I could see my children broken into pieces of flesh, and I could see my wife burning alive.
Ali (pictured) lived through the months-long battle to re-take Mosul, frequently moving with his extended family in search of safety. His family were killed in an airstrike in Mosul: he spent 5 days trapped in the rubble surrounded by the bodies of over 20 family members.
"The clashes were really intense, using all kinds of weapons – mortars, artillery, being launched from really far away. Airplanes started bombing the neighbourhood, destroying house after house. I saw one airstrike hit seven houses where civilian families were living.
After my family saw what happened to other civilians we were afraid, so we left the house we had been sheltering in and went to a friend's house about 60 metres away. We had to go by foot with the kids through our neighbourhood to get there – we weren’t able to see much, and each family with kids lost track of one or two children on the journey between the homes. It was terrible, the flesh of people who had been killed was strewn about the streets. It was awful for our children to see this.
On 17 March 2017, several rockets hit the home we were sheltering in. I was conscious for most of the time: I could see my kids broken into pieces of flesh, and I could see my wife burning. And I was buried to my chest in rubble.
I stayed like that for five days. All of my limbs were broken. It took me an hour to remove the rubble around my right hand, and then I put my arm in a blanket. At night it was so cold, so in order to sleep I tried to shift the rubble around me to block off any draughts, but every time there was an airplane or artillery strike the rubble moved and I had to start all over again. For those five days trapped in the rubble, the hardest thing to deal with was the smell. It was very difficult to stay alive: even though god made me live, the smell of dead bodies was really too much."
After he was rescued from the rubble, Ali was taken to a hospital in Erbil. He had 64 surgeries in the space of a few months, and now, several years later, he still has not regained the use of his right arm. He is in constant pain, and his ears ring continually.
I spent 7 or 8 days in hospital – because of nerve damage they decided to amputate my leg above the knee because it was going bad.
"There were so many airstrikes, mortars and artillery attacks. At some point it became almost normal. Then one night a bomb hit our roof, and it completely caved in. No-one was injured - we all ran from the house and stayed in a neighbour's house for six or seven months. We were starving – no one had food, because the city was surrounded. In every street ISIS had a kitchen and cooked food but it was very little – for 6 members of my family, we had 6 spoons of rice and 6 spoons of soup. Eventually, with my siblings and our mother, we decided to flee Mosul.
We split into two groups and all carried white flags - pieces of fabric tied to firewood. We spotted the Iraqi army and waved our flags - they motioned for us to come towards them so we did. My brother and sister in law were at the front of the group and started to pass, and I was at the back behind the children – and then the IED exploded. I felt something like a wind and something cut off, then I saw my niece and nephew cut in two and burning and my brother injured with shrapnel, shouting ‘my children, my children,’ and I saw my sister in law, wounded and crying out for her children too. The four children and their parents all died. The children died straight away, and their parents on the way to the hospital. I spent 7 or 8 days in hospital – because of nerve damage they decided to amputate my leg above the knee because it was going bad. I now have a prosthetic leg from the ICRC."
Hashim and his mother rented several houses in Mosul after ISIS was routed, but with many houses destroyed, rents increased and they fell into debt as he struggled to regain his livelihood. He and his extended family now live in a camp for internally displaced persons in northern Iraq.
Conflict-related violence not only erodes a society's capacity to meet the health needs of those directly and immediately effected, but often strains healthcare services to the point of overwhelm. Explosive weapons cause extensive damage to buildings, infrastructure, equipment and ambulances when they hit or detonate nearby, while small arms fire can be devastating to the normal operations of a hospital by killing medical workers and damaging specialised equipment and ambulances. In Iraq, at least half of the health facilities in the majority of conflict-affected cities were damaged or destroyed by the conflict with ISIS, with the damage to these cities’ hospitals alone estimated to be worth $1 billion.
Even where healthcare infrastructure is not directly affected by violence, the destruction of services vital to its successful operation (such as electricity, water, sanitation, and transport routes) can severely erode the capacity of a healthcare system to respond to traumatic injuries and to maintain standards of ongoing care. Medical staff are drawn away from other specialties into trauma or other directly-conflict related practices, diminishing capacity in other areas of medicine including reproductive and gender-specific healthcare. This exacts a heavy toll: in Syria, for example, almost 46% of population deaths over the decade-long conflict have been due to chronic diseases such as cardiac conditions, diabetes, cancer or respiratory diseases such as asthma – higher than the number of deaths caused as a direct result of trauma injuries. As conflict rages, infectious diseases spread due to reduced availability of sanitation and hygiene at a time when the ability to conduct preventive health measures such as immunisation programmes is severely compromised.
Amena was 24 when she was forced to flee her home in Ras al Ain. She has two children aged six and five, and was pregnant with twins when the airstrikes began.
As we fled we saw dead bodies, and blood everywhere, blood running through the streets like it was a river.
"We heard Turkey was going to bomb our area, but we didn't believe it, we thought it was just talk in the news. Then on 4pm on the 8th September 2019, it happened – the airplanes started bombing Ras Al Ain. They bombed everywhere – they were just randomly targeting everywhere suddenly, and everyone fled. Some people were so frightened they even forgot their children and had to go back and get them. It all happened so quickly.
Before the Turkish airstrikes began, I was pregnant with twins. When we fled, the stress made me miscarry. After I lost my twins I continued bleeding and had so much pain in my back. When we arrived at the camp I went to see the women’s doctor here and begged for a thorough exam, but all they had were basic painkillers. I have continued to experience pain in the weeks we’ve been here and sometimes I feel like I can’t breathe, but I no longer go to the clinic as there is nothing they can do. As women we don’t have underwear or anything for when we have our period – we don’t have anything to use. Our husbands also have old injuries that need more treatment, but there is no help for them."
The experience of the group friends took a toll not just on their physical health, but also on the mental health of themselves and their children. They spoke of feeling trapped and helpless, and of losing hope for not only their own futures but the futures of their children. They also spoke of the enduring fear they suffer:
"Right now in the tent the children are laughing, but so often they are sad. We have suffered a lot with so many things. When we were fleeing Ras al Ain we saw dead bodies, blood everywhere, blood in the running through the streets like it was a river. We fled that situation with blood everywhere. I don’t want the children to grow up in this situation. The children know everything, they have seen too much – if they hear a plane overhead they will go inside because they think an airstrike is coming and they are afraid. And us too - I feel afraid whenever there is an airplane overhead, I get a feeling of panic – I am more afraid than the children, and everyone is crying and shouting."
I was afraid for him, because I just had him now, so I didn’t send him to school.
Surya and Ibrahim, a mother and her son, are from Aleppo. Several years into the Syrian conflict, and distressed by near-constant airstrikes, they left Aleppo for Hasakah and the crossed into Iraq in search of safety.
"When we were in Hasakah, if I heard about an airstrike somewhere else I felt so worried for my son Ibrahim. After our experience in Aleppo, it really disturbed me hearing about any airstrikes at all. So I decided to leave Syria and come here to Iraq. My son Ibrahim had previously gone to school in Aleppo, before it became too dangerous. In Hasakah, even though it was safe, I was still afraid for him, because I just had him now, so I didn’t send him to school. I kept him at home as I was just too scared to send him. In Aleppo there were cases of kidnapping of children so I was really afraid for my son. The constant worry really affected me mentally, and the whole time I just wanted him where I could see him."
Sahala (pictured) lives with her husband and six of her nine children in Tulaband village, which was on the frontlines of the battle with ISIS. They fled when ISIS attacked the village, and returned over three years later when the school reopened.
For the first year after the liberation there was no school, no health centre...
"When we came back we did not have electricity at first, and only water from the well. We decided to return when the school was open again for the children to go. For the first year after the liberation there was no school or health centre. We returned back, when these services were open again - they weren’t open before mainly because there were not enough staff to run them. When we got back, the destruction in the village was so sad to see. We are facing a very hard economic situation and we can’t afford to rebuild the house. I don’t know how I feel about the future. I hope maybe one day things will be better than they were before."
We took turns sipping small amounts of water from the lid of a bottle to make it last
"My family and the families around us fled into the mountains. It was summer time so the weather was very hot and we didn’t have any water. There was only one small spring in the mountains for everyone - we fetched water when we could, as did our children. We took turns sipping small amounts of water from the lid of a bottle to make it last. There was no food, nor milk for the children - they were crying from hunger and tiredness. The children kept crying until they could cry no more. Many people got sick. My aunt and father died upon arriving to safety - they never recovered from the strain on their bodies.
After 12 days we heard that there was a safe route out of the mountains - we walked from 8 in the morning until we reached trucks that would take us to safety at 2pm. There were many people walking the same way as us. The trucks first brought us to an IDP camp but the camp was full... then heard about the unfinished houses lying empty in this village and so we came here. Living in these unfinished houses is not good for our children, and conditions are very difficult. There’s only one school at the mountainous end of the village, so it takes a long time for the kids to walk to school, and soon winter will be coming which will be even worse."
After we crossed the border, we finally felt safe.
The bombs started to fall in our neighbourhood. Our son Mohammed, who has a mental disability and is mute, was very scared and was screaming when the airstrikes were happening. We were really scared during the bombing... the sound of the was so loud, the kids were very scared. Mohammed did not understand what was happening, when there were airstrikes all we could do was hold him tightly.
The four of us decided we should leave, mainly for Mohammed but also because the situation was dangerous. It was not an easy journey with our disabled son – he is always afraid when there are loud noises. But after we crossed the border, we finally felt safe.
In the camp, we understand that it is difficult for the camp management to provide us with all we need and we are patient. They are building a school, and the NGOs are giving us food and water. But, there is a shortage of medicine. I love Syria, but we would need there to be security to go back, and that means for our sons not be conscripted into any armed forces or militias as well.
All photos © Article 36/Emily Garthwaite