 100,000 people, some of whom are now being told to prepare to leave at short notice.
“Today I saw four or five cases who are leaving, mostly widows” Dr Mohammed Ali said on Monday.
“Some of them don’t know where to go. Some of them are worried that they will not be able to buy medications or get mental health support from other places.”
Many of the families have been rejected by their communities for having a relative affiliated with IS and are unable to return to their communities. Births in the Islamic State were often not registered with the government, meaning children are often unable to attend school.
These factors are combining with unaddressed trauma and acute poverty to contribute to alarming rates of depression, anxiety and suicide, according to Action Against Hunger (AAH), Doctors Without Borders (MSF) and the International Medical Corps (IMC), which have all provided mental health services in Qayyarah.
“I’ve worked in other camps where in one year I saw one or two suicide cases but the first week here I saw three,” said Dr Mohammed Ali, who recently began working for IMC in Qayyarah’s camps.
Closing camps without providing alternatives could increase suicide rates, she warned, while dispersing vulnerable populations will make it harder for NGOs to provide help.
“There is an acute lack of psycho-social support in the places where these IDPs [internally displaced people] are supposed to return to,” said Sabah Abdulrahman, deputy director of Azhee, a local suicide awareness organisation. “Basic services are not available, let alone psycho-social support for vulnerable people.”
Even outside the camps, Qayyarah faces alarming suicide rates, with an estimated three to five fatalities reported monthly, according to AAH, with self-immolation prevalent among women.
The small community lost 600 men in the war against IS, some killed by the extremist group and others having joined it, leaving hundreds of widows and female-headed households.
“After the war there was a real big mental health crisis in Qayyarah” said Anfal Mezar, who works in the town as a mental health programme manager for AAH.
“There is a lot of domestic violence, gender-based violence cases, it’s very hard to reach out to the female population, there are a lot of cultural barriers,” said her colleague Alessandra Sacchetti.
Those women who had a relative join IS face exclusion, while widows struggle to find work to support their families.
“Many women are isolated or cannot work, they can’t leave the home, the community and their family won’t accept it,” said Salma, a woman in Qayyarah who works to support her family and received counselling for depression from AAH caseworkers.
“I’m breaking all these cultural norms but I’ll face anyone who says I cannot work or should stay in the house,” she said, asking to be identified by a pseudonym because of the stigma of discussing mental health issues.
Gwenola Francois, head of mission in Iraq for MSF, said the high suicide rate in Qayyarah was alarming and more frequent among women. “We definitely saw that there were some issues inside the camp and inside the city,” she said. “It was an alert for us.”
MSF warned in October that “people’s mental health had worsened significantly” in Iraq generally, noting “very high rates of anxiety and depression among patients trying to recover from the effects of war and displacement, aggravated by the current economic situation and the impact of Covid-19.”
With the Iraqi government facing a deficit caused by low oil prices, mental health spending has not been a priority. When MSF’s programming in Qayyarah ended in September, Ms Francois said they could not hand over to the health ministry because it had no mental health specialist available in the town.
The government does not make publish statistics on suicide but experts believe it is increasing.
Iraq’s Human Rights Commission recorded 549 suicides in 2019 compared to 319 the year before. Local media suggest suicide rates are increasing this year, and in one instance in October outlets reports six cases within 24 hours of each other.
But even these figures likely under-represent the total, partly due to the stigma of reporting suicide.
“Unfortunately there is no centralised source of data,” said Mr Abdulrahman. “Reporting on suicide is on the rise, is the minimum we can say.”
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