Brutal fighting and years living under ISIS have left Mosul’s children with dangerous levels of psychological damage, new research by Save the Children shows. Experts found children are so deeply scarred by memories of extreme violence they are living in constant fear for their lives, unable to show emotions, and suffering from vivid ‘waking nightmares’.

New research reveals impact of Mosul conflict on children’s mental health

All children displayed signs of ‘toxic stress’ – the most dangerous stress response

90% lost loved ones, majority suffering from nightmares

Children left numb and emotionless

The research, based on focus group discussions with 65 children in a displacement camp south of Mosul, is the largest study to date on the impact of the Mosul conflict on children’s mental health.

With the right help, most children will eventually be able to rebuild a normal life. But Save the Children is warning that without an urgent boost to the provision of psychological support, Mosul’s children could be left with life-long mental – and even physical – damage.

The loss of loved ones was the biggest cause of distress for children, with 90% reporting the loss of at least one family member through death, separation during their escape, or abduction.

Children told the charity they witnessed family members killed in front of them, dead bodies and blood in the streets, and bombs destroying their homes. Others shared stories of family members shot by snipers, blown up by landmines or hit by explosive weapons as they fled.

The majority of children – and 78% of girls – said they had nightmares or were unable to sleep.

Children also mentioned fear of an unidentified “thing”, “person” or “monster”. Their mental images of traumatic experiences, and subsequent nightmares, appear to be so vivid they are haunted by them during the day.

Almost all children the charity spoke to were slow to understand instructions and most showed ‘robotic’ behaviour, unable to play or show emotion.

Many spoke about the constant threat of punishment from ISIS, and of relatives killed or imprisoned for going against their rules. Some said they continue to be terrified that ISIS might still attack them even in the relative safety of the camp.

When children were asked to play a game where they could put anything they did not want into a ‘magic bag’, either an item or an aspect of themselves, they most frequently chose “war”, weapons, “sadness” and ISIS. When they were asked to take an item out of the bag to make them feel better, they often had difficulty answering. Of those that did, most chose “happiness” and lost loved ones.

Dr Marcia Brophy, Save the Children’s Senior Mental Health Adviser for the Middle East, said: “What was striking was how introverted and withdrawn children have become. They rarely even smiled. It was as though they had lost the ability to be children.

“When we asked them what they liked about themselves, children often said things like ‘I’m quiet’, ‘I stay in a safe place’ or ‘I obey orders’. Their time under ISIS, and making a life-or-death escape, has taken a truly terrible toll.

“These children are not going to heal in weeks, or even months. They’ll need support for years to come.”

Support from parents and family is vital to help children cope with extreme stress, yet the war has ripped many families apart.

Many parents are themselves psychologically affected by their experiences and are unable to provide comfort to their children. Domestic violence has increased in the camp as a result, with more than 85% of children identifying being beaten – or seeing others beaten – as a major source of ongoing anger and sadness.

The charity’s experts found exposure to extreme levels of violence and deprivation is causing all children interviewed to display clear signs of a condition known as ‘toxic stress’. The condition is the most dangerous form of stress response where the mind is constantly in a fight or flight response.

Left untreated, damage to the brain’s architecture caused by toxic stress can have a life-long impact on children’s mental and physical health, leading to increased instances of heart disease, depression, anxiety, diabetes and substance abuse.

But psychological support for children and their parents is chronically underfunded, with programme needs for 2017 so far just 2% funded. The total UN Humanitarian Response Plan for this year has less than half the funding it needs.

Save the Children is calling for international donors to urgently and significantly increase support for mental health and psychosocial care, and the Government of Iraq to increase investment in training child psychologists and counsellors.

Ana Locsin, Save the Children’s Iraq Country Director, said: “Children escaping Mosul have gone through horror piled upon horror. They have been starved and abused inside the city. Explosive weapons have been dropped in narrow streets by all sides with little regard to their impact. But the impact on children is clear: even if they make it out alive they are left scarred and broken. And right now, that’s what Mosul’s future looks like.

“Life-saving aid like shelter, food and water are crucial in this crisis – but to help children recover and rebuild after their ordeals psychological support must be considered a priority. The world must do more to repair the damage.”