From genocide to pandemic: Yazidis in Iraq face looming mental health crisis as Covid-19 spreads

It came after half a decade of suffering and residual trauma that psychologists have been trying to address in the internally displaced person (IDP) camps where many Yazidis still reside.

But with disaster looming as coronavirus cases mount in Iraq, many fear this could threaten the recovery of the persecuted sect and make them vulnerable to further psychological harm.

"IDPs are [an at-risk group who] need greater health awareness on how to stay safe and [protect themselves] from Covid-19," says Director of the Duhok Health Directorate Dr. Nezar Ismet, adding that more psychosocial mental health support is needed to "cope with the new scary situation in [this time of] coronavirus."

Over 350,000 Yazidi survivors live in the IDP camps in northern Iraq, including in Khanke, a town in the Duhok governorate of the Kurdistan region of Iraq.

Run by Amar International Charitable Foundation, a London based humanitarian organisation with projects in the Middle East, Khanke refugee camp is just over 100 miles from Sinjar, where thousands of Yazidi men were massacred in 2014 while women and girls were taken as slaves after the Islamic State (IS) captured the town.

Over 350,000 survivors of the Yazidi genocide live in IDP camps in northern Iraq

The UN says the terror group, to which Taha Al-J belonged, is responsible for genocide against the religious minority.

The camp and town's only facility is a primary health clinic run by Amar. It serves the camp's official population of just over 15,000, while around 20,000 more people living around the camp and in the town also use its services.

While the virus hasn't yet reached the camp, its staff have been on high alert as cases started appearing in neighbouring states. "We started to collect information on preventing the spread of this disease, since February," says Dr. Ali Jawad, who runs the clinic in Khanke.

After immediately publishing announcements in Kurdish Padenanei, the Duhok dialect spoken by residents, the staff at the camp created posters and information cards to inform camp residents about recommended hygiene practices, including washing hands, and social distancing measures. Masks have been handed out, but with a global PPE shortage, there's an appeal for more support.

Read more: 'Their wounds must be acknowledged': What does the future hold for Yazidis who survived IS?

The primary health clinic has a laboratory, antenatal care facility, pharmacy, and a 24-hour ambulance. It is staffed by 25 medics and volunteers who educate residents about ways to identify potential Covid-19 symptoms, differentiating them from other cases of flu or tonsillitis.

A system for registering Covid-19 cases exists, but the clinic can't facilitate escalating coronavirus cases, at which point, an ambulance would take them to the nearest major hospital, 30 minutes away in Duhok city.

Jawad hopes preparations, which are also taking place in a camp run by the charity in Essian, are simply precautionary without the onslaught of the pandemic, as the reality of quarantine with five people on average per tent is almost impossible.

"Khanke is very dense and crowded, if the virus came into the camp, it would be a disaster," Ali says. "Tents sit side by side, and the virus would spread very quickly."

Residents have already adapted to the new procedures, says Jawad, limiting movement and physical contact. In addition, the Kurdish Regional Government (KRG) has imposed a lockdown and curfew from 6pm.

Nearly 30 NGOs have warned that Covid-19 has the potential for disaster in northern Iraq. Still, insecurity and instability prevail with reported Turkish and KRG military activity in the region, as well as cross-border movement by the Peshmerga.

As of 8 May, more than 3.7 million people have contracted the disease worldwide, while deaths from the virus have surpassed 265,000.

There was an increase among Yazidis in the experience of depression, anxiety, post-traumatic stress disorder, and other psychological disorders after the coronavirus outbreak

Numbers in Iraq are rising with 2,296 confirmed cases, according to national data, 387 of which are in the Kurdistan region. Overall, 97 deaths have been reported, but scepticism remains around official figures.

So far, one case of coronavirus has been documented in a refugee camp in Iraqi Kurdistan – Darashakran camp, northeast of Erbil.

"We expect Covid to come to these places," says Ryan Bohl, Middle East and North African analyst at Stratfor, referring to the camps in the Kurdish region of Iraq, anticipating that the dire estimates of it being "devastating" will ring true.

Read more: The Iraq Report: Mustafa al-Kadhimi takes the helm in stormy political waters

Low numbers are likely down to lack of testing, says Bohl, with the virus already potentially widespread in the country. "Iraq is quite dysfunctional right now, so the notion that it would be either in refugee camps already, and not being reported correctly, or that it soon will be are not terribly off-the-mark assumptions to make," he says.

Bohl also worries that the virus isn't being taken as seriously as it should as people in the region, particularly IDPs, have seen higher death counts through a legacy of conflicts, which could mean containment measures are flouted.

"The countries that are most effective at carrying out lockdowns are the ones with a sort of authoritarian centralised leadership," says Bohl. "Iraq is in many aspects the complete opposite of that, refugee camps are even further away from it."

Furthermore, says Bohl, the humanitarian footprint in the region has been diminishing, which means refugee communities in northern Iraq could be battling a coronavirus outbreak without much international support.

Read more: For Middle East refugees, social distancing is a privilege few can afford

Physicians worry such an event could hold back the gains in psychologically rehabilitating the already traumatised Yazidi population.

According to research by Dr. Jan Ilhan Kizilhan – a psychologist and Dean of the Institute of Psychotherapy & Psychotraumatology at the University of Duhok – witnessing crises, even natural or chemical disasters, can laden people with psychological impacts.

Thousands of Yazidi men were massacred in Sinjar in 2014, while women and girls were taken as slaves after the Islamic State captured the town

Conducting a psychological survey of refugees in northern Iraq, he compared data from October 2019 with information collected through the same set of questions among the same population in April 2020.

All participants were Yazidis, who fled IS in 2014 and have since lived in the camp setting near Duhok city. They had either experienced an attack, witnessed harm, or had lost friends and family members in the genocide.

Kizilhan said there was a general increase in the experience of depression, anxiety, post-traumatic stress disorder (PTSD), and other psychological disorders after the coronavirus outbreak, by up to 10 percentage points in some cases. Suicidal thoughts had also increased.

Read more: Traumatised by caliphate's reign of terror, Iraq's religious minorities fear plans to resettle IS families

Kizilhan says this increased prevalence was primarily due to anxieties of not being able to get medical support in the event of a Covid-19 outbreak. However, Kizilhan admits the sample for the study is small and provides a "momentary overview."

Khanke's primary health care centre has also been providing mental health services, and Ismet, like Kizilhan, believes there should be assessments in the future to understand the impact the Covid-19 pandemic will be having on displaced people with psychological disorders.

Such a study could illuminate the need for new evidence-based psychotherapeutic and psychiatric treatment in the event of future pandemics.

In the current situation, however, restrictions on movement not only hinder humanitarian actors' ability to distribute essentials like food, water, and medicine but also from delivering psychosocial support.

And it has effectively stalled much of the fieldwork of UNITAD, the United Nations team investigating the genocide of IS, leaving not just recovery, but justice, and the chance to rebuild, hanging in the balance.