DOHUK, Iraq — Dozens of children, bundled in sweaters against a winter chill, sprawled on a patch of grass in their camp for displaced people and studiously began to draw. The kids, some as young as 6, drew pictures of beheadings or shackled women or their families running, with armed men at their heels.
The children fled when the Islamic State of Iraq and the Levent (ISIL) advanced on their villages last summer, with most of them witnessing their parents killed or captured along the way. Some of the children were also captured and held as slaves. Now living in a camp as battles rage in the villages they fled, they are haunted by the horrors they have seen.
Their caretakers do the best they can to comfort them but know the children's psychological wounds are deep and far beyond their levels of expertise.
"There's definitely something wrong," said Nazik Shemdin, the director of a nongovernmental organization caring for children from the Sinjar region of Iraq who lost parents to ISIL. She organized the art project in February, distributing colored pencils and paper to about 50 children ages 6 to 14 at one of the many camps dotting the region. She told them to draw anything they wanted.
Intended as a respite from the monotony of life in limbo, it instead served as a grim reminder of how deeply they — and millions of other children in Iraq and Syria — have been traumatized by war.
Mental health care services are severely lacking in the Kurdish region of northern Iraq, where more than 1.5 million Syrians and Iraqis displaced by fighting currently live. In the province of Duhok, which hosts the bulk of them, officials say there are fewer than a dozen qualified clinical psychologists and well-trained psychotherapists.
So severe is this drought that Nezar Ismet Taib, a psychiatrist and the Health Ministry's Duhok director, is personally treating some of the most severe cases — victims of rape and torture at the hands of ISIL. He points out that those spared the worst atrocities are also suffering and in need of help.
"Displacement by itself is trauma, and escaping from horrifying events is trauma," he said.
More than half the people displaced by fighting and now living in the Kurdish region of Iraq are children. In order to fill the gaps in mental health care, the government has invited doctors and organizations from outside the region to treat patients and run training sessions to bolster the expertise of workers already there.
Yet the additional assistance has not been nearly enough.
Wahid Harmz, a psychologist who spends two days a week at a camp housing more than 25,000 displaced people, said he has treated only about 50 patients there over the last three months. One person can treat only a limited number of patients, he added, and there is a reluctance among many victims to seek help.
Among those most in need of psychological care are the Yazidis, a religious minority considered infidels by ISIL and viciously targeted by the fighters. The children who sketched the grisly drawings this winter were all Yazidis. ISIL killed hundreds and kidnapped thousands of members of their communities, forcing the captives to serve as slaves. Many have since escaped, shedding light on the horrors Yazidis face in ISIL captivity, with some of the worst atrocities directed at children.
Sold as sex slaves, girls as young as 10 have been raped, according to doctors treating victims in the region. Boys have been forced to fight, attend ISIL schools and do manual labor or risk brutal punishments.
The Yazidis who escaped have joined the hundreds of thousands of other displaced Iraqis who fled to the country's relatively stable Kurdish region. Their stories circulate through overcrowded camps, where news of tragedy dominates conversation.
Harmz, who works with the Jiyan Foundation, an NGO that has been filling in many mental health gaps in the region, said the environment in the camps is especially tough on kids.
Besides being privy to all the grim, grown-up conversation, they are surrounded by people on edge. Parents suffering from their own fears, shame and exhaustion sometimes take their frustrations out on their children.
"They beat them. They don't let them talk. They keep them in their tents and don't let them out to play," he said.
Sherwan Hassan, a trained nurse who received additional certification to counsel patients, explained that many children he sees cannot sleep well. "They have a lot of fear," he said. "I see a lot of sleep disorders, anxiety and behavior problems with kids."
Most children are not receiving mental health treatment at all. One Yazidi family that recently escaped ISIL captivity, for example, feels entirely forgotten. After making it from ISIL territory to safety in the city of Duhok, Sharf Ali Xudeda, a 38-year-old construction worker, was unable to secure a space for his family in any of the city's crowded camps. Instead, he was handed flimsy tents he set up on a patch of dirt on the side of a road. His son and nephews, who are struggling after months of manual labor, indoctrination and weapons training, have not been offered any help.
"They're so tired psychologically," Xudeda said. His 4-year-old nephew, who witnessed ISIL beat his cousins with metal poles, dreams that fighters are trying to kill him. "The boy is afraid of everything. He's afraid of beards. He is not normal anymore."
Even those spared the worst have found themselves unable to stop thinking about the horrors they have read and heard about.
Sarween Khero Qassim, a 17-year-old Yazidi from Sinjar, managed to make it to safety with her entire family before ISIL laid waste to her village. Her family had enough money to rent a simple home near Duhok and continue sending their children to school.
But stories of what other Yazidis suffered haunt her, and she found herself staring at gruesome pictures online and then drawing them.
"I'm feeling this," she said as she spread some of her ISIL-inspired work on her living room's concrete floor. Her younger siblings looked on as she talked about the grisly inspiration for the work, which depicts women in chains and weeping families running from their homes.
Qassim considers herself one of the lucky ones but says that, even so, she has been scarred.
"I still don't feel comfortable," she said.