Aziz

Boy, 10 years old, in Zakho, northern Iraqi Kurdistan

Dalal is an ancient stone bridge that is still standing in the border town of Zakho, in northern Iraqi Kurdistan. Dalal means beautiful and unique. It is also the name of a resort on a hill overlooking the river, where people used to celebrate weddings and take their children to play on the Ferris wheel. Today, the grounds of this resort are lined with tents and dotted with few latrines and water points.   It has never been this busy; it is currently the home to over 5,000 people who have fled Sinjar. MSF has been running a mobile clinic offering primary healthcare as and mental health services for the past month.

Aziz, a 10 year old boy, has come to the MSF clinic for his last session with Dr Shirine, an MSF psychologist from Dohuk. He is wearing a worn down orange Real Madrid t-shirt with Ronaldo written on the back.  Aziz wrings his hands as he recalls “one day MSF health promoters came to the tent to explain the services the clinic offered in the camp. They told my mother there was a psychologist.”

Aziz was having bad nightmares and had problems passing urine at night. His mother entrusted his older sister to take him to the MSF clinic. A doctor prescribed some antibiotics for his urinary infection but also referred him to the psychologist who supports the team in the camp.

“So many people here are traumatised” says Dr Shirine. “They have suffered a lot; many struggle to adapt their new living conditions and so they become depressed”. MSF offers psychological counselling in individual or group sessions. “We ask patients to share their feelings and describe any traumatic events that have affected them”, she says.

Aziz is normally very brave but admits that the thing he is most afraid of is his own nightmares. He recalls how he reacted when fighting erupted in his neighbourhood as the Islamic State forces approached. “The day before we fled, people had been fighting all night. I was at home with my little brothers, looking after them while they slept. I was not afraid. As the fighting came closer I woke them up and took them to a safer place.  I even managed to put them to sleep again”, he says proudly, “then in the morning the Peshmerga withdrew so we escaped to the mountains”.

“The time we spent in the mountains was hard” he says. “We were walking a lot. Some had no shoes. I was wearing plastic slippers. We walked for 4 hours up the mountains but the worst part was walking down.  It was very slippery and by then the little ones were too tired. I was carrying my 5 year old sister on my back”, he recalls proudly with a big smile. “She was so heavy but she wouldn’t walk so we had to do it. Then my mother tripped and fell over. We had to stop for a while and then one of my uncles carried her”. Aziz’s mother was 3 months pregnant. When she finally got to the bottom of the mountain, soldiers drove her to the hospital in Kanishli. “She is ok now” says Aziz, “but she lost the baby”.

“I worry a lot about her; I fear I will lose my parents. Coming to see Dr. Shirine was a good idea, she helped me a lot, now I don’t wet my bed anymore and the nightmares have gone. I took some medicine and she told me not to think too much at night. Now I just have a pee before going to sleep and think of nothing”.

Dr. Shirine explains “most of the children complain of fear and nightmares. Aziz had been having these problems before coming here too; he use to dream of being choked or drowning. Fleeing from Sinjar and his mother’s poor health only made things worse”. Dr Shirine had three individual sessions with Aziz. “I also spoke to the family because they need to be aware of these problems and supportive of the children. I asked his parents to be gentle with him and spend time with him before he goes to sleep”.

“I have many friends in camp”, says Aziz, “we play football together, and generally I am the goalkeeper.  I am very popular” he boasts. “Some of my friends could do with seeing a psychologist; my cousin is my age and has the same symptoms as me” he says. “I told him to come but he doesn’t listen, maybe he is shy or maybe his mum doesn’t insist as much as mine did”.

Dalal

Dabin City housing complex in Zakho, northern Iraqi Kurdistan, 18th September 2014

Property developers in Northern Iraq were not expecting to see their newly constructed cinder-block housing complexes become the home to thousands of displaced people who have recently fled from Sinjar. This may explain why at ‘Dabin city’, a recent housing project in Zakho comprising of 7 high-rise tower blocks, construction is still in progress in spite of 6,500 people having settled in some of the half-completed buildings.

While builders bring up unstable loads up to the top floors, and heavy construction materials are unloaded from trucks, children run around the site as if it were a playground, groups of men gather to chat, and women wash clothes and fill up buckets and jerry cans at crowded water points.

Dalal is the second wife of Ahmed, a teacher from Sinjar. The 30 members of her extended family share four rooms on the 6^th floor of an unfinished building. She speaks facing a flock of children quietly sitting on the bare cement floor. “Where do I begin? My life here is a daily struggle” she declares quietly. “There is not enough room here. We have so many young children and they have nowhere to play”.

Dalal and her family are amongst the many people living without electricity or running water.  There are a few stoves, but fuel is expensive for people who have nothing left. Some of the higher floors are without external walls, but the biggest problem is sanitation.

“I cannot walk down the stairs because of the pain in my hips” says Dalal. But the kids wake up at night and need to go to the toilet: it is very hard to take them all the way down to the latrines in the dark”. Dalal’s mother-in-law can barely stand; she has been confined to the room ever since she arrived.

On the site grounds, the 20 latrines available that are overflowing with sewage are far from a solution. The stench and flies are breathtaking; a scene from hell. 50 more toilets are in the process of being installed, but the developers have already threatened legal action against anyone digging the property grounds.

Residents entering the building take turns to walk across wooden boards used to create walkways over black foul-smelling water on the flooded ground floor. One floor above, two masked men in plastic boots shovel away fetid muck into plastic bags that are then left sitting at the entrance of the building.

“Our findings show that poor sanitation and overcrowding is increasingly affecting people’s health”, says Dr. Zahra, who works at the primary health care unit MSF has set up next to the construction site. “Diarrhoea, gastro-intestinal problems and skin diseases are on the rise”, she adds. A cholera vaccination campaign was planned by the local health authorities and then dropped because the outbreak season is nearly over.

Several camps are being constructed, but two months after an estimated 400,000 people crossed into the Kurdish region of Iraq none are ready.  In response to this emergency, an MSF water and sanitation team is now on the ground. The construction of 100 latrines, 100 showers and 50 washing areas is planned. A team of 40 people will be hired to clean the site and manage the waste, and hygiene kits will be distributed to the people living on the site. MSF experts are also putting in place a water waste management system.

Dalal is now standing by a gap where a window should be. She hoists a rope tied to a heavy jerry-can filled with water all the way to the 6^th floor. “We use so much water and we don’t even know if it is good for drinking”, she says. “We have no windows, it’s getting cold and we don’t have enough blankets. Winter is approaching. How will we survive without windows and heating when temperatures will drop below freezing?” she wonders.

Upper respiratory infections are now the first cause of morbidity. Queues at the clinic are long and people are growing restless. “The vast majority of patients are affected by diseases that are perfectly preventable and are directly related to their poor living conditions. The number of patients turning up at our clinic is rising and we have to turn down many patients every day, we cannot cope”, says Dr. Zahra. MSF is preparing a distribution of over 10,000 blankets by November.

Back in her bare flat it is Dalal’s turn now to ask questions: “Please tell me, when will the camps be ready”, she asks. “When will be allowed to move in? Does anybody care about us?”

Malican

Girl, 10 years old, Sharya high school

Since the beginning of August, schools in Dohuk have been closed and are instead being used as temporary shelters for the thousands who have fled violence in neighbouring areas.  Kandala refugee camp, on the border with Syria, is the only camp currently ready to accept new people. Another camp in Sharya, south of Dohuk, is to be completed soon. In Sharya, over 3,000 people are now living in the town’s schools and non-residential buildings.

Since the beginning of the crisis, MSF has been running a primary health care service from a classroom in Sharya high school. After the clinic closes at 4pm, the classroom turns into Malican’s home. In the morning, Malican’s family store their blankets and personal items in a corner before the MSF team brings in its medical equipment.

Malican is a bubbly 10 year old girl with a sparkle in her eyes. Malican and her family fled from Hatare, a small town south west of Al Qosh. Sitting on the floor of the school’s corridor she is playing knucklebones with a friend while a crowd of people bustle around her.

“Life has got much harder since we came here; I have to tidy up, wash clothes and I have a lot of chores” she confides. Malican’s mother is very ill. She has been in and out of Dohuk general hospital for the past few months. “Today is a good day. I am going to the hospital to visit her. I worry about her and miss her very much” Malican says.

There are only 4 toilets in the school and these are used by both the residents of the school and by the 350 patients that visit the medical facility each week. “Every morning as I wake up, the first thing I do is go and wash my face and hands in the toilet. The restroom is always disgusting. Despite cleaning it every day it is still dirty because everybody uses our bathroom” Malican adds. To address the gap in the humanitarian response for water and sanitation, MSF has been installing temporary latrines and showers, and distributing hygiene kits in refugee camps across Dohuk. “Back at home we used to have a shrine in the corner of the house. Here we don’t pray anymore, it is too dirty, it would be a sin” she says.

Malican is an enthusiastic student; her favourite subjects are English, Kurdish and sport. She misses going to school. “My teacher came by a few days ago and I asked him when we would restart school.  He told me they are not going to open the schools in Hatare soon because it is too dangerous”.  

In spite of the fighting in the north of Mosul, some families, including Malican’s uncle, have chosen to return to their homes rather than face the appalling living conditions in Sharia. “My big brother has left to go look for work in Erbil” says Malican, “I think he hated this place. I don’t think he will come back. I miss him so much and I wish he would call us more often”

“What I miss the most is my friends” says Malican, “I miss Madeline most of all. I don’t know where she is, I miss playing dolls with her. I don’t have a doll here, I had to leave them all behind”. Malican says she has a few friends at the school but looks down on the children from Sinjar. “I don’t speak to Sinjar kids; they are dirty and throw rubbish around. I am more used to Hatari ways”, she says proudly.

“Kids from Sinjar tell us stories about what happened to them. One told us that he saw a small child being shot and falling off a cliff, but adults tell us not to talk about these things” she says and adds “All I want is for my mother to get better and to go back home. And I want a doll too”.