The Islamic State militant group’s rampage through northern Iraq over the past year has left a deeply traumatized population in its wake. Survivors' needs are so overwhelming that organizations are coming up with creative ways to help.
“I know 70-year-olds who cannot sleep, women who are afraid when a man asks, ‘How are you?' and a child under six years old who explained to me how his parents were killed,” said Salah Ahmad, a Kurdish psychologist based in Germany and the president of the Jiyan Foundation for Human Rights.
Ahmad founded the organization in 2005 to help survivors of torture under Saddam Hussein’s regime. The group now provides medical and psychological services across northern Iraq’s semi-autonomous Kurdish region. “There are millions of traumatized people in our country, and the need is bigger than what we can do,” Ahmad said.
Together with the Free Yezidi Foundation, a nonprofit founded last August to raise awareness about the massacre of Iraq's Yazidi minority and support its survivors, the Jiyan Foundation is setting out to bring a new form of trauma therapy to a region buckling under the Islamic State’s brutality.
In early November, a team of international experts traveled to Sulaymaniyah, Iraq, to begin training over 30 psychotherapy staff members from the Jiyan Foundation and other nonprofits in a relatively new trauma therapy called "eye movement desensitization and reprocessing," or EMDR.
“This is already a highly traumatized population. There is a real lack of mental health care. Now add the Islamic State and the genocide of the Yazidis, and you have high numbers of a traumatized population, but not sufficient resources to deal with it,” said Derek Farrell, a British psychologist who lectures at the U.K.’s University of Worcester and led the initial six-day course in Sulaymaniyah.
Farrell, who is a Free Yezidi Foundation board member, will return for a second EMDR course dealing with more complex situations in April 2016, and will continue to supervise the trainees via Skype after that.
EMDR therapy, first formulated by American psychologist Francine Shapiro in 1987, involves asking patients to recall traumatic memories while receiving “bilateral stimulation” -- usually, therapists prompt patients to move their eyes from side to side, but they also stimulate patients with sounds, lights or taps that alternate between the right and left side of the body.
Experts believe this jump-starts the brain’s ability to handle the trauma through "desensitization" and "reprocessing" -- in other words, by dimming the power of the traumatic memory and creating new mental connections and thoughts about it.
EMDR proponents say the therapy is well-suited to humanitarian crises like disasters and war, in which large populations are dealing with trauma and may be moving from place to place for safety. Advocates say it works fast, doesn’t require "homework" like cognitive behavioral therapy, and can be used in groups without requiring people to discuss their experiences in detail.
“EMDR is very efficient -- the requirement in terms of contact time is hours and days rather than weeks and months,” said Rolf Carriere, a development economist and advocate for EMDR therapy around the world, who is also a Free Yezidi Foundation board member. “It’s also more culturally appropriate," he said, noting that EMDR doesn't require patients to talk about traumatic events that may have a social stigma attached to them, such as sexual violence.
More than a year after the Islamic State militant group captured swathes of Iraq and Syria -- killing thousands of people and enslaving hundreds of women and children from the Yazidi minority -- the full extent of the atrocities are still coming to light. ISIS considers the ancient religious community of Yazidis to be “devil worshippers.”
Since Kurdish fighters recaptured the Yazidi homeland of Sinjar last month, they have discovered six mass graves containing hundreds of bodies in the area. Women who escaped Islamic State captivity have returned with harrowing stories of rape and torture, and hundreds of people are still missing.
There are now at least 1 million displaced people in Iraq’s Kurdish region. But in all of Iraq, there was only one psychiatrist per 400,000 people in 2011, the latest year for which World Health Organization statistics are available.
Another major problem is widespread stigma associated with seeking psychological treatment, Ahmad said. There are particularly few women working in the field, and female rape survivors often prefer female psychotherapists, he explained.
Ahmad saw EMDR therapy working in Germany, and felt it could help people in Iraq. It is a relatively new therapy, and some skeptics have balked at its seemingly unconventional methods.
“EMDR took a while to be accepted, but 25 years later, there is the accumulated evidence of over 20 clinical trials,” Louise Maxfield, a psychologist and editor of the Journal of EMDR Practice and Research, told The WorldPost. In 2013, the World Health Organization cited EMDR as an effective treatment for trauma.
The therapy does have limitations. “No therapy is good for every person ... some people won’t respond to EMDR,” Maxfield said. “And with other types of trauma therapy, there are concerns that memories are stirred up and people will have a strong emotional reaction -- although it's inbuilt into the treatment process to manage this situation.”
It is still very early to measure the success of EMDR in Iraqi Kurdistan, but the founder of the Free Yezidi Foundation, Pari Ibrahim, urges cautious hope.
“The training will help these practitioners to have another tool in their toolbox to help deal with those who need help -- not only Yezidis, but all others,” Ibhrahim said. “Since the trauma is very intense, there will need to be treatment for a long time. So it is a work in progress, and it will take a lot of planning, a lot of training, and time and funding to do it the right way.”
Farrell says it will likely take eight to 10 years to build up northern Iraq’s capacity to deal with trauma. “This is not a quick fix,” he cautioned.
Farrell helped introduce EMDR in Pakistan in the aftermath of the deadly 2005 earthquake, when the country’s small mental health sector was overwhelmed. Now, Pakistan’s EMDR therapists are almost self-sufficient, and help out nearby countries like Nepal and Myanmar, he said.
Ahmad says the potential benefits for survivors of Islamic State violence, and for the region as a whole, make the investment worthwhile. “If you first help a person get peace, then he will find peace in his family, and if families are at peace, then society is at peace, and if societies are at peace, then a country is at peace,” he said.
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