From the frontlines of trauma in Iraq, one clinic’s challenges
In 2014, the so-called Islamic State abducted thousands of women and children when they invaded large parts of Iraq and tortured, enslaved, and killed many people affiliated with the Yazidi religious group. In response, in November 2015, the Jiyan Foundation for Human Rights, an Iraq-based organization that helps victims of human rights violations, opened a trauma clinic for women in the Kurdish city of Chamchamal. The clinic is a place in which women can be treated extensively, in a comprehensive in-patient manner.
Laila Ahmed, the clinic manager, is a psychologist who works as a psychotherapist at the clinic in Chamchamal. Here, Ahmed talks to Marina Zellner, an intern at the Jiyan Foundation for Human Rights, about the clinic.
Marina Zellner: Could you tell us a little bit about the Jiyan Clinic?
Laila Ahmed: The  invasion of Islamic State brought a lot of suffering to our region. While there are several organizations offering outpatient psychosocial support to the survivors—meaning a meeting with a therapist or counselor for one or two hours per week—this is not enough for severely traumatized women. They need a stable environment and medical care, psychosocial support, and trauma therapy on an inpatient basis, 24 hours a day.
At the Jiyan Clinic, every family gets one room. The staff and clients have their meals together in order to create a daily routine. Besides therapy, we also offer vocational training such as sewing or knitting courses. In the clients’ free time, they play games or watch movies.
MZ: How do your clients find out about the clinic?
LA: One of the main reasons women come here is that other women have told them about how therapy helped them. So knowledge of the clinic’s services spreads mostly by word of mouth. Our mobile teams in the camps or other organizations also refer cases to the clinic.
MZ: Who are your clients and what are their backgrounds?
LA: Until August 2017, 200 women and children of various ages were held captive by Islamic State. Some were released or escaped just recently; others, two years ago.
Now, almost all of the women live in camps around the Kurdish city of Duhok, together with their families. Many have children, who they can bring to the clinic. The youngest child we had here was just 4 months old. The oldest boy was 12.
Most of the women share similar experiences like physical abuse, rape, human trafficking, abortion, or family members being hurt or killed in front of their eyes. Many of them have symptoms that include sadness, lack of interest, or detachment from reality. They also have flashbacks or nightmares. They avoid things that remind them of the traumatic events. Many have concentration problems. Sometimes they are hypervigilant, suffer from sleep disturbances, get angry very easily, or have suicidal thoughts.
To prevent suicide attempts, we count and lock all the knives in the kitchen. Our nurses supervise the distribution of medication. Children, young women, and older women all suffer in a different way. Older women are more experienced in life and usually have developed some coping strategies. So we cater to all our clients individually in therapy.
MZ: What is the clinic’s approach to deal with the traumatized clients?
LA: First of all, we try to understand their problems. As we cannot undo the trauma, we help them live with their experiences. The therapists create individual therapy plans for our clients according to their special needs. These include medical care as well as psychological support and specialized trauma therapy. Besides individual sessions, we use various therapy approaches such as art, play, and group therapy. We also offer leisure activities including sports, gardening, picnicking, going to the park, and vocational training to help the women earn some money after they leave the clinic.
The clinic employs 21 staff members—medical doctors, gynecologists, psychiatrists, psychologists and trauma therapists, a physiotherapist, and nurses. All our employees are female actually. Our staff graduated from local universities and attends regular trainings on various therapy methods. For instance, the staff is currently taking part in training on Eye Movement Desensitization and Reprocessing (EMDR), a technique that helps reduce symptoms of trauma.
MZ: How long do the clients usually stay in the clinic?
LA: Currently, women stay at the clinic for four to six weeks on average. An outpatient stay is not sufficient. We need time to understand them, and they need time to think about themselves. We want them to feel comfortable and leave the stress behind.
Our staff is present 24 hours a day, seven days a week. The clients can come to the staff room whenever they need assistance. We also allow their families to visit and see that they are taken care of. As most women have families to look after or have children who need to attend school, some leave earlier than we’d like them to. But of course we don’t force anyone to stay.
And, by the way, leaving the clinic does not mean the end of therapy! Most women continue their therapy at our center in Duhok or with the mobile teams in the camps.
MZ: You said that some women bring their children with them. What are the children doing during the day?
LA: Children receive psychosocial support and therapy if needed as well, but in a more playful way. We do art, play, and group therapy with them and we provide them with formal education. We start with the letters, as most of them have never attended regular school.
MZ: What obstacles does the clinic face?
LA: One of our main challenges is the fear of stigmatization. Psychotherapy is not part of the culture here, so many people don’t speak about their psychological problems. Fortunately, this is slowly but steadily changing. Another challenge is earning our clients’ trust. The language is a challenge as well as the fact that our clients speak one Kurdish dialect and the staff mostly another Kurdish dialect. But we get used to it and we actually learn from each other.
MZ: Can you share an experience with us that you find particularly memorable?
LA: When clients come to the clinic, they are tired, not interested in anything—they are burned out. After a couple of weeks of therapy, I notice changes because they start to think of themselves in a different, more positive way. Sometimes I ask myself: Is this the same person who came here three weeks ago? This is a great achievement. Every single one of these success stories is very special for me.
MZ: What are the fees for the stay?
LA: No fees! All services provided by the Jiyan Clinic are free of charge for the clients so they don’t have to think about financial issues.
More articles by Category: Gender-based violence, Health, International, Violence against women
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