Some of those working with Yazidi former slaves say they have never before seen such severe psychological trauma. As part of our “Women and Jihad” series, experts tell us there are not enough resources to provide long-term care to all of the survivors, who could take a lifetime to recover.

Last January, Skye Wheeler, women’s rights emergencies researcher at Human Rights Watch, arrived at the Dohuk camp for displaced people near the Kurdish region of Iraq. Wheeler was there to interview Yazidi women and girls who had been kidnapped from their homes in Sinjar and held as sex slaves by the terror group known as the Islamic State (ISIS).

Wheeler, who interviewed 22 Yazidi women and girls, has spent her career documenting war crimes against women. Yet she says the accounts of sexual violence she heard from the Yazidi survivors continue to haunt her.

“It is some of the most distressing work I have ever done, and my colleagues who have also interviewed the survivors say that same thing,” she says.

Wheeler says the abuse inflicted on Yazidi women and girls “is on a different level” from other cases she has documented. The women she met had been kidnapped and sold in slave markets to ISIS soldiers who then raped them, often multiple times a day. In some cases, the women would be resold to another fighter who would continue the sexual abuse. Wheeler spoke with four women who were sold at least four times before they managed to escape.

“It’s just horrible, [ISIS] treat people like animals,” she says. “All the women we spoke to were exhibiting some type of symptoms from the trauma they suffered.”

Those symptoms include severe depression, anxiety, social withdrawal, suicidal thoughts, insomnia and, when they finally do sleep, nightmares in which they relive their sexual abuse.

In February 2015, the German state of Baden-Wurttemberg offered to help by agreeing to take in 1,100 refugees, including hundreds of the most traumatized Yazidi women and girls. The program, which runs for three years and will cost the German government a total of $107 million, provides Yazidi survivors with specialized psychological care and German residency for two years.

But the program is now at full capacity, which means hundreds of Yazidi women and girls who didn’t make it into the program and those who have only recently escaped from ISIS remain in the internally displaced peoples (IDP) camps in Iraqi Kurdistan, where treatment for mental health is severely lacking.

Psychotherapist Salah Ahmad has been working with trauma victims in Iraq since 2005, when he established the Jiyan Foundation for Human Rights to provide mental health care to Iraqis who were tortured by the Ba’athist party. Ahmad has spent much of the last two years traveling between IDP camps in Dohuk Kurdistan to help treat Yazidi women and girls.

Ahmad says they display some of the worst cases of post-traumatic stress disorder he has ever seen. “To be sold, to be enslaved, to be raped many times … they can’t accept all this violence,” he says.

Suicidal thoughts are not uncommon.

“We have seen many women who feel that they can’t live with the aftermath of what happened to them; they think the only way to escape is through killing themselves,” says Ahmad.

In November 2015, Ahmad established the Jiyan Clinic, a psychosomatic trauma clinic solely for Yazidi women and children in Iraqi Kurdistan. He found many trauma survivors were hesitant to recount their abuse to other men, especially Muslim men, so he employs an all-female staff.

The patients spend at least three months living in the clinic, where they undergo daily treatment, which includes individual and group therapy, and EMDR – or eye movement desensitization and reprocessing therapy – a technique designed to alter the way the brain stores and recollects traumatic memories. The women can also take part in therapeutic activities like yoga and gardening.

Since its opening, the clinic has treated 80 female Yazidi survivors of ISIS, but Ahmad says he doesn’t have the resources to provide treatment for all the Yazidi women who need help.

Ali Muthanna, regional director in Iraq for the AMAR Foundation, is also struggling to provide support to all the women who need it. He spends the majority of his time at Khanke Camp, an IDP camp in Iraqi Kurdistan, where he treats the 18,500 Yazidis who have been living there since the ISIS attack in 2014 forced an estimated half a million Yazidis to flee their homes. Among Muthanna’s patients are also around 500 Yazidi women who escaped ISIS.

Through its Escaping Darkness project, AMAR is working to establish a network of 10 mental health facilities to treat the post-traumatic stress disorder Yazidi women grapple with. The foundation is also working with psychiatrists to train local GPs in psychological care, showing them how to spot and manage psychiatric issues.

But AMAR faces huge challenges, not least the fact that Iraq’s medical infrastructure has been decimated by years of conflict.

“There is a severe shortage of financial resources, the drop in oil prices has created a situation where the government is unable to provide medical requirements to cover the needs of IDPs,” Muthanna says.

And the longer women go without medication and treatment, the worse their condition can become.

“Those suffering from psychological disorders need long-term treatment,” Muthanna says, adding that drugs for treating symptoms of stress, depression and trauma need to be taken continuously to work.

“The magnitude of the problem is beyond the capacity of the U.N. agencies and Iraqi and Kurdistan governments to respond to.”