In 2014, the so-called Islamic State (ISIS) invaded large parts of Central and Northern Iraq. Especially in the Sinjar area they did unbelievable harm to the local people: thousands of Yazidis, a religious group that makes up a huge share of the local population, were expelled, enslaved, tortured or killed. As a result, many persons are traumatized and need psychological support. In November 2015, the Jiyan Foundation opened a trauma clinic for women and children who have been abducted by ISIS. At the Jiyan Clinic they receive inpatient medical and psychological treatment in a healing environment. Read what Laila Ahmed, the clinic manager, tells us about the work of her team:
Laila, what is special about the Jiyan Clinic?
The invasion of ISIS has brought a lot of suffering to our region. Especially the targeting of women on such scale is a unique event and needs special attention. There are several organizations offering outpatient psychosocial support to the survivors. This means the clients meets the therapist or counselor for one or two hours per week and then return home. 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. In order to to create a daily routine, the staff and clients have all their meals together. Besides therapy, we also offer vocational training such as sewing or knitting courses. In the free time we play games, especially traditional Yazidi games the clients know from their childhood, or we watch movies. Sometimes we just sit and talk about the peculiarities of our areas; we explore similarities and differences, and exchange ideas.
What are the clients’ backgrounds?
By August 2017, over 200 women and children from various ages have undergone therapy. All of them have been held captive by ISIS. Some were released or escaped just recently, others two years ago. Now, almost all of the women live in camps around Duhok together with their families. Many have children, who they can bring to the clinic of course. The youngest child we had here was just four months old, the oldest boy was twelve. Women who want to undergo therapy at the clinic should not suffer from severe physical issues which may prevent them from focusing on the psychological therapy. Minor injuries or illnesses can be treated in our clinic.
How do the clients get to know about the clinic?
The clinic got well-known since opening. But still the most convincing reason for women to come here are other women telling them about how therapy helped them. So, knowledge of the clinic’s services spreads mostly by word of mouth. Additionally, our mobile teams in the camps or other organizations refer cases to the clinic.
What are the reasons for the traumas? As the clients have all been held captive by ISIS, can you observe any similarities between the women’s experiences?
Indeed, most of the women share similar traumatic experiences like physical abuse, rape, human trafficking, separation of mothers from children, abortion, or family members getting hurt or killed in front of their eyes. The symptoms of these traumatic experiences can be classified into four groups: emotional numbing, re-experiencing the event, avoidance behavior, and hyperarousal. More specifically speaking, our clients have symptoms such as severe states of sadness and crying, lack of interest, disappointment in life, or detachment from reality. They also have flashbacks, nightmares or day dreaming. They avoid things that remind them of the traumatic events. Many have concentration problems; they keep forgetting how to do things they used to do before. Often they are hypervigilant, suffer from sleep disturbances, get angry very easily or have suicide thoughts. In order to prevent suicide attempts we count and lock all knifes in the kitchen after use. Our nurses supervise the distribution of medication to avoid that clients collect pills and take them all at once. 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 the therapy.
What is the clinic’s approach to deal with the traumatized clients?
We have a therapy concept that supports the clients in a way that takes into account their individual realities. First of all, we try to understand their problems. As we cannot undo the trauma, we help the women to live with their experiences. The therapists create individual therapy plans for our clients according to their special needs. The therapy includes 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 offer leisure activities including sports, gardening, picnicking, going to the park and vocational training in order to enable the women to earn some money after they leave the clinic. Currently the staff is taking part in a training on Eye Movement Desensitization and Reprocessing (EMDR), an effective technique that helps to reduce the symptoms of trauma.
How long do the clients usually stay in the clinic? And why don’t they just undergo therapy at one of the Jiyan centers?
Currently, women stay at the clinic 4 – 6 weeks on average. An outpatient stay is not sufficient. We need time to understand the clients. And the clients need time to think about themselves. If they stay in the camp during therapy, they think about their family’s daily life, about what to cook and what to do with the children etc. We want them to feel comfortable and leave the stress behind. The therapeutic possibilities in the clinic are better than in the camps. Our staff is present 24/7. The clients can come to the staff room whenever they need assistance. We also offer their families to visit us and see that their wives or sisters are taken good care of. As most women have families to look after or have children that 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 in our center in Duhok or with the mobile teams in the camps.
You said that some women bring their children with them. What are the children doing during the day?
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 formal education. We start with the letters, as most of them have never attended regular school.
That are a lot of things you provide! What are the fees for the stay?
No fees! All services the Jiyan Clinic provides are free of charge for the clients so they don’t have to think about financial issues. The clinic is financed by Misereor.
How many employees do you currently have and what is their educational background?
Currently, the clinic employs 21 staff: medical doctors, gynecologists, psychiatrists, psychologists and trauma therapists, a physiotherapist, and nurses. Further, one woman is preparing the meals, sometimes with the help of our clients. All our employees are female actually. All staff graduated from local universities and attend regular trainings on various therapy methods as well as supervision sessions.
Which obstacles does the clinic face?
A main obstacle is the fear of stigmatization. Psychotherapy is not part of the culture here, so many people don’t speak about psychological problems. Fortunately, this is slowly but steadily changing. The most challenging obstacle in the clinic is to earn our clients’ trust. It is very difficult and takes a long time because of the horrible experiences they had made. The language is a challenge as well as our clients speak the Northern Kurdish Kurmanji dialect and the staff mostly speaks the Central Kurdish Sorani dialect. Both dialects have similarities but they are not the same. But we get used to it and we can actually learn from each other.
What is your personal reason for working at the Jiyan Clinic?
I am a psychologist who has been working at the Jiyan center in Chamchamal as a psychotherapist for many years. At the center, I helped people who needed support but I think I have a bigger impact on clients working at the clinic. They faced unimaginable experiences. I just want to support them to live a life as normal as possible.
Can you share an experience with us that you find particularly memorable?
There are a lot of bad memories, but some good ones as well. The mind tends to memorize the bad experiences more easily than the good ones. I need to think of the good ones for a moment [thinks silently]. When the clients come to the clinic, they feel tired, are not interested in anything, they are burnt out. After a couple of weeks of therapy, I can notice changes in their faces because they start to think of themselves in a different, more positive way. And sometimes I ask myself: Is this the same person like the one that came here three weeks ago? This is a great achievement for me. On the clients’ departure day, I can see that most of them don’t want to leave, but they need to. Yet at least they leave as more life-affirming persons. Every single one of these success stories are very special moments for me.
If you had one wish, what would it be?
I would like to have more capacity building for my staff. They are keen to extend their knowledge concerning different therapy techniques. Furthermore, they would like to increase the exchange of experiences and ideas, especially with trainers from abroad. If I had a second wish, which is not less important but more challenging, I would like to have awareness campaigns to reduce stigmatization of psychotherapy in society.
Thank you for the interview and for the insight into the Jiyan Clinic, Laila!