Kizilhan photo by Annette Ekin from Aljazeera (June-2018)

Trauma Care

Genocide against the Yazidi

In August 2014, ISIS extremists began a campaign of genocide against the Yazidi religious minority in Northern Iraq. ISIS/Daesh murdered Yazidi men and captured over 6,800 Yazidi women and young girls to systematically enslave, serial and gang rape and, in many cases, murder.

The German Model of Yazidi Trauma Care:
Background Information

The Canadian parliament has a Standing Committee on Citizenship and Immigration that is appointed by the House of Commons to investigate and make recommendations as requested, including a 2016 request to research and make recommendations concerning the Yazidi genocide and the plight of the women and girls tortured by ISIS.

On November 17, 2016, the Standing Committee met by videoconference with Dr. Kizilhan and Dr. Michael Blume[1]. Kizilhan and Blume spoke of the extreme gravity of the Yazidi genocide, including the psychological effects on the victims, the therapy being implemented in Germany, and about the moral duty we have to assist Yazidi women and girls.

As far as structure and expertise is concerned Dr. Blume indicated that the German prime minister Winfried Kretschmann “offered all the support we are able to give to Canada”.[1]

Kizilhan and Blume were asked if they would share how they supported the women when they came to Germany. They said ‘yes’, of course, and invited the Canadians to come to Germany and visit them with the Yazidi women and children.[2]

Their recommendations for specific care were ignored and the Yazidi refugees in Canada were pushed onto existing services already overwhelmed by a large influx of Syrian refugees.

Dr. Kizilhan was later approached again, this time by the Canadian medical community because many Yazidi females in Canada were suffering from dissociative seizures. He understood that Canada had not acted on their recommendations: “It’s not enough to just offer them a safe country.”[3]

Based on articles we have read online, the Women Refugees Advocacy Project (WRAP) has championed Dr. Kizilhan’s approach to caring for Yazidi survivors. However, there are details about Dr. Kizilhan’s approach to trauma care that we couldn’t find online. So, through Vanessa, a Canadian friend living in Germany, we approached Dr. Kizilhan and asked these questions.

The German Model of Yazidi Trauma Care:
Questions and Answers

Q.  Could you give us a general idea of the structures you set up for the Yazidi community and their trauma care?  

A.  I approached all levels of government within the province of Baden-Württemberg – cities, mayors, health centres, hospitals, doctors, psychotherapists, psycho-traumatologist and asked which cities, villages, or communities would be willing to accept Yazidi women and children.

I also asked how many refugees they would accept. Thus, the numbers and names of those Yazidi who were to come to Baden-Württemberg (Germany) were determined before their arrival. Each Yazidi group was allotted a trauma care team. I will talk more about teams later.

For example, the city of Konstanz received 80 women and children. This number was too great for one group, so two groups were formed. Each group remained close; they were housed near one another. The housing facilities were normal houses, flats, old rooms in hospitals. You name it; wherever space was available.

Q.  How did you choose who would come?

A.  In August 2014, from the refugee camps in Northern Iraq, I chose the women and girls who would be brought to Germany. I based my choice on who had the best chance of benefiting from therapy, through medical exams, preliminary therapy sessions and research.  

My criteria for selection: first-time captivity by ISIS, medical severity (physical and psychological trauma), and those females who would not be accepted back into their communities. According to their religion, any sexual contact with non-Yazidi will result in exclusion from the community. The Yazidi have a traditional patriarchal society and culture, a culture of shame. When a Yazidi female is raped it is considered a violation of Yazidi honour.

Though thirty-five men survived the genocide, I only brought women and children to Germany. If entire families were to have come then, in effect, this would have limited the number receiving care to approximately only 200 instead of the 1,100 women and girls whom we did help. The men/family members left behind could eventually join the women and girls under a family law program in Germany.

Q.  Who other than the therapists received training?

A.  The trauma care teams consisted of trained physicians, social workers, nurses, trauma therapists, psychotherapists, counselling psychologists, psychiatrists and translators. Psychiatrists were included in the team because some survivors needed to be medicated. Translators were native speakers. It was very important that they understood language and cultural nuances, idiomatic expressions, and symbolism in the language. For example, a translator would need to know that pain in the area of the liver symbolizes a broken heart. Languages spoken by the translators included Kurdish, Arabic and German.

I was the one who provided all team members with specialized training. The training consisted of background comprehension of the Yazidi culture and society, nursing and severe trauma care, and culturally adapted cognitive behavior therapy for the respective therapists. All staff received training in cultural sensitivity.

The Yazidi survivors were greeted at the airport by their entire team. The team knew who and how many Yazidi were arriving, and organized everything.

Two social workers, similar to nurses in Canada, and a translator remained with the Yazidi women and children 24/7 for the first three months. After that, they were with them for regular working hours, 8:00am to 5:00pm.

Many team members also faced another issue, their own traumatization (otherwise known as secondary traumatization) from hearing of the Yazidi’s torture by ISIS.

Q.  Where did the therapy take place? We know sessions took place in the community, and was there anywhere else?

A.  Therapy sessions never took place at home. One of the goals of this program was for the Yazidi to become completely independent and self-sufficient. And to integrate into society. Therefore, they learned to move about in society and get themselves where they needed to go, without assistance. Orientation to their environment was crucial. Along with language classes they needed to learn about traffic lights, shopping, money, how to get to their medical appointments, as well as how to get the children to school. The aim was for these survivors to regain control over their lives, mentally and physically. This, of course, included overcoming fear and learning crisis techniques. Social workers helped with this. 

Three pillars of this trauma care program are orientation, which I already mentioned, stability and security. For some, stability took longer to establish so extra time was given to those who needed it, BEFORE starting therapy. In order to start the healing process, these women and children desperately needed security in their lives, to be protected from physical harm and the potential of harm. Hence, the need for anonymity and safe housing.

Q.  What would be a realistic way for people here in Canada to get the specialized training needed to effectively provide Yazidi trauma care? 

Could trainers from Germany come to Canada, or would Canadian trauma care providers go to Germany, or a combination of both? Or could web conferencing be used to learn from you?

 A.  Yes to all four. It would be more economical to have me come to Canada to offer training. However, if the money is available, Canada is more than welcome to send team members to me in Germany.                     

The trauma care program in Canada will not resemble exactly that which has been implemented in Germany. Canada is dealing with intact, or somewhat intact, families. Therefore, the Yazidi in Canada will require family therapy, community therapy and community support. The refugee family members know very little, or nothing, about mental illnesses and mental disorders, and have, most likely, little or no knowledge of how to deal with episodes of fear, angst, alienation and flashbacks. The entire family must be integrated into the therapy, not just the traumatized woman or girl. And community education is needed to educate the public about the Yazidi plight and their cultural norms.

Q.  What was included in your budget?

A.  Our budget was 95 million euros. It included everything – transportation, housing, salaries, therapy and all other medical costs.

Q.  What happened after 2018?  Did the comprehensive therapy end, did the community disperse, was it repurposed and if so, in what way?

A.  The program ends this year (2020).  The Yazidi can decide to remain in Germany on a permanent basis, return home or move on.  If they stay, they receive a health insurance card, which allows them access to the medical system.  There is absolutely no pressure to leave and/or return home. If further care is needed, I have 20 beds in a nearby clinic for those still in need of medical attention requiring hospitalization.

Q.  Has your model of Yazidi trauma care been copied in other parts of Germany or in other countries?

A.  Brandenburg has 100 people in a similar program. There are 70 in Niedersachsen, 30 in Schleswig-Holstein, and 200 families in France.

Our heartfelt thanks to Dr. Kizilhan for sharing this important information.

Further reading:
Germany opens its doors to Yazidi women and children enslaved by Isis
By Lara Whyte, The Guardian, March 2, 2016
What Canada can learn from Germany’s Yazidi refugee relocation program
By Levon Sevunts, rcinet.ca, November 30, 2016
‘They raped us; they killed our men’: Psychologist helps Yazidi women recover from trauma of ISIS captivity
Yazidi women and families are finding security and therapy in Germany
By Nahlah Ayed, CBC News, Jan 09, 2017
Once Used as Sex Slaves by ISIS, These Yazidi Women Are Rebuilding Their Lives
By Yuka Tachibana and Kelly Cobiella, NBC News, Sept 24, 2017
Jan Kizilhan: ISIL rape victims need culture-sensitive therapy
By Annette Ekin, Aljazeera, 10 Jun 2018

Bibliography:
Trauma Workbook for Psychotherapy Students and Practitioners
by Jan Ilhan Kizilhan (Author), Nadine Friedl (Author), Florian Steger (Author), Nina Rüegg (Author), Pascal Zaugg (Author), Christian Thomas Moser (Author) (2019) Pabst, Wolfgang Science
Trauma and Recovery: The Aftermath of Violence – from domestic abuse to political terror
by Judith Lewis Herman (1997) (1992) New York: Basic Books
Group Trauma Treatment in Early Recovery: Promoting Safety and Self-Care
by Judith Lewis Herman, Diya Kallivayalil, and Members of the Victims of Violence Program, November 19, 2018, Guildford Press

Footnotes:
[1] Nov. 17/2016 (Standing Committee on Citizenship and Immigration)
[2] What Canada can learn from Germany’s Yazidi refugee relocation program
By Levon Sevunts, rcinet.ca, November 30, 2016
[3] A Yazidi family’s traumatic first days in Canada
By Naomi Buck, Chatelaine, Maclean’s, Dec 16, 2017