They lived under ISIS; now they struggle with deep depression or other mental illness

— LONDON -- Some have nightmares or insomnia. Others are depressed all the time. Still others are developing schizophrenia or other mental illness.

They are people who lived under ISIS in Syria and who are now living in tents in a camp in northeastern Syria.

Paula Orsi, a Doctors Without Borders psychologist, treats people at the Ein Essa camp, which houses thousands of displaced people, mostly Syrians who fled from ISIS’ former de-facto capital of Raqqa as well as from ISIS-held Deir-Ezzour. She visits the camp about two to three times a week to have consultations with 10 to 12 patients a day.

Following are excerpts from a recent, edited conversation with Orsi.

How are people who came from Raqqa coping in the camp?

People came from war and airstrikes. They were trapped and lived very, very stressful lives. Some of them lost family members and saw people die in front of them. They managed to leave to a place where the stress continues. People live in tents. Sometimes they don’t have a place to stay. The tent is supposed to be for six to eight people, but sometimes many more people live in one tent. They have to queue up for the toilet. There’s no moment for them to start recovering. For them to start a process of healing they need to feel that they are in a safe place. The cause of the stress is still there. Even if it wasn’t perfect before, they maybe used to garden, have their sheep, have their home. Suddenly they’re in a place that is not home. The mental state of the whole camp is very compromised. It’s very heartbreaking and catastrophic. The majority of people have resilience and can cope. They will cope and rebuild their city. A minority is going to develop a mental disease due to a combination of environmental factors and genetics. Maybe if they could have been taken to a super-comfortable place where they feel safe and welcome that could have helped prevent the development of a disease.

What types of mental diseases do you see people developing?

I see people developing schizophrenia, hallucinations, delusions. Some are developing depression and experience sadness all the time. They feel tired and are losing a lot of weight. They have no appetite and less strength to take care of the children and get food. So the whole family suffers. I treat people who have nightmares, insomnia and hypervigilance. For some, every noise reminds them of what happened and of the time when they saw someone killed in front of them. I think all of them are going to carry the luggage for life, but for some it’s going to be more severe than others. It will be a trauma that they will never forget, but you can give this trauma new meaning. For example, the meaning of this trauma can be, “I am a poor woman put in this terrible place,” or the meaning can be “I went through a war and I survived. Maybe I can have a second chance.”

Do you meet other psychologists in the camp?So far I haven’t met any psychologist from any other place. There are counselors, yes, but not people who can offer specialized care and from the level of suffering that I’ve seen, that’s what we need.

How many patients do you see?

I’ve been seeing quite a lot of patients - between 10 and 12 patients every day, not more than 13 in a day. Most of them need medication. Some of them need close follow-up sessions to help them talk about their experiences. It can be difficult for the families to understand a person who is not coping. A depressed person is seen as a lazy person who doesn’t want to help. It requires a lot of education for the family.

Can you give some examples of the patients you treat?

One is a 19-year-old boy who fled from Deir Ezzor. I don’t know his whole story. He almost doesn’t speak, he’s catatonic. He got lost from his family when he was running away. He’s alone. What’s heartbreaking about him is he’s so scared and quiet. He didn’t eat anything for a week and is emaciated, looking almost sick. He’s suspicious, but not psychotic. He’s not delusional and not hallucinating. But he’s so apathetic that when you look at him it’s almost like his soul is not there anymore.

He started improving a little bit and could explain the story I’m telling now. I think he managed to leave Deir Ezzor in June and met people from Raqqa on the way and joined them. He doesn’t know where his family is. He wants to get better because he doesn’t want to meet the family in the state he’s in now. I know that people from the camp found his family. The family thought he was dead. The family, I guess, is in Damascus. They were happy. The boy knows one person in the camp, but not very well. He’s the link of the communication with the family for now.

There are other people like him. One of them is an 18-year-old boy who lost his whole family. They all died in an airstrike.

A woman ended up dying in the camp. I don’t know why. I visited her in her tent. She was very, very depressed. She was in Raqqa before. After an airstrike in Raqqa, her house fell down over her. She didn’t break anything, I don’t know how. She left the hospital walking. That was two months before I saw her. She was with her sister and extremely depressed, psychotically depressed. She was so depressed that she believed her body was dying and that she couldn’t walk anymore. She was crying all the time. Her family told me a week later that she had a heart attack and died. She believed her body was already dead. Her sister said she wasn’t eating. Unfortunately, she ended up dying.

A boy from Deir Ezzor saw his brother divided in two. A tank attack divided his brother in two. I don’t know exactly how. He also saw his neighbor lose her head. An airstrike blew off her head.

He’s always helping everyone in the camp and trying his best. He has nightmares every night. He doesn’t eat. He’s very skinny. He’s improving slowly, but still has symptoms. It takes time.

I’m also treating a young, 16-year-old girl from Raqqa. Her story is related to ISIS, not to airstrikes. She used to live with her father and younger sister. When she was 13 her father made an agreement to give her sister who was 11 at the time to ISIS. ISIS changed her behavior and life.The 13-year-old started bed-wetting and she is still bed-wetting, which causes her a lot of shame. She has depressive symptoms, but more anger. She tries to kill herself and has tried many times. She cuts herself when she feels very anxious and afraid. It’s like she’s developing a fragile personality. She needs a lot of support. It’s very difficult for her to trust people. She didn't say it was related to her sister. She says, ‘Well, that started when my father gave my sister to ISIS.’ She wanted to find her sister. She even joined Kurdish intelligence to find her sister. She tried to kill herself with one of the guns. She’s still trying to find her sister. She’s so unstable and can’t handle her emotions. Her sister managed to run away and came back home a month ago.

There’s also a man, I think he’s around 27 years old now. He was living under ISIS and all the time he was reminded that he had to wash his body well before praying. After he fled, he started developing obsessive thoughts. He is delusional at the same time. He thinks that he’s dirty. It’s like OCD. He stopped eating because if he doesn’t eat, he doesn’t have to go to the toilet and then his body doesn’t get dirty. He wants to keep himself pure for praying. I’m trying to understand if he’s now psychotic. He pours water on himself 10 times a day, but with his clothes on. He may need to be treated for a long time.

There are many stories of people who say ‘I can’t forget when I had to collect the pieces of my father after an airstrike and bury the pieces,’ or ‘I saw my son being decapitated in front of me.’