Psychological impact of COVID-19 in a refugee camp in Iraq

Abstract

The worldwide spread of COVID‐19 is especially causing a humanitarian catastrophe in refugee camps in crisis regions.1 For example, currently over 350 000 survivors of Islamic State of Iraq and Syria (ISIS) terrorism in the Kurdistan region of Iraq live in more than 20 refugee camps. These communities, which had already been traumatized, are now confronted with further adversities that exacerbate the ongoing psychological suffering and lead to increased suicide rates2; however, medical and psychological care is limited,3 and the work of humanitarian actors is restricted.4 Moreover, social distancing is almost impossible in high‐density camps, and hygiene practices are often simply not applicable.5 The objective of our pilot study was to briefly examine for the very first time the development of mental health of a cohort of Yazidis in a refugee camp in Iraq using selective psychometric measures before and shortly after the COVID‐19 outbreak.

The participants were aged between 18 and 58 years (N = 68; mean age = 45.72 years, SD = 3.52 years; 38 females). They had fled from ISIS in 2014 and have since been living in a refugee camp near the city of Duhok, Iraq. This cohort was interviewed in October 2019 prior to the COVID‐19 pandemic and, having adapted the study to challenging circumstances, again in April 2020 during the spread of COVID‐19 through demographic questionnaires, the revised Impact of Event Scale (IES‐R),6 and the Composite International Diagnostic Interview (CIDI).7 Descriptive data are illustrated as the mean values of the standard deviation, and categorical parameters are presented as percentages. The presented comparison of both investigated groups was calculated with χ2‐tests, t‐tests, and a univariate two‐factor analysis of variance. Questionnaires in Kurdish were read by native Kurdish interviewers who had been trained by the research team at the Institute for Psychotherapy and Psychotraumatology at the University of Duhok under the leadership of the first author of this correspondence. The investigation was approved by the University Review Board of the University of Duhok; all subjects gave informed consent.

The refugees had not been taken captive but had friends or family members who had been murdered. They lived in small tents together with 8–12 other people and their educational level ranged from 0 to 12 years of school attendance (mean = 6.8 years, SD = 2.61 years). Approximately 88% of the respondents were victims of a terror attack, 34% had witnessed a person being beaten or tortured, and 69% had lost at least one sibling. The mean initial IES‐R total score for females was 9.2/15 (SD = 2.6, Mdn = 11, range = 10–15) and that for males was 6.2/15 (SD = 2.4, Mdn = 10, range = 10–15). Yazidi who had individually experienced rape or torture were excluded from this investigation because they evidenced markedly high post‐traumatic stress disorder (PTSD) rates and comorbidities even before the COVID‐19 pandemic.8 The different psychometric prevalence rates of mental disorders in October 2019 and April 2020 according to CIDI were calculated and then sex‐matched compared (Table 1). (...)