In these classrooms, immigrants take the first tentative steps in their next passage. Arriving with little English and no friends — and aching for those left behind — the teens must quickly learn to navigate a complicated new culture. Some stumble. Others show remarkable resilience.

The challenges the Patterson students face are daunting — offering a preview of issues the counties near Baltimore and many areas around the country are beginning to confront. Some teens come to America barely literate, and many are drawn away from school by the need to earn money for their families. Less than half will pass their state high school tests, and about a quarter will drop out.

Like Narmin, many immigrant teens also carry psychic wounds, and their trauma surfaces in the classroom. Mirroring a national trend, teachers are seeing more cases, and more extreme cases, of mental health issues — depression, anxiety and self-mutilation — than ever before. The city school system sent a part-time bilingual counselor to help students cope, but it is not enough.

These are not teens whose families immigrated mainly for better economic prospects, as in past generations. Instead, they came to escape war, gang violence and starvation. They had seen their villages burned, their parents kidnapped and tortured, their friends shot. They had floated across the Rio Grande in darkness and been driven out of Baghdad in the middle of the night. They had run from exploding Syrian cities and walked from African villages overrun by ethnic fighting.

“Even though your body is here, it takes a really long time to bring yourself here.” Amy Rakusin, psychotherapist

“Even though your body is here, it takes a really long time to bring yourself here,” said Amy Rakusin, a psychotherapist who works with immigrants for the Intercultural Counseling Connection in Baltimore. “The impact of trauma, it stays alive in you for a very long time — in your dreams, in your thoughts, in your memories.”

Narmin's trauma

Even among her Arabic-speaking friends at Patterson, Narmin (pronounced Narmeen) was not a giggly teenager. She sauntered down the school’s wide halls in khaki jeans, tennis shoes and a colorful head scarf, or hijab, pinned perfectly in place. Her teacher, Tom Smith, could see she was bright, and she had an openness that allowed her to work with people from other cultures and try new activities. Last year, she even joined the junior varsity basketball team despite knowing little about the game.

Narmin Al Eethawi, in back row, listens during Tom Smith's English as a Second Language class at Patterson High School. In front is Dama Traore, left, and Pampha Kadariya. OPEN GALLERY

But Smith, a thin 70-year-old who had been teaching English to immigrants for a decade, noticed that when Narmin thought no one was looking, she lost her cheerfulness. He saw sadness in her eyes, sensed her mind wandering to a dark place.

Smith could have retired years ago, but he stayed in his third-floor corner classroom, unable to abandon the daily satisfactions of helping immigrants unfurl their dreams, guiding them through everything from understanding the past perfect verb tense to recognizing the signs of an abusive relationship. Sometimes, he witnessed a student who had arrived speaking no English make extraordinary progress and land in a four-year college. Too often, he saw his students drop out, broken by the need to earn money for their families and the almost impossible task of getting through high school on their limited English. He knew that many, like Narmin, were haunted.

“When I hear where they’re from, I can imagine their stories,” Smith said, “and I don’t want to do anything that will add to their pain.”

Narmin’s nightmares began almost as soon as she landed in the United States in December 2013. Eventually, to feel safer, she dragged her mattress into her parents’ bedroom and positioned it next to her mother’s side of the bed. A night owl, she often stayed up later than her parents, then sneaked into their darkened room to lie down. She kept her cellphone close, so if she needed consoling, she could silently text her boyfriend in Baghdad.

To Narmin, the witch in her dreams had been sent by the devil to put a curse on her. She knew it was a nightmare, but it came to embody all she had endured in Iraq. Her father, a truck driver who once delivered containers of flour, was hired by Americans to haul war supplies. In the eyes of the Mujahedin rebels, he was a traitor, and when Narmin was in elementary school, he was kidnapped. She remembers how the family stayed locked in their home for a week, how her mother frantically gathered $3,000 to pay the ransom, how her father returned with a large gash down the side of his face. The scar is still visible today.

Family photos from Narmin's childhood in Iraq. (Vertical) Narmin as a toddler, on her older cousin's lap. (Horizontal) Narmin, left, with family, stands in the garage that was later firebombed in retaliation because her father hauled war supplies for the American military.

To feed his family, Narmin’s father continued his work, but discreetly. For three years, Narmin’s mother walked her to school, telling her to look straight ahead so she wouldn’t see body parts and bloated, decomposing bodies littering the roadsides. American soldiers occasionally came through and loaded bodies into a truck, but often the corpses rotted in place. Iraqi residents knew that if they tried to retrieve a body, snipers from warring factions might shoot at them, the family said.

The fear was so great that even when Narmin’s mother thought she glimpsed her brother’s face as they drove among the corpses, her father would not turn the car around to see if it was him. They later discovered that the brother, Narmin’s uncle, was still alive. But their worries were legitimate: Four of Narmin’s uncles were killed in the war, a toll her mother said wasn’t unusual for Iraqi families.

“I see people get killed. I see everything,” Narmin said. “This is my country. Where do you go? We have a war. You can’t do anything.”

The third floor

At the start of an April week at Patterson, six new students showed up to the English as a Second Language program.

Margot Harris, chair of the program, was coaxing a nervous Angolan girl with a head full of curls and a wide, white-toothed smile on an English assessment. The new student couldn’t understand a word Harris put in front of her, but she was trying desperately to pick up clues, her eyes darting from Harris’ face to the paper. Patiently, Harris urged her on, even as she answered every question wrong. The test was the only way Harris could determine what class to put the girl in.

Immigration statistics Baltimore Nation Baltimore immigrant population over time Immigrants as percentage of U.S. population Source: DHS Office of Immigration Statistics, Pew Research Center, U.S. Census

For months, enrollment had been spiking with teens who had fled the Middle East, Africa and Central America. In the past two years, the number of immigrants at Patterson had tripled, to about 370 in a student body of 1,100.

“It feels like we are enrolling one a day,” Harris said.

That morning, Harris barely had time to give the test to the Angolan girl and the new boy from Pakistan when problems started showing up.

One teacher popped in the office to ask if the new students were all supposed to be in one class. Harris made a quick decision that relieved the teacher: “Let’s disperse them and get them through the next 40 days.”

Moments later, another teacher poked her head in. She thought they should check on a girl who had confided she was planning to have an abortion. At the same time, Harris knew she needed to call the parent of a girl who appeared to be skipping school with boys. Later that day, Harris would be pulled aside by a teacher who said that one of her students was having thoughts of hurting himself. She took off to investigate, marching down the third-floor hallway.

Harris was the center of the universe for the third floor, a short-order cook of an administrator who rarely had time to sit down. For months, her office, a converted classroom she decorated with rocking chairs, bookshelves and the warm colors of fabrics from around the world, had felt like a mini-crisis center. She marked a Sunday in December as a turning point.

That day, Harris was standing in a pew waiting for people to file out after a service at the Church of the Holy Apostles in Arbutus. She glanced at her phone and saw a text from a co-worker. A Nepalese student at Patterson had killed herself, and a picture of her body was being circulated by students on Facebook. Harris found herself staring at the image of her student’s body wrapped up and marked with a religious symbol.

Harris collapsed in the pew. The priest came back to her, and they said a short prayer. Then she collected herself to call the principal, Vance Benton. The death, and the photo, sent shock waves through Patterson’s immigrant students, teachers and the African-American students who had grown up with their own share of trauma from city violence. The next day, additional counselors were brought in to help students and staff.

Patterson High School's diverse student body includes more than 300 immigrants. Students leaving school at the end of a spring day include, starting fourth from left, Nadifa Idriss, Mona Al halabi, Manuel Maurizaca and Fayza Al halabi. SEE MORE PHOTOS OF PATTERSON

The girl’s family had put her photo on Facebook so relatives in Nepal, who were illiterate, would understand she had died. She was a happy girl who played soccer and had many friends among the American-born students. “She was what we always wanted our kids to be,” Harris said. “She was doing everything right.”

Harris knew that some students were abusing drugs, that others had violent outbursts in class, and that a few seemed, at times, unable to stop crying. Pregnancies had doubled. But the teachers were so overwhelmed with the number of new students that they hadn’t been able to focus on the severity of the emotional issues.

“That is when I really started to see our kids’ trauma,” Harris said. “It was an epiphany.”

A mile down Eastern Avenue, the students’ problems were also turning up in many calls to the Hispanic Psychiatric Clinic at Johns Hopkins Hospital, said Donna Fallon Batkis, the clinic’s senior psychiatric psychotherapist. Young immigrant patients have been kidnapped for ransom, witnessed beheadings and seen dying people abandoned in the Mexican desert. The new waves of youths, she said, come with backgrounds far more violent than those of the Latinos who arrived a decade ago.

In their native countries and on their journeys here, Fallon Batkis said, there are “more rapes than I have ever seen, not just rape of women, but sexual abuse of men.”

The result, she said, comes out in many ways: cutting, eating disorders, depression, suicide. The children are clingy and suffer terrible nightmares. “The protective factors of routine and feeling safe aren’t there for the kids and the adults,” said Fallon Batkis, because they are in a new culture. “It’s like one giant ball of worry.”

Across the nation, the story is the same. “The level of atrocities these kids are experiencing is off the map from my point of view,” said Dr. Richard Mollica, director of the Harvard Program in Refugee Trauma, who has been studying and treating trauma in refugees for 35 years. “I have never seen this before.”

“The level of atrocities these kids are experiencing is off the map from my point of view. I have never seen this before.” Dr. Richard Mollica, director, Harvard Program in Refugee Trauma

While there has been little research on the effects of trauma specifically in teens, Mollica and other researchers have shown that trauma damages the health of refugees. The short-term impact includes stomach aches, headaches, bad dreams, irritability, poor concentration and anxiety. Over a longer period, they face higher death rates from heart disease and diabetes. The rates of depression and post-traumatic stress disorder are both 10 times higher in adult refugees than in the general population.

At Patterson, after the Nepalese girl’s suicide, Smith changed his approach in class. He had always cracked jokes and laughed with students, but he began to show them more of his emotions, to share more love. And as he did, their stories came pouring out. One day, he knelt at a student’s desk to correct her writing and saw that her arm was scarred with cuts he thought were self-inflicted. He turned over her arm and gently asked her what was wrong. She began to sob.

Down the hall, another girl cut herself during a class. She approached her teacher as the period was ending, blood dripping from her arm. The teacher called the school nurse, who bandaged the girl’s arm. Harris found a social worker to talk to the girl, and then they drove her home and had a long talk with her mother.

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Cutting, particularly by immigrant boys, appears to be more common among the new immigrants at Patterson than among other students, according to Eric Haber, a Spanish-speaking social worker who came to the school nearly a year ago. Teenagers who have been through trauma sometimes shut down emotionally, to avoid reliving it. But if they grow numb and depressed, cutting themselves can sometimes provide an endorphin rush and relief.

To help the students, Haber held group support sessions. Students can also see a Johns Hopkins Bayview Medical Center mental health worker available to any Patterson student as part of a citywide initiative. Harris believes more is needed: more counselors, more training for teachers.

Teacher Tammy Mayer agrees. “We are not prepared to deal with these students. They have complicated lives and need a lot more than what we're doing.”

The trauma causes anguish for teachers, too. Kati Casto didn’t anticipate she would become a nurse, mother, friend and social worker to her students. “I felt I was carrying them home with me. I would dream about them.”

Global connections

Narmin’s phone buzzed with Facebook text messages throughout her day with snippets of news from Iraq. Her sister, in Baghdad, chatted about her 2-year-old son. The boyfriend Narmin left behind, Mustafa, remained her confidant, as close as her clutch of Arabic-speaking girlfriends at Patterson. They texted constantly, relaying every detail of their day. When she got lost in Baltimore and didn’t know what to do, she called 22-year-old Mustafa to help her with directions.

Memi Desta, left, and Narmin Al Eethawi get ready for a volleyball game after school at Patterson High School. OPEN GALLERY

Even though they’d been briefly engaged, they had not seen each other in two years. She felt deeply in love, filled with questions about how they would ever be together. He often pleaded with her to come back home.

“My boyfriend talk with me, ‘Narmin, come back to Iraq,’’’ she said, looking sad. But she feared that if she did return, the people who threatened her father might go after her. “Maybe they find me and kill me. I don’t know what I can do. I am really confused.”

Generations ago, immigrants came by ship, and letters from the homeland took days or months to arrive. Today, it’s much harder to leave behind news and friends — particularly for tech-savvy teens who straddle two worlds.

“It is unbelievably disturbing to have a relative in a foreign country and go to YouTube and see a beheading,” said Harvard’s Mollica.

Teachers like Smith grapple with this every day. He never knew when to intervene and stop the texting going on. Was it just teenage chatter or some vital family communication arriving from thousands of miles away?

He worried about students like Yamen Khalil, a serious Syrian boy who sat in the back of his classroom. At home, in the West Baltimore rowhouse he shared with his father, Yamen could Skype with his mother and disabled brother, stuck in Turkey. But the cellphone was a distraction at school, where Yamen often checked it between classes for news of bombings in his village.

Reema Alfaheed, left, and her younger brother, Ahmed Alfaheed, 15, look at videos depicting the Iraq refugee camp near the border with Syria, where they lived for six years after fleeing Baghdad. OPEN GALLERY

On the third-floor hallway, teachers tried different approaches: One allowed a student who seemed particularly desperate one morning to put her faraway boyfriend on speaker phone, so he could join an English class. Another teacher gave the kids’ phones a “vacation” in a plastic container on her desk with cutouts of a sandy beach and palm trees taped to it. The phones comically buzzed, chirped and jumped during the class, but her students were free to live in the present.

Even amid the tranquillity of a soccer field, Reema Alfaheed, one of Narmin’s best friends, couldn’t escape. She was on the phone with a friend, a boy in Syria, who was lamenting that, because of the war, he couldn’t play soccer or go to school. Then Reema heard an explosion and people screaming. The phone went dead.

Three days later, she learned her friend had survived the bombing, but was left with a head injury and broken leg. Reema felt guilty: “We are safe, and they’re not.”

Four countries

Narmin picked up a piece of chalk and with a sweeping hand drew the Arabic characters on the blackboard for the word “stay.”

It was an April afternoon, the time immigrant students liked to gather in Smith’s classroom to unwind after hours in mainstream classes. Smith had just tried to write the word in Arabic and asked her for help. Narmin smiled, pulled her fingers down the side of her face to adjust her hijab and corrected her teacher’s flawed attempt. The long trailing lines and flourishes came easily to her.

She had recently told him of her dilemma. She knew it would destroy her father, but she loved Iraq and had a half-baked plan to go back to live there. Iraq held memories of warm summer nights with her close-knit family, of going to her favorite ice cream spot, of caring for her favorite grandmother. “When I was a child, everything is beautiful there,” Narmin recalled. “I have a special life in Baghdad.”