Cultural Barriers in Kurdistan Challenge Treatment for Psychological Wounds

Erbil, Kurdistan Region – Emerging from decades of conflict and violence, it is little surprise that many in the Kurdistan Region suffer from a variety of psychological ailments linked to trauma, such as Post Traumatic Stress Disorder (PTSD).

Violence has long accompanied Iraqi Kurds in their daily lives, even though the region now enjoys stability and peace. But peace alone cannot sufficiently heal psychological wounds that can go back decades, and affects thousands on a daily basis.

Rezhna Abdulkhaliq, 27, attempts to address this issue, while finishing her master’s degree in clinical psychology. She conducts research on the psychological consequences of Anfal through structured interviews with numerous survivors who have had to endure imprisonment, torture, strife, or all-out warfare. She says that most of her respondents show various signs of PTSD, depression, and anxiety. Other symptoms she observed include sleep disorder, nightmares, flashbacks, back pains and headaches, and compulsive crying.

"These people feel they have no one to talk to. Our study is descriptive, but we try and refer them to psychiatrists, or to another organization. Our main problem is that there is a strong social stigma in Kurdistan associated with seeking psychological support," Abdulkhaliq explained.

When she has to refer patients, she sends most to the Kirkuk Center for Torture Victims, led by Dr. Salah Ahmed, who is trained in psychiatry and psychology, and practiced for more than 20 years in Germany before returning to Iraqi Kurdistan in 2005 to set up his first center in Kirkuk.

"Kirkuk was my home, and there was no one helping people deal with trauma-induced psychological issues. I just had to return," he said.

His organization now has 16 centers in Kurdistan, spread in Erbil, Kirkuk, Sulaimani, Chamchamal, Halabja, and Dohuk. These centers help more than 2,000 patients a year, free of charge.

"Whether we are talking about children who lost parents during the Anfal, Peshmargas who developed PTSD after fighting or victims of terrorist attacks -- they all needed psychological support, and there was no place for them to get it," Ahmed said.

At the center, patients undergo weekly therapy sessions, and are sometimes given medication. But Ahmed maintains very tight control over the medicines, for fear they could create addiction and worsen the problem.

Abdulkhaliq noted that there are few psychiatrists in Kurdistan, and that they tend to give away medication rather carelessly. She was also critical of government efforts.

"There is virtually no support from the government on this issue. They don't really recognize trauma as something that can be treated, so I never send the people I know to a public hospital,” she said.

Ahmed was less critical of government efforts.  “The KRG is trying to set up psychological centers, and this is a great step forward. The problem is the absolutely huge need for help right now: there are too many people in need and not enough facilities.”

But Ahmed believes that the cultural stigma is the biggest setback to his work. "People think that if you go to a psychiatrist it means you're crazy, so they prefer to live with insufferable conditions rather than admit that they need help.”

Both Ahmed and Abdulkhaliq say that the majority of patients and respondents are female, because women are less likely to feel ashamed of seeking help. This is particularly true when it comes to Peshmargas who have developed PTSD: As fighters, they feel that admitting to suffer from trauma is a sign of weakness.

Another problem is the vicious cycle this stigma creates: By not seeking help, one individual suffering from trauma can shatter the lives of those around him, and therefore create more traumas.

Abdulkhaliq believes that a lot of the abuses suffered by women in Kurdistan are from husbands or relatives, who are themselves suffering from trauma. Instances of beating, rape, marital rape, honor killings, or even female genital mutilations have been known to occur, and these experiences lead to more trauma victims.

Abdulkhaliq also believes that the lack of social interaction, and therefore induced isolation, is a prominent factor in developing trauma.

"In Erbil or Sulaimani it is not necessarily a problem, because there are a lot of places where people can go and socialize, helping them to feel less isolated. But in smaller, more remote villages that were often equally or more affected by war, there are no public places for this purpose -- no restaurants, no cafes, no cinemas.  Therefore, apart from work, the victims have nothing to do but think about their traumatic experiences." Abdulkhaliq concluded.