Need for mental health experts who know local culture in post-ISIL Iraq is immense, says Jan Kizilhan a German-Kurd psychologist, after visiting Khaparto refugee camp in Northern Iraq this May.
When German-Kurd psychologist Jan Kizilhan visited Khaparto refugee camp in northern Iraq in May, he met a four-year-old boy who until a few weeks ago, had been a captive of the Islamic State of Iraq and the Levant (ISIL, also known as ISIS).
The child was so terrified of fighters returning to take him away, that he slept with a knife under his pillow.
At another camp, Kizilhan met a nine-year-old girl who was repeatedly bought, sold and raped during her three years in captivity. She now has post-traumatic stress disorder and lives in a state of dissociation.
These children are among the many survivors of the Islamic State of Iraq and the Levant group’s brutality who are suffering from psychological trauma.
Last year, Kizilhan, dean of the Institute for Psychotherapy and Psychotraumatology at the University of Dohuk in northern Iraq, began a programme to train local students to become psychotherapists.
The need for local mental health experts and treatment in the region is immense, according to Kizilhan.
There are just 26 psychotherapists in a population of 5.5 million in Iraq’s Kurdistan region, Kizilhan said at a panel on Wednesday during the two-day European Development Days conference held in Brussels, which focussed on the protection and empowerment of women.
In Dohuk province where his students work, Kizilhan said there are just five psychiatrists for a population of about two million, including more than half a million refugees.
Kizilhan is also the chief psychologist of a special asylum project financed by the German state of Baden-Wurttemberg. Starting in 2015, 1,100 severely traumatised Yazidi women and children who escaped from ISIL, were brought to the German state to receive treatment.
The asylum scheme has been criticised for uprooting the women from their culture. In response to this criticism, Kizilhan asks: “There are roots in refugee camps?
In the past four years, Kizilhan said he has documented about 60 suicides in Iraq among survivors of ISIL sexual slavery.
Kizilhan, who comes from a Yazidi Kurd family, spoke to Al Jazeera about the importance of understanding a culture and its past in treating trauma and why he is running a programme to train future psychotherapists in northern Iraq.
Al Jazeera: How would you describe your approach to treating psychological trauma?
Jan Kizilhan: We focus on transcultural psychotherapy or transcultural trauma therapy, which means we start with the culture that people belong to. You need to know the coping strategies which are part of the culture or even the religion. You are not able to do psychotherapy with [just] modern, Western ideas of psychotherapy because psychotherapy was founded in the West, especially in America. They have a way of understanding illness and health but indigenous people have a different way to cope.
And we know from history, many times, ethnic groups, different kinds of groups, have faced major catastrophes – wars, conflicts. And somehow they find a way to cope with this conflict and grow with it. So we have to look at the resources of the people – and they have resources. We have to use these cultural resources to adapt the modern ways of medicine and psychotherapy. This is how we are working.
Al Jazeera: More than 1,000 Yazidi women and children were brought to Germany for treatment through a special programme. Where is the programme at now?
Kizilhan: The project finishes at the end of year. The women will stay in Germany and can stay indefinitely. [The aim] was to support them to deal with their trauma, to do psychotherapy, teach them German because language is very important. The children go to school. Many of them now have jobs or [are pursuing] education. This last period now is [to help] them be totally at the head of their own households and lives and to be part of society.
Al Jazeera: Do you think the programme has been a success?
Kizilhan: Absolutely, yes. From 1,100 people, just 15 women returned to Iraq – to join freed family members or those with illnesses. Most wanted to stay [in Germany]. They feel accepted as women. No one asks whether they were raped or not. They have more of a feeling of freedom. In Iraq, they don’t have any future. Especially for a minority like the Yazidis, the political situation is not clear.
Al Jazeera: The programme was criticised for removing the women from their culture. You’ve said it had to be done to save lives – that it was an emergency situation. How is the project in Dohuk different?
Kizilhan: Normally we should help people in the home of origin of the conflict. In some cases, we don’t have this possibility and this was an emergency situation and we had to act. We also have traumatised refugees in Europe and we have to provide them with mental health support of which there’s not enough.
We cannot bring all the traumatised refugees from Iraq and Syria to Germany. What we can do is give the [local] people the know-how to treat their own people [with their] own language and cultural background.
In 2017, we started to train and educate psychologists with a bachelor’s [degree] to obtain a master’s in psychology and to be licensed psychotherapists like in Germany. This [degree] continues for three years (each student must complete 1,800 hours of clinical work). In October 2018, we will start with our second group. Each group consists of 30 people and my hope and vision is that other universities in Iraq will follow us in this project and instead of having 30 psychotherapists now hopefully we’ll have in 10 years 1,200 psychotherapists.
We’ve also started to build a trauma network which means we’re bringing all actors who are somehow involved in trauma – it can be NGOs, hospitals, the state government – to give them information and discuss more about the issue of trauma because we have to reach the population. Many people don’t know what psychotherapy or trauma are.
Al Jazeera: What are you seeing in terms of the local population’s psychological needs?
Kizilhan: According to our observations – we are talking about northern Iraq – Daesh (ISIL) is [just] one trigger of trauma. In 1998, in Halabja, we had a chemical weapons attack by Saddam Hussein – 5,000 people were killed – and during the Anfal era, 168,000 were killed by the Saddam regime. So these historical traumas continue and evolve with ISIL.
Al Jazeera: Who are you focussing on treating?
Kizilhan: Our institution’s focus is mainly now on traumatised refugees who were in ISIL captivity. We are working in 24 camps, but we are [also] open to all people in Iraq.
Al Jazeera: What are the key challenges of treating survivors of sexual violence?
Kizilhan: The first thing is to give them the confidence to talk about their feelings of shame. This is one basic part of psychotherapy, to discuss with them why they are ashamed. Sometimes they answer [that] they’ve lost their honour because they were raped. This idea of honour is due to a patriarchal society which sees honour as the most important value. We ask them: Who lost their honour? The perpetrator or you? Because you didn’t do anything. The perpetrator lost his honour if he has any.
We have to draw on these cultural ideas and take them into account in psychotherapy – these feelings of shame, feelings of trauma, being part of a patriarchal society and apart from that, we are looking for resources.
Yazidi or other ethnic minorities, through trans-generational trauma, have a special resilience. They are very strong. They deal differently with trauma and we can use these resources, this resilience, to be more competent.
Al Jazeera: In what other ways have you tapped into this reserve of strength?
Kizilhan: Everyone we speak to we ask whether they know about “ferman”. Ferman means holocaust against the Yazidis. They tell me [about it] through recitation, religion, books and stories. I say: Look, you are not the first one facing trauma, because your ancestors faced it, too. And if your ancestors survived, you will also survive. And the difference between you and your ancestors is that I’m here as a therapist to work with you. Your ancestor had no psychotherapist 300 years ago and they survived. So we try to activate that.