DOHUK, Iraq — During her 19 months of captivity under the Islamic State, Nofa Mahlo, a 37-year-old Yazidi woman from Baa’j, lived each day not knowing what the next would bring. Her imprisonment in crowded, underground prisons had turned her skin a pale white. She’d been separated from her children and made to subsist on two meager meals a day. Other than occasional visits from younger Yazidi girls who shared horror stories of their lives as sex slaves for Islamic State fighters, she had little contact with the outside world.

In late March, her guards suddenly took her and 50 other Yazidi women to the Syrian border, pointed them eastward, and told them to walk. From a point northwest of the Sinjar mountains, the group walked four hours through rocky plains before reaching a military outpost in Iraq, where they were received by Kurdish militias in what was later believed to be a clandestine prisoner exchange.

In August 2014, thousands of Yazidis — an ethnically Kurdish minority community whose religious practices are rooted in ancient Mesopotamian tradition — fled their ancestral homes in northwest Iraq’s Sinjar Mountains when caravans of Islamic State fighters overtook the area. Claiming the Yazidis were “devil-worshippers,” the Islamic State engaged in an ethnic cleansing campaign determined to wipe them out from caliphate-held territories. Until that point, the Yazidis had lived a relatively peaceful existence amid a war-ravaged Iraq. Within the first days of the Islamic State invasion, 5,000 people were executed and buried in mass graves, and more than 3,000 young women were kidnapped and forced into sexual slavery.

For those who manage to escape, the path to freedom is often daunting, if not inconceivable without professional help. Nearly 200,000 Yazidis have been displaced in northern Iraq, where many now live in refugee camps that provide basic food and shelter. But doctors at these camps say there is a severe lack of mental health services for victims of torture, and the overwhelming need is exhausting already limited resources.

A month after her release, Mahlo sat in a refugee camp near Dohuk. Two of her six children remained in captivity, and her husband’s whereabouts was unknown. “I’m not going to feel free until they free my family,” Mahlo said, speaking inside her canvas tent on a hot day in April. “I never thought I would get out. Now that I am, everything is the same as before. I’m always thinking about my family. I don’t know if they are dead or alive.”

Of the 15 or so camps for internally displaced people located near Dohuk, none provide regular psychotherapy sessions for victims of rape or torture, said Azzat Ibrahim Khadeeda, a medical clinic supervisor for the Swiss charity Medair. Sitting in his office in Sharya camp, home to about 17,000 refugees, many of whom are Yazidi, Khadeeda explained that providing basic medical services was enough of a challenge, and that neither funding nor staff was available to handle mental health problems. While the U.N. and a patchwork of humanitarian aid groups, including Yazda and Medecins du Monde, provide the occasional psychologist, few stay long enough to deal with more complex issues such as sexual abuse, Khadeeda said. “It’s our biggest weakness in the services we provide,” he said.

A group of Yazidis gather outside the abandoned building they live in on the outskirts of the Sharya refugee camp, on April 8. A Yazidi girl stands in the Sharya refugee camp on April 8. A group of Yazidi children meander through the Sharya refugee camp on April 8.

During their captivity, some Yazidi women were held in bedrooms, where their Islamic State captors would routinely rape them and threaten them with death if they disobeyed. The bodies of prisoners who rebelled were left to rot in nearby fields to discourage those contemplating escape. Khadeeda said many of his Yazidi patients report having frequent nightmares and difficulty sleeping. Children are startled by cars that pass their tents at night, and many women suffer constant flashbacks and anxiety attacks, he said.

“We know these are symptoms of trauma, and we simply don’t have the staff to deal with them,” Khadeeda said. “Therapy or no therapy, the root of these problems is that Yazidis just don’t feel safe in Iraq. They can’t trust anyone anymore, and they have a very black picture of their future in the Middle East.” Most of them, he added, just want to leave the region.

Following the Islamic State takeover, captives deemed of lesser value were set aside and held as prisoners. Yazidi elders, children under the age of 10, and mothers like Nofa Mahlo were often kept in abandoned buildings and moved repeatedly from one location to another, spending prolonged periods in Islamic State strongholds like Mosul. Mahlo described being held in a windowless school basement near Raqqa with 50 other women and about 200 children over her last four months in captivity. Split among three dark rooms, Mahlo said that prisoner contact with Islamic State fighters was limited to mealtimes, when a door would open and food would be distributed to prisoners. Meals were usually heavy on rice and bulgur wheat. “They gave us enough not to die,” she said.

Though Mahlo was spared from the worst suffering under Islamic State captivity, she was separated from one or more members of her family each time she was moved to a new location and eventually ended up alone. Through her days in captivity, her mind drifted to the uncertain fates of her sons. “The hardest part was when they took my sons,” Mahlo said. “I tried to hold on to them, but [the soldiers] beat me until I couldn’t hold them any longer.”

But while Mahlo evaded the rape and torture suffered by many captives, the psychological abuse has left her unable to face daily life. She is wary of eating meat from unknown sources, recalling stories of mothers in Islamic State prisons supposedly being fed their own children. The mothers said “the meat tasted strange, and when they finished, the IS fighters told them it was their own children,” Mahlo said, adding others were rumored to have found human fingers mixed into their rice dishes.

Stories of institutionalized rape were common, as teenage daughters forced to marry Islamic State fighters were allowed routine visits to family members in the school basement, where they told of repeated assaults and forced contraception.

According to the caliphate’s strict interpretation of Islam, female slaves can change partners only when it can be proven that they have not been impregnated by their previous captor. Traditionally, this was confirmed with a three-month waiting period between partners. But Islamic State members have taken a shortcut around such measures by forcing women to ingest large amounts of birth control medication, allowing slaves to be traded without delays, as documented by the New York Times. “They were always looking for young virgins and left mothers like us in their prisons,” Mahlo said.

Though fewer in number, Yazidi men also suffered. They were forced to dig military tunnels beneath occupied cities, as in Sinjar, and exploited for other hard labor projects. Some were also used as front-line decoys to draw enemy fire away from Islamic State fighters.

One such decoy was Khero Maijo, a 27-year-old construction worker from a village near Baa’j. Soft-spoken and too shy to make eye contact, Maijo was given a choice: stand guard on the front line, or have his head chopped off. “Some prisoners were given suicide jackets and sent to blow themselves up near [Kurdish] Peshmerga forces,” Maijo said, taking quick drags on his cigarette. “We were prisoners for a long time,” he continued. “I was alive, but I thought it would’ve been better to die. I never thought I would get out.”

Khero Maijo's brother-in-law recounts how he was separated from his wife for nearly two years after the Islamic State's invasion of Sinjar, in the Sharya refugee camp on April 7. A Yazidi man who requested anonymity holds out photos of his wife, who was kidnapped and remains in Islamic State captivity, in Khana Sor on April 4. A Yazidi man explains how he escaped the Islamic State's invasion of Sinjar, in Khana Sor on April 4.

Eventually, Maijo did escape, finding his way to Iraq through a network of Yazidi smugglers. Now, sitting in Sharya camp, he struggles with simple tasks. “I try to watch shows, but I can’t concentrate enough to follow what is happening,” he said. “I can’t follow stories.” Maijo said he hears the words people say to him, but oftentimes has trouble gathering meaning from them. “I got sick from thinking too much,” he said.

Maijo’s condition clearly suggests post-traumatic stress disorder (PTSD), said Heather Barahmand, a case manager for psychosocial services with Yazda, a non-governmental organization based in Dohuk. She coordinates one of the few mental health programs for Yazidis in northern Iraq, where she sets up reception services for new escapees and weekly support groups.

The groups are open to anyone in the camps, and participants are invited to speak about their experiences, providing a venue to release whatever emotions they may be holding back. “When they escape, many believe no one can understand what they’ve been through, because no one has seen the things they have,” Barahmand said. “This is exactly why support groups are so effective. It lets victims realize they are not alone and gives them a place to talk or just cry if they need to.”

One of Barahmand’s first tasks is orienting recent arrivals to their new realities. “In captivity, people tend to construct realities that are not going to line up with the actual reality after they get released,” she said. “They think they are going home, but instead they are going to IDP [internally displaced person] camps. They think they will be reunited with their families, but they may end up alone. Our patients are basically going from one trauma to another trauma.”

For particularly difficult cases, Yazidi community leaders take some women to Lalish, the holy site for Yazidis in northern Iraq, where they are encouraged to relax inside simple mountainside accommodations as a sort of religious pilgrimage toward recovery. There, the women can also seek the advice of Baba Sheikh, the resident “pope” of Yazidis, who issued an unprecedented decree after the Islamic attacks on Sinjar that all victims of rape must be welcomed back into Yazidi communities, which, according to tradition, usually cast out individuals who have sexual relations with members of other faiths. Baba Sheikh also asked community members to forgive Islamic State captives who converted to Islam in order to save their lives, showing flexibility in his interpretation of strict religious guidelines in the face of an ongoing crisis.

Resources to support such initiatives are meager, but recent developments are promising. Barahmand said one of her patients tried to commit suicide twice before being sent to Lalish and returning with a vastly improved state of mind.

There are also new avenues opening for victims of extreme trauma. The charity Air Bridge Iraq has provided asylum assistance to Germany for more than 1,000 women and children who suffered at the hands of the Islamic State. It is the only program of its kind, with most Yazidis still resorting to irregular migration routes to Europe, but the organization’s founder, Mirza Dinnayi, hopes to expand his campaign to offer safe havens for Yazidis in need.

At the moment, he said his main obstacle is finding new reception sites and funding as European nations continue to struggle with the refugees already residing within their borders. “It’s difficult to recover from psychological trauma if a person cannot feel safe,” said Dinnayi, a physician who is also an Iraqi Yazidi. “We have to act fast if we want the Yazidi community to recover anytime soon.”

Yet for survivors like Nofa Mahlo, who wakes up every day thinking of her missing children and husband, the main challenge is finding solace in the understanding that her most pressing questions may never be answered.

“I don’t care about having food or a house. I don’t want to go to Europe,” Mahlo said. “I just want to know what happened to them.”

Photo Credits: Diego Cupolo

