Decades of suffering: Long-term mental health outcomes of Kurdish chemical gas attacks

(Press-News.org) Dr Ibrahim Mohammed is a clinical psychologist and researcher specializing in trauma, somatic symptoms, and psychopathology in conflict-affected populations. He has worked for over a decade with survivors of massacres in the Kurdistan Region, integrating clinical practice with research. He is also a lecturer at the Institute of Psychotherapy and Psychotraumatology at the University of Duhok. His current research focuses on validating psychological instruments for Kurdish communities and exploring genetic and phenomic factors related to trauma-related disorders. 

In a new study in Frontiers in Psychiatry, he and colleagues showed exceptionally high levels of trauma among survivors of a notorious atrocity: the 1988 chemical attack on Halabja in Kurdistan. In this editorial, he summarizes their findings.

The Halabja attack was among the most notorious targets of Saddam Hussein's genocidal Anfal campaign of 1988, during which an estimated 182,000 Kurds were killed across Iraqi Kurdistan. At Halabja, an estimated 5,000 people died that day from chemical agents, primarily mustard gas and nerve agents. Thousands still suffer from its long-term effects. Entire families were shattered, homes destroyed, and the community bears the wounds to this day.

When anybody speaks about this chemical attack, the immediate horror often overshadows the story: the thousands of lives lost, the destruction. But less attention is given to what befell those who survived, carrying with them memories, fear, and pain several decades later. Our new study has tried to understand precisely what happens to people after surviving such a catastrophe. How do trauma and loss shape an entire lifetime?

We worked closely with more than 500 survivors of the Halabja chemical attack. We collected information on their experiences, health, and mental state. Somatic complaints, anxiety, depression, and symptoms of post-traumatic stress disorder were also assessed, as were the various traumatic experiences and social and clinical factors. The aim was to ascertain the full impact of such exposure in the long term.

The results were striking: even decades after the chemical gas attack, many survivors showed severe PTSD, depression, and anxiety. Sometimes more obvious than the psychological presentations were somatic symptoms like pain, fatigue, and chronic health issues. It is important to note that trauma does not just disappear with time: it evolves, remains, and weaves itself into the fabric of daily life, particularly in a community that remains under economic pressure and social strain.

Embodied trauma

One of the things we noticed was the tendency of trauma to be embodied. In this part of the world, as in many others, physical symptoms reflect emotional distress, for example in the form of headaches, back pain, exhaustion, or stomach problems. These are not simply medical complaints, but the echoes of psychological injury. We need to understand this in our attempts at care the care that is meaningful and compassionate.

Our study also underlined the cumulative stress. Survivors who faced multiple traumatic events like displacement, loss of loved ones, or witnessing brutal violence, suffered higher levels of distress. Their vulnerability was heightened by factors such as chronic illness, low income, and less education. Yet, despite such hardships, we saw remarkable resilience. After profound experiences, people manage to adjust, provide for their families, and move on.

One story that still stays vividly in my mind is that of a man who was suffering from acute respiratory problems, due to the chemicals at the scene. He bore the scars as deep in his mind as in his body. We arranged for him to see a mental health professional, in hopes of lessening his load. But just a week later, I would hear the news that he had died from complications related to his lung issues. Even decades after the attack, lives are still lost, echoing the enduring toll of that tragedy.

Call to action

In our data, almost 79% of our participants met symptom criteria for PTSD, while 65% had clinically significant depression or anxiety, and well over half experienced severe somatic symptoms. Women, those with lower incomes, and less education were especially vulnerable. Fewer than 17% were receiving psychotropic medications, representing an enormous gap in mental health treatment for survivors.

Perhaps the most sobering finding was the glaring lack of mental health support. Many participants reported never having received proper psychological care. There has been long negligence in attending to the needs of chemical attack survivors, and services in Kurdistan are scant. This study is more than a set of numbers: it is a call to action. Besides recognition, survivors need access to culturally sensitive mental health services, programs to trace missing family members, and official support for compensation and ongoing care.

This is the story of the people behind the statistics. Every number represents a life, a memory, a struggle that extends decades beyond the event. Survivors gave accounts with courage and honesty, reminding us that trauma is very much more than any clinical diagnosis could contain. It is deeply, painfully human.

Healing from mass violence is not a process of forgetting nor returning to some naive version of ‘normal’: for survivors, it may mean carrying memories that will not fade, while finding ways to live with them day after day. Recovery is a journey premised on understanding, empathy, and steadfast care from the community to top levels of policymakers. We hope that this study contributes to such an understanding.

By detailing the long-term psychological and physical effects of chemical attacks, we aim to inform authorities, health professionals, and communities on offering better care. By sharing their experiences, we honor the survivors' resilience and bravery in the face of such profound trauma.

Besides being a story of great loss, Halabja serves as a living reminder that the effects of war continue long after hostilities cease. They echo across lifetimes and generations. By listening closely, studying respectfully, and responding thoughtfully, we can ensure survivors are neither forgotten nor neglected and that their ongoing struggles receive the care and understanding they deserve.

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