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Treating the Tortured 



There is a 55-year-old woman who has lived in northern Iraq for most of her life. In 1974, she married a farmer and by 1988 had six children with him—four girls and two boys. She lived in close proximity to her family—three sisters and two brothers who, together with their husbands and wives, had more than 50 children among them. It was also in 1988 that Saddam Hussein sent soldiers to her village, separated the men from the women and children—including 68 members of her family—and transported them to a place called Noogra Salman in central Iraq. In less than one year’s time—exactly 236 days—she watched 20 members of her family die slow deaths due to malnutrition, mistreatment, lack of sanitary living conditions, and other abuses.

Today, this woman, one of her daughters, and two of her nieces are the only family members of the original 68 known to have survived. Her life forever marred through her suffering from the long-term effects of post-traumatic stress disorder (PSTD) and depression, she recently made her way to the trauma recovery and training center in Sulaimania, where she is now receiving treatment. It’s a miracle of sorts in a country where mental illness is looked down upon and mental health workers are shunned in the Middle East. In Iraq, even those who are trained to give treatment to those suffering from mental illness carry this stigma.

(For reasons of security, I cannot share with you her name or other identifying details—or that of any other “survivors” mentioned in this article. Out of respect, I have chosen not to give these survivors pseudonyms—I leave it up to you to provide them with names.)

Located on a corner property facing a small but heavily transited road, the brand new facility—a previously unused building provided by the Kurdistan Ministry of Health and rehabilitated with $30,000 from the USAID Provincial Reconstruction Team and run under the auspices of the international arm of Heartland Alliance for Human Needs and Human Rights, a non governmental organization, or NGO, based in Chicago—had its formal opening on July 8. The center has been in operation since early January, with staff working out of a much smaller building. After three years, the building will revert back to the Ministry of Health, which according to its medical director, Dr. Ahmed Amin, is a good thing. “Government involvement adds to our potential sustainability,” he says. “Once the NGOs cut their funding, more than likely, the government will continue to fund the center.”

Since its opening, the center has seen approximately 60 clients. Dr. Amin explains that the site is a training facility as well as a treatment center providing three kinds of service: “medical, psychiatric, and psychosocial. Basically, we do training and treatment. We treat individuals and groups such as families. And we also have a training component where we have conducted trainings for social researchers, psychologists, medical staff.”


DESIGN, MONITOR, AND EVALUATE

The center is a work in progress, with training procedures and treatment techniques under strict evaluation and review under the guidance of Heartland Alliance, experts from their Marjorie Kovler Center for the Treatment of Survivors of Torture and from Johns Hopkins University. “Our role is to assist NGOs in designing, monitoring, and evaluating mental health programs around the world,” says Paul Bolton, an associate scientist at the Center for Refugee and Disaster Response of the Johns Hopkins Bloomberg School of Public Health. Bolton has been working since 1988 both with victims directly and as a technical consultant with NGOs in war, disaster, and development settings, including Rwanda, Cambodia, Angola, Mexico, and Kazakhstan. The Victims of Torture Fund at USAID partially funds Bolton’s work and it was USAID that asked him to work with Heartland Alliance and its trauma recovery and training center in Sulaimania.

“You can’t have any design without data, so we do a process of needs assessment, says Bolton. “So, for example, for torture survivors here in Sulaimania we assist in designing programs by first assisting in collecting data.” Bolton began collecting data last April interviewing 70 torture survivors around Sulaimania using ethnographic interviewing methods. The questioning was open-ended. Yes/no, multiple choice, and leading questions were avoided. Trained interviewers spoke with the torture survivors on two separate occasions, probing them to give as many answers as possible to specific questions. Interviewers were also trained to set up a rapport with those they were interviewing.

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