Al Alam camp, near Tikrit, is home to about 8,000 women, children and men who have been displaced from their homes to the north by the ongoing conflict. The families have come here in search of safety and support, from towns and villages ravaged by conflict, where food, fuel and medicines are scarce.

The camp has two sections, each surrounded by high metal fences. In the strong wind, the tents seem to crouch under a steely grey sky. Children wearing sandals and light clothes run and play between the tents. One family stands outside the gates, their few belongings in their arms. They have just arrived and are waiting to be registered and allocated a tent.

“People bring only what they can carry”

In the camp’s clinic, which is run by Médecins Sans Frontières (MSF), a queue forms from the early morning. The waiting area rapidly fills up with children and their mothers.

“People are extremely vulnerable and rely on humanitarian assistance,” says MSF medical coordinator Géraldine Duc.

“They have fled conflict and often arrive here bringing only what they can carry. And the climate here is extreme – in winter the temperatures drop to zero and in summer the sun is scorching. People live in tents, sleeping on the ground or on thin mattresses.”

“It exploded in my hand”

In October, Khalid, 19, came with his family to Al Alam from Hawija, a district to the north.

“We walked all night, staying away from the roads for fear of being caught,” he says. “During the walk, I picked up an object and it exploded in my hand.”

The explosion caused serious injuries to Khalid’s arm and head, and he has undergone several rounds of surgery in hospitals in the area. Now he comes to MSF’s clinic to have his wounds cleaned and dressed.  

The district of Hawija has been under the control of the Islamic State (IS) group for more than two years. Since military operations intensified in August, tens of thousands of people have fled Hawija. Many fleeing families describe shortages of food and fuel in the area, and perilous journeys to reach safety.

More than three million Iraqis have been displaced from their homes since the beginning of 2014 because of violence. The conflict has also disrupted the country’s healthcare system and increased the overall need for medical services.

Living in unfinished buildings

MSF is also providing healthcare and mental health support in Al Hajjaj Silo, a transit camp, and in Samad, a neighbourhood in Al Alam where displaced families have settled in unfinished buildings.

In Al Hajjaj Silo, three women who recently arrived on foot from Hawija are waiting outside MSF’s mobile clinic with two babies. The babies were born on the same night about six months ago, but one is much smaller than the other.

“She has a heart problem,” says the mother. “We walked all night over the mountains to reach here because there is not enough food in Hawija. There are no doctors, and everything from fuel to drugs to soap is very expensive there.”

Not one traumatic event but many

Most of the displaced people in the Tikrit area come from Hawija, to the northeast, or from Shirqat and Baiji, to the northwest. Almost all have witnessed or experienced brutal violence, which can bring on psychological problems.

The trauma of displacement and separation from loved ones, as well as limited access to medications, have also exacerbated people’s pre-existing mental health conditions. Poor living conditions and uncertainty about the future add to people’s stress, which is why mental health support is an important component of MSF’s activities.

“We see many patients arriving with symptoms of stress and trauma,” says MSF mental health activity manager Ana Martins. “They have not experienced one or two traumatic events, but have been continuously exposed to traumatic events and ongoing violence. Now this is showing in symptoms like panic attacks, post-traumatic stress disorder, sleeping problems and generalised body pain.”

With the help of psychosocial counsellors, MSF provides patients with support to prevent these symptoms from becoming more serious. But for some people the symptoms are already severe, and they need specialised psychiatric care, though as Martins explains, making sure this happens can be a challenge.

“Some of our patients need to be referred to a hospital for specialised psychiatric care,” says Martins. “But there is only one psychiatrist in Salaheddin general hospital, and the right psychotropic medication is not always available. Referrals can also be complicated because the patients need to have security clearance to pass through the checkpoints and access the hospital.”

Displaced people in Iraq are in a very difficult position: the conditions in safer zones where fleeing populations are heading are far from being optimal and their return home is rendered difficult due to persistent instability and the absence of fundamental survival requirements.