In northern Iraq, they have escaped Syria’s bombs and bullets but their crisis is far from over: A delirious woman who thought she was pregnant with eleven babies. A 10-year-old boy embarrassed about his sudden bed-wetting. A businessman who started cutting himself because “he gets relief from seeing the blood.”

All three Syrian refugees are among the growing number of mental health patients now being treated at Domiz, a Syrian refugee camp in the Duhok province of Iraq. Syria’s two-year civil war has killed an estimated 110,000 people and created more than two million refugees — more than 48,000 of whom now live in Domiz, a camp meant to accommodate just 1,000 families when it first opened in April 2012.

And as the population of Domiz has swelled, so too have the camp’s mental health needs. In 2012, roughly seven per cent of mental health patients had symptoms of severe mental disorders, according to Médecins Sans Frontières, which is providing health services at the camp. This year, that number has already more than doubled to 15 per cent.

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“These are very, very high numbers so it is very alarming,” said Dr. Henrike Zellmann, an MSF psychologist from Germany who has been working at Domiz since August. “The situation has become more complicated, more complex, the future is very unclear.”

Zellmann supervises a team of four psychologists, two of whom are Syrian refugees themselves. She said many patients suffer from depression, anxiety and post-traumatic stress, having lost their homes to bombing or witnessed terrible events in Syria. Others are previously diagnosed psychiatric patients who have been unable to access medication or treatment during the crisis.

The woman who believed she was carrying 11 babies, for example, has schizophrenia but had not been treated for some time. Zellmann said the woman, who appeared to be in her 40s, visited a gynecologist several times with her concerns and was eventually referred to MSF’s mental health clinic.

When Zellman first met the woman, she was emotionally unstable — laughing one minute, moody the next. She also had three children between the ages of six and 11 and the counselors were worried about their wellbeing.

But visits to the woman’s home demonstrated that she was managing okay and had good support from her neighbours; the children were also attending school and appeared to be in good shape. The woman has now been given antipsychotic medication and psychiatric care and appears to be improving. “She’s doing better now,” Zellman reports.

A particularly vulnerable population are refugees in the “single men area” of the camp — men who crossed the border alone, some who have escaped the army.

These men are more reluctant to seek help so a male MSF counselor named Nihad is now visiting them in their tents, Zellman said. One man who had lost his business and family was coping by cutting himself, leaving scars all over his body.

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“(These men are) a very vulnerable group within the whole vulnerable group of the whole camp,” Zellman said. “They are isolated, they don’t have social support, a lot of them may have also had very difficult experiences in Syria.”

But almost half of all mental health patients are 18 years old or younger and Zellman said her clinic sees children who are anxious and bed-wetting almost every day. One 10-year-old boy was recently brought into the clinic by his parents, overwhelmed with shame and embarrassment over his new nighttime habit. But after counselors explained his reaction was common amongst other children who had undergone similar experiences, he began to brighten and open up. He has now stopped bed-wetting, Zellman said.

Zellman said her work is rewarding and she feels encouraged when patients improve. But the mental health needs at Domiz are growing more numerous and complex by the day.

And for Domiz’s temporary residents, any hope they once had is now fading.

“In the beginning, the people were (like), ‘Okay, we’re out of the country, we are safe now, it’s only going to last for a couple of months,” Zellman said. “Now, nobody knows how long (they will be here) but it’s very unlikely that this crisis is going to finish quickly. So yeah, there’s a condition of disillusionment.”

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