In 2014, the Islamic State group swept through the Sinjar region of north western Iraq mounting a genocidal campaign against the Yazidi people, a socially isolated Kurmanji (a dialect of Kurdish) speaking religious minority whose connection to the Sinjar mountains goes back centuries. The militants slaughtered thousands of men and abducted an estimated six thousand women and children, either selling them into servitude or forcing them into sexual slavery. Those who escaped the initial attack fled further into the mountains, were forced to take refuge in other areas of Iraq and Syria or sought asylum in Europe.

Whilst an alliance of Kurdish and Yazidi fighters recaptured the city of Sinjar in 2015, the return of those who fled has been slow. Still today families refuse to return to their villages, not only because they lay decimated and lack basic services like water or electricity or because of the trauma they now associate with their ancestral homelands but also because of an overwhelming sense of hopelessness in the area. For those who have returned, the everyday struggle to survive is immense. Jobs and reliable incomes are hard to come by with health care, education and other services slow to return to pre-2014 levels. The sense of loss across the mountain is pervasive.  More than five years on, many families are still looking for their loved ones who went missing in 2014, mourning those who died or emigrated and fighting to rebuild their livelihood.

An MSF team began supporting the Sinuni General Hospital with emergency and maternity services in December 2018 and quickly realised that mental health was a huge unmet need in the area. Since then, the team has increased the mental health care activities to cover psychiatric and psychological health care activities in Sinuni hospital as well as group sessions and mobile mental health clinics for the displaced on Sinjar mountain. Despite these activities, and those of other NGOS, the mental health crisis in Sinjar runs deep. Since the team began counting in April, MSF has counted 24 young people dead by suicide. The youngest was just 13 year old.

Making the response to this crisis even more difficult is the fact that Iraq has historically lacked psychologists and psychiatrists and that those who are trained  and qualified are overloaded in other areas of the country and unwilling to move to Sinjar which is still considered unstable and underdeveloped. For now, MSF must bring in international mental health care professionals to work alongside local counsellors and nurses which is not sustainable.