Years of living under Islamic State has left the children of Mosul with such dangerous levels of psychological damage they are unable to show emotion or play and are haunted by waking nightmares.
Experts report that the children are so affected by witnessing extreme violence that they have symptoms of “toxic stress” – a severe form of psychological trauma that can cause lifelong damage.
The research, by Save the Children, was based on discussions with 65 children who had escaped to the Hammam al-Alil camp for displaced persons, south of the battered city.
All of the children interviewed by the charity’s workers displayed signs of toxic stress, 90% had suffered the loss of a loved one, and the majority had nightmares. Almost all were slow to understand instructions and displayed “robotic” behaviour, unable to play or show emotion.
Hundreds of civilians fled Mosul last month, as the fight against Isis reached a tipping point. More than 860,000 people have escaped to the liberated eastern part of Mosul since the war to recapture the city from Isis militants began last October, but an estimated 100,000 remain in the old city, where fighters have been using them as human shields.
The children at Hamman al-Alil camp, aged between 10 and 15, shared stories of the horrors they had witnessed: family members killed in front of them, seeing dead bodies, and blood in the streets. Others spoke of seeing relatives shot by snipers or blown up by landmines, and of their homes being bombed.
Many spoke of the constant threat of Isis punishment, with death or imprisonment facing those who flouted the militants’ rules.
One 13-year-old boy, Jad, told researchers: “If we were caught in the street at the time of prayer, we might get lashed. Also, they used to perform beheading or whipping in the street every now and then … they used to hang the dead bodies on iron sticks in the streets for days.”
Children also spoke of their fear of an unidentified “thing” or “monster” – a mental image of traumatic experiences that were so vivid they were haunted by them day and night.
Dr Marcia Brophy, Save the Children’s senior mental health adviser for the Middle East, said: “What was striking was how introverted and withdrawn children have become. They rarely even smiled. It was as though they had lost the ability to be children.
“When we asked them what they liked about themselves, children often said things like ‘I’m quiet’, ‘I stay in a safe place’ or ‘I obey orders’. Their time under Isis, and making a life-or-death escape, has taken a truly terrible toll. These children are not going to heal in weeks, or even months. They’ll need support for years to come.”
One teenage girl said: “Since I came to the camp, I don’t feel safe, because I don’t believe we are here. And I don’t think we are far from Isis.”
When the children were asked to play a game where they could put anything they did not want into a “magic bag”, they most often chose “Isis” and “sadness” as well as war and weapons of war. When asked to take any item out of the bag to make them feel better, they often had difficultly answering, but chose “loved ones” or “happiness”, the research found.
The children’s problems are compounded by the psychological impact of their experiences on their parents. Inside the camp, domestic violence is common, with 85% of the children reporting being beaten, or seeing others beaten, as a major source of anger and sadness.
Toxic stress is the most dangerous form of stress response, where the mind is constantly in fight or flight mode. Left untreated, it can damage the brain’s architecture and have a lifelong impact on mental and physical health, leading to heart disease, depression, anxiety, diabetes and substance abuse.
The charity is calling on international donors to increase support for mental health and psychosocial care and for the Iraqi government to increase investment in training child psychologist and counsellors. Save the Children said psychological support for children and their parents is chronically underfunded, with programmes for 2017 so far just 2% funded.
The total UN humanitarian response plan for this year has less than half the funding it needs.
“Children escaping Mosul have gone through horror piled upon horror,” said Ana Locsin, Save the Children’s Iraq country director. “They have been starved and abused inside the city. Explosive weapons have been dropped in narrow streets by all sides with little regard to their impact. But the impact on children is clear: even if they make it out alive, they are left scarred and broken. And right now, that’s what Mosul’s future looks like.
“To help children recover and rebuild, psychological support must be considered a priority. The world must do more to repair the damage.”