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Wednesday, 5 July 2017 - 7:34am

Brutal fighting and years living under ISIS have left Mosul’s children with dangerous levels of psychological damage, new research by Save the Children shows. Experts found children are so deeply scarred by memories of extreme violence they are living in constant fear for their lives, unable to show emotions, and suffering from vivid ‘waking nightmares’.

  • New research reveals impact of Mosul conflict on children’s mental health
  • All children displayed signs of ‘toxic stress’ – the most dangerous stress response
  • 90% lost loved ones, majority suffering from nightmares
  • Children left numb and emotionless 

The research, based on focus group discussions with 65 children in a displacement camp south of Mosul, is the largest study to date on the impact of the Mosul conflict on children’s mental health.

With the right help, most children will eventually be able to rebuild a normal life. But Save the Children is warning that without an urgent boost to the provision of psychological support, Mosul’s children could be left with life-long mental – and even physical – damage.

The loss of loved ones was the biggest cause of distress for children, with 90% reporting the loss of at least one family member through death, separation during their escape, or abduction.

Children told the charity they witnessed family members killed in front of them, dead bodies and blood in the streets, and bombs destroying their homes. Others shared stories of family members shot by snipers, blown up by landmines or hit by explosive weapons as they fled.

The majority of children – and 78% of girls – said they had nightmares or were unable to sleep.

Children also mentioned fear of an unidentified “thing”, “person” or “monster”. Their mental images of traumatic experiences, and subsequent nightmares, appear to be so vivid they are haunted by them during the day.

Almost all children the charity spoke to were slow to understand instructions and most showed ‘robotic’ behaviour, unable to play or show emotion.

Many spoke about the constant threat of punishment from ISIS, and of relatives killed or imprisoned for going against their rules. Some said they continue to be terrified that ISIS might still attack them even in the relative safety of the camp.

When children were asked to play a game where they could put anything they did not want into a ‘magic bag’, either an item or an aspect of themselves, they most frequently chose “war”, weapons, “sadness” and ISIS [Figure 2]. When they were asked to take an item out of the bag to make them feel better, they often had difficulty answering. Of those that did, most chose “happiness” and lost loved ones. [Figure 3]

Dr Marcia Brophy, Save the Children’s Senior Mental Health Adviser for the Middle East, said:

“What was striking was how introverted and withdrawn children have become. They rarely even smiled. It was as though they had lost the ability to be children.

“When we asked them what they liked about themselves, children often said things like ‘I’m quiet’, ‘I stay in a safe place’ or ‘I obey orders’. Their time under ISIS, and making a life-or-death escape, has taken a truly terrible toll.

“These children are not going to heal in weeks, or even months. They’ll need support for years to come.”

Support from parents and family is vital to help children cope with extreme stress, yet the war has ripped many families apart.

Many parents are themselves psychologically affected by their experiences and are unable to provide comfort to their children. Domestic violence has increased in the camp as a result, with more than 85% of children identifying being beaten – or seeing others beaten – as a major source of ongoing anger and sadness.

The charity’s experts found exposure to extreme levels of violence and deprivation is causing all children interviewed to display clear signs of a condition known as ‘toxic stress’. The condition is the most dangerous form of stress response where the mind is constantly in a fight or flight response.

Left untreated, damage to the brain’s architecture caused by toxic stress can have a life-long impact on children’s mental and physical health, leading to increased instances of heart disease, depression, anxiety, diabetes and substance abuse.

But psychological support for children and their parents is chronically underfunded, with programme needs for 2017 so far just 2% funded.[1] The total UN Humanitarian Response Plan for this year has less than half the funding it needs.

Save the Children is calling for international donors to urgently and significantly increase support for mental health and psychosocial care, and the Government of Iraq to increase investment in training child psychologists and counsellors.

Ana Locsin, Save the Children’s Iraq Country Director, said:

“Children escaping Mosul have gone through horror piled upon horror. They have been starved and abused inside the city. Explosive weapons have been dropped in narrow streets by all sides with little regard to their impact. But the impact on children is clear: even if they make it out alive they are left scarred and broken. And right now, that’s what Mosul’s future looks like.

“Life-saving aid like shelter, food and water are crucial in this crisis – but to help children recover and rebuild after their ordeals psychological support must be considered a priority. The world must do more to repair the damage.”



·       In April 2017, Save the Children researchers spoke to 65 children aged 10-15 (32 boys, 33 girls) who had recently escaped the city to Hammam al Alil camp, south of Mosul.

·       With dice featuring six emoticons, children were asked when they most felt angry, sad, shocked, scared, anxious, bored or upset. They most often chose to share when they felt “sad”, “scared” or “felt like crying”, identifying their main sources of distress as memories of violence, deaths of loved ones and being beaten. [Figure 1]

[1] https://fts.unocha.org/appeals/550/projects?order=project_property_2&sort=asc

Figure 1

When do you feel the most angry/sad/scared/shocked/upset?




Remembering attacks/violence



Remembering deaths of loved ones



When I get beaten



When I have nightmares



Being separated from loved ones



When someone is mean to me (yells at me, curses at me, talks badly about me)


Remembering ISIS (including 'escape from ISIS', 'ISIS abductions', 'photos of ISIS', 'ISIS finding us')


Seeing something or someone scary in the camp



Witnessing or getting into a fight



Being alone



Leaving home



*Children could give the same answer to multiple questions

·       Children were also asked to play a game where they could put things they did not want, either an unwanted item or aspect of themselves, into a ‘magic bag’ to make them disappear.  [Figure 2]

Figure 2

“If you could put into this magic bag anything in your life that you no longer want or that makes you feel sad, scared, or upset, what would it be?”


War & Weapons











   ‘Airplanes & bombs’


















   ‘Photos of ISIS’






Bad/Scary things



People that hate/don’t like me



Anything that bothers me/makes me feel sad



People that are mean









Unwanted toys









Don't know/silence



Leaving camp



Leaving camp and going home












Wild animals like tigers



When my family is sad



*Children could give multiple answers

·       They were then asked to play a similar game and take out of the bag things that made them happy. [Figure 3]

Figure 3

“If you could take anything out of this magic bag that would make you feel better or happier what would it be?”





Lost/dead loved ones



Going back to Mosul



Loved one



Don’t know






Loved ones in Mosul



Soccer ball






Seeing happy people












*Children could give multiple answers

·       The research in Mosul follows a recent study by Save the Children into the impact of six years of war in Syria on children’s mental health. LINK

Comments from Focus Group Discussions conducted at Hammam al-Alil camp, Iraq (April, 2017)

“I dream of a woman with blood all over her face.” -  Girl aged 10-12

“My aunt was baking and she was attacked suddenly and killed. I am scared, shocked and very sad because I loved her.” - Girl aged 10-12

“ISIS killed women that were taken to an ISIS car and they couldn't escape. Then they threw their bodies into the garbage.” -  Girl aged 10-12

“I have bad dreams of dead bodies.” -  Girl aged 10-12

“I have a bad dream that everything in Mosul is destroyed, the houses, the schools, the people.” -  Girl aged 13-15

“I was scared when we didn't have enough food to feed my baby sister.” -  Girl aged 13-15

“Since I came to the camp I don't feel safe, because I don't believe we are here. And I don't think we are far from ISIS.” -  Girl aged 13-15

“Everything was destroyed, and there were dead bodies around, and people were crying and bleeding.” -  Girl aged 13-15

“ISIS climbed the wall of my house and went to my grandparents room to take them and they killed many of my family.” -  Boy aged 10-12

“ISIS is taking people from the military and the police – and they will come here next.” -  Boy aged 10-12

“My cousin was offered a cigarette by ISIS and when he accepted they gave it to him and then killed him by gun-shot on the back.” -  Boy aged 10-12

“My uncle was digging on the ground and then a plane went over him and dropped a rocket on him and then he exploded.” -  Boy aged 10-12

“I am shocked when I see something scary like a monster in front of me, or dead bodies in the street.”

-  Boy aged 13-15

“I was scared when we escaped from ISIS because they want to kill us by shooting us.”

-  Boy aged 13-15

“I’m afraid that mines can explode on us.” -  Boy aged 13-15