DOMIZ REFUGEE CAMP, Iraq — There’s more than one way to be scarred by war. And when it comes to mental health, many Syrians are finding the refugee camps nearly as damaging as the war-torn homeland they left behind.
Domiz refugee camp in Iraq was built to hold 25,000 refugees — a number that the camp held over a year ago. By now the population has doubled. The camp's borders have been expanded and new areas constructed, but quarters remain cramped.
Domiz has grown into a city of sorts, with an economy of its own. Cafes where men drink tea and puff on waterpipes, internet cafes where kids play computer games, a smattering of salons named after Kurdish cities in Syria, a booming number of wedding businesses, and even a watch shop line the dirt paths of the settlement.
But life is not comfortable. While some families have built structures out of breezeblocks, many refugees still live in tents or shacks made entirely of corrugated metal roofing. Even in the soundest structures, families sleep in the same room with little privacy or personal space. In some parts of the camp, 15 refugees or more share a single outhouse. Sewage flows in gutters carved out of the sand and collects in fetid pools.
The transition — from relatively comfortable lives in Syria for many to the harsh realities of living in an overflowing refugee camp — has taken a toll.
“Most of the people here, they are suffering from psychological conditions,” said Adel Ismail, a 28-year-old English teacher in the camp. “And because of these bad psychological conditions, there are a lot of social problems.”
The residents of this camp are nearly all Syrian Kurds. Many are from the Kurdish heartland in the northeast of the country, a place that has largely escaped the levels of violence seen elsewhere in the war.
They are primarily economic refugees. As the war spread, it destroyed the Syrian economy: Jobs disappeared and prices of basic commodities like cooking gas and vegetables skyrocketed. Many saw a chance at a better life with their fellow Kurds in semi-autonomous Iraqi Kurdistan.
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In 2012, 7 percent of Doctors Without Borders’ (Medecins Sans Frontieres, or MSF) mental health patients in the camp displayed symptoms of severe mental disorders. Last year, that rate more than doubled, to 15 percent.
“Obviously they have suffered a lot in Syria and they also suffer from the living conditions in the camp,” said Henrika Zellman, an MSF psychologist from Germany who works in Domiz. “They withdraw from their social activities — some people don’t even go outside their tents anymore. They just lose interest in their lives, they are completely hopeless about the future.”
Post-Traumatic Stress Disorder is the mental health affliction many people associate with war. But aid workers say that anxiety disorders and depression are the most widespread psychological problems in the camps — and these too cause harm, both to those suffering from the affliction and those around them.
While mental health problems are less likely to make headlines in the West than gas attacks or bombings, aid workers say it is dangerous to dismiss these more subtle, pernicious consequences of the conflict.
“The visible wounds of a war are more easy to see and probably sometimes more easy to treat,” said Ana Maria Tijerno, an MSF mental health advisor based in Geneva. “But those invisible wounds, those mental health problems, can have as well chronic consequences for the society itself.”
There are no camp-wide figures on prevalence of mental health disorders. But symptoms of stress are not hard to find among the refugee population.
Back when he lived in Syria, in the eastern city of Hassakeh, 25-year-old Ahmed Hammou worked in a restaurant — until it was robbed by Arab gunmen. The loss forced the restaurant to close, leaving Hammou jobless as the security situation deteriorated.
“When I came to this camp, I myself would sometimes like to be alone and not speak to anybody. Thinking about my house, my garden: I miss my house, my city,” said Hammou, a father of three.
“Sometimes, I beat my children because of my bad situation. And sometimes I go outside the camp, alone, to decrease this pressure on me. I beat my children because of my trauma,” he said.
This scenario is tragically common, aid workers say.
“Generally our caseload is a lot of domestic violence,” said Kirsty Jenatsch, senior protection manager for Domiz camp at the International Rescue Committee (IRC), an international aid organization focused on refugees. “The camp is overcrowded, and in a crowded space it creates a lot of stress on families,” she added.
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Getting refugees to go to counseling for problems at home or to seek help for mental health disorders remains difficult. Hammou’s neighbor, 32-year-old Hilwa Omar, said the stress of living in the camp had led her to beat her children on occasion, too.
“I heard about the women’s center,” she said, referring to an IRC project that designated space where women could gather to discuss problems with community leaders.
But, “I have never gone and would not like to go there," she said. "Why would I go? I do not have any trouble with my house or with my husband.”
Aid organizations working inside the camp are trying to overcome stigmas about mental health treatment and counseling, but sentiments like Omar’s are predominant, said Ismail, the schoolteacher.
“If you go to a psychologist or a psychiatrist, maybe they will say you are mad, you are crazy,” he explained. “They are ashamed to go to the health center.”