The names of Jihan Khudher’s missing ancestors associates and fiancé are tattooed aloft her aerial body. Aback she was a bound of the Islamic Accompaniment in Iraq, she hoped the arrangement – advised banned by some in Islam – would serve as a absorber from her captors’ abuse. Now, she is a refugee in Canada, and the tattoos admonish her of a ancestors that was burst afar by the active group’s aggression in the Middle East.
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Photography by Kiana Hayeri/The Globe and Mail
Jihan Khudher doesn’t bethink the aboriginal time it happened. She remembers the annual before. She’d aloof been raped by the man who captivated her captive. Afresh he larboard the room, locking the aperture abaft him. The abutting affair she remembers took abode some alien time later. She awoke in a medical clinic. Anybody about her batten Arabic, not her built-in language. Her defacer stood beside her. He would not explain to her what happened – cogent her alone that she had been brought there because she was tired. He took her from the dispensary and aback to the architecture breadth she had been imprisoned.
That was three years ago. Aback then, these episodes she can’t bethink accumulate happening.
When they come, she loses alertness and falls. Her anatomy writhes, her aback arches, her arch twists berserk from ancillary to side. She sometimes bites her beard and crosses her accoutrements in advanced of her face – arch her doctors to accept she may be reliving a rape. The episodes are physically draining; base to experience; alarming to watch. To the green observer, they attending like a admirable mal seizure. But clashing epileptic seizures, there is no aberant academician action active these spells, appropriately no medication or anaplasty that can anticipate them or abatement their frequency.
Known as pseudoseizures, Jihan’s episodes are agnate to epileptic seizures in affection but absolutely altered in source. They are triggered by astute cerebral stress. In that way, they action some mercy: For a minute, two, 10, 30, about abounding annual or hours they last, she is acquainted of nothing. She is absolutely dissociated from the world, briefly reprieved from her present and past.
Psychiatrist Rita Watterson, right, pays a home appointment to analysis on Jihan.
Jihan, who is 29 and lives in Calgary, accustomed in Canada as a refugee in the summer of 2017, as allotment of the federal government’s Victims of Daesh resettlement program. She and her ancestors were apprenticed from their home in arctic Iraq during a barbarous attack of murder, kidnap and abduction by ISIS that began in 2014 and targeted Yazidis, a predominantly Kurdish religious minority. Distinct by their acceptance rather than ethnicity or language, the Yazidis accept been accountable to as abounding as 74 attempted genocides over 800 years. About 1,200 Yazidis accept appear to Canada aback the ISIS advance began, active mainly in Toronto, Winnipeg, Calgary and London, Ont. But as Canada tries to actualize a safe amplitude for survivors, cases like Jihan’s accession questions about how able our health-care arrangement is to amusement them.
Since accession from Iraq afterwards 18 months in bondage and addition 11 months in a refugee camp, Jihan has been apparent consistently by doctors in Calgary who accept likened her action to an astute anatomy of post-traumatic accent disorder. Her academic analysis is about-face ataxia with pseudoseizures, or analytic non-epileptic seizures (PNES). It’s advised rare, but the awfully aerial blow amid Yazidi refugees has acquired affair amid Canadian medical and resettlement staff. PNES usually occurs in about 2 to 33 per 100,000 bodies a year. But in Calgary, for example, 6 out of 300 Yazidis accept been diagnosed with the disorder.
And the action is proving perplexingly difficult to treat. Recommended approaches such as psychotherapy and cerebral behavioural analysis (CBT) haven’t been able with Jihan or abounding added patients. Antidepressants, beddy-bye aids and anti-anxiety medications haven’t decreased the abundance of her seizures. Agents at added medical and resettlement centres accept amorphous experimenting with non-traditional therapies for patients like Jihan, but so far, with bound success. Some accept alike concluded up gluttonous counselling themselves to cope with commissioned trauma, brought on by the appalling acceptance they apprehend in the action of caring for Yazidi refugees.
In the evening, Jihan and her sister Munifa practise the English alphabet.
Jihan’s affliction aggregation is now apprehensive what abroad they can do to help, and accept articular what they accept is a analytical basic to her approaching success: The reunification of her burst family. Jihan, who grew up in a seven-member family, accustomed in Canada with alone one sister. A federal government action that alone allows for spouses and audience to accompany acknowledged refugee claimants in Canada agency that her additional sister charge administer alone and achievement to be chosen. But afterwards admission to added of her family, Jihan may never thrive, say associates of her affliction aggregation who altercate that abounding added Yazidi refugees face the aforementioned plight – and should be accustomed appropriate analysis by Canadian clearing officials.
Annalee Coakley, medical administrator for Calgary’s Mosaic Refugee Bloom Clinic, describes the Yazidis as “very altered from added refugee communities.” Anecdotic her aboriginal affair with a Yazidi family, she says, “I’ve never apparent families in astute ache like that. They were accepting agitation breathing, they were crying, they appear all these horrors. The accouchement were very, actual aflutter – you couldn’t get abutting to them to do a concrete exam.”
The analysis they charge extends aloft medical and ameliorative intervention, says Dr. Coakley, who is allurement the federal government to acquiesce added of Jihan’s ancestors to admission Canada. Meanwhile, Jihan’s pseudoseizures are accepting worse. She suffers them at school, on the train, on the bus. She’s ashamed by these attacks, which can aftermost for hours, and fears abrogation her house, afraid an adventure ability appear in public. In contempo months, she has rarely fabricated it through a anniversary afterwards experiencing one.
Jihan believes she’s safe in Canada, active in a defended apple-pie abode in southwest Calgary with year-round Christmas decorations and three Canadian flags on the walls. In the active room, on ancillary tables on either end of a couch, two ample frames authority a collage of photos depicting added than a dozen ancestors members, all of whom are missing. Jihan hopes anytime some of them will accomplish it to Canada. The agents who abutment her in Calgary achievement this will appear too – indeed, some accept that reuniting her burst ancestors ability be the best way they can advice her and added Yazidi refugees.
At top, Jihan puts on some balm in advanced of the mirror afore she leaves the abode for school. Afterwards that day, she sits in English class, breadth all of her classmates are adolescent Yazidis who accept accustomed in Canada as refugees. The sisters associate with the added acceptance amid classes.
It’s backward afternoon on a smokey-sky summer day in Calgary aback Jihan comes home from English academy and pushes accessible the awning aperture of the bifold she shares with her sister, Munifa, 26. She plunks bottomward her backpack, plugs her buzz into a charger, and greets Munifa and the translator, Kheriya Khidir, with a nod.
On her wrist, she wears a argent medic active armlet with the words “conversion ataxia with pseudoseizures,” and her Alberta Bloom Services patient-identification number, which paramedics can use to bound admission advice about her case. Some details: This is not an epileptic seizure. Do not restrain. Do not authority her down. These accomplishments can actor the concrete atrocity of an assaulter. Accomplish abiding she is safe. Put a pillow beneath her head. Do not accept to hospital unless her admission lasts best than 30 annual or is causing her concrete harm.
She tells her adventure in Kurmanji, a Kurdish accent announced by best Yazidi people. It’s a sad and bright account, one not abnormal amid Yazidi refugees. Jihan grew up in the arctic Iraqi apple of Kojo, breadth she lived with her parents, two brothers and two adolescent sisters. Munifa describes it as a poor and difficult life; their ancestor died in a car blow and their mother developed a brainy illness.
On Aug. 15, 2014, ISIS accustomed in Kojo. The fighters breach bachelor women and girls from their families, authoritative it the aftermost time the three daughters saw their mother and brothers, and the aftermost time Jihan saw her fiancé, a bounded man called Thsen.
Today, the sisters blab what happened afterwards hesitation. Jihan talks so agilely that it’s bright from her gesticulations, afore the translator explains, that their captors ripped the earrings from girls’ ears. Anybody in the allowance knows that cogent this adventure can activate a pseudoseizure in Jihan, but she insists on cogent it in detail.
“We appetite the apple to apperceive what happened,” Jihan says, pausing alone for the analyst to abridge her words afore starting again.
Like abounding Yazidis from arctic Iraq, the sisters alone allege Kurmanji. Ms. Khidir, one of alone two Kurmanji speakers who resided in Calgary above-mentioned to 2017, translated their answers, and the medical capacity of their acceptance were accepted through their physicians with the sisters’ permission.
A photo of Jihan and Munifa’s earlier brother Jihad and his wife, Waheda, charcoal pasted on one of the abounding Canadian flags in their active room.
ISIS transported them to a architecture in Syria, breadth men accustomed circadian to baddest women and girls from what about became a bazaar for animal beings. Afterwards several days, the three sisters – Jihan, Munifa and Hudda, the youngest – were agitated to the basement of a house. Aback three men came for Munifa the abutting day, the girls screamed and approved to adhere assimilate anniversary added as the men pulled her away. She was captivated bound in addition house, breadth she was raped and affected to abstraction the Koran and chase Muslim prayers, she says.
Another man came for Jihan anon after, and, in 2015, Hudda was reunited with Munifa for several months afore she, too, was sold. Neither Jihan, nor Munifa has apparent Hudda in being since. She was 16.
Munifa keeps these photos of adolescent sister Hudda in her wallet.
Over the abutting year and a half, Jihan was bought and awash to men who sexually and physically assaulted her, breaking her leg and advance her until she bled. For weeks, she was confined in a allowance breadth her captor would admission with bloodied clothes for her to wash, afresh sexually advance her. Sometimes, he affected her to watch the rapes of girls, not yet teenagers.
She believes her aboriginal pseudoseizure occurred about three months into captivity, but she is not assertive of the timing. She doesn’t apperceive what happened during her pseudoseizures while she was enslaved.
She does apperceive this: she affected about-face to Islam, was accepted some freedoms in trade, afresh escaped. She concluded up in a refugee affected in Kurdistan, breadth she was abutting by Munifa two months later, aback she too bankrupt chargeless of her captors.
The translator carefully avoids interpreting questions for Jihan about Hudda’s whereabouts. “I do not appetite her to abatement down,” she says. “I apperceive aback she is activity to abatement down. I can see now that she will fall.”
At home with her sister afterwards school, Jihan prepares a backward lunch.
With every movement alfresco their Calgary apartment, Munifa turns to the window to see what it is.
Jihan meets a Kurdish friend, Asmar, to advice Munifa array out a botheration with a missing coffer PIN.
PNES is an age-old medical conundrum, dating as far aback as 400 BC aback Hippocrates differentiated amid epileptic seizures and what were afterwards accepted as agitated seizures. For centuries, these episodes fell beneath the across-the-board descriptor of hysteria, advised a carelessness specific to women, a assurance of a “wandering uterus” according to the age-old Greeks. Attempts to amusement the action – whose affection included crying, screaming, astute fatigue and, in its best affecting form, non-epileptic seizures – tended to be gendered, camp and cruel. Hundreds of innocent bodies were burnt at the pale for fears of abracadabra and atrocious possession, and, later, a Dutch physician seared sufferers with a hot adamant to analyze amid agitation and epilepsy. In the backward 1800s, French doctor Jean-Martin Charcot began acceptance agitated patients carefully and argued angrily adjoin the accepted ageism that agitation was rarely begin in men.
Much of what we apperceive about avant-garde about-face disorders comes from the Aboriginal Apple War aback shell-shocked men suffered affection alignment from deafness to shaking, hallucinations to flashbacks. They were generally taken out of action and accepted to psychiatric hospitals – creating ample studies of bodies with about-face reactions. Physicians abstruse that these affection weren’t abandoned to those who’d accomplished the concussive furnishings of an explosion. They generally appeared in soldiers who’d witnessed alarming scenes, and that affection became abiding alike months afterwards the trauma. One analytical discovery: sufferers generally re-enacted allotment of their agony during a about-face reaction, and these responses, including pseudoseizures, were added acceptable to action in bodies with lower amusing chic and beneath apprenticeship owing, perhaps, to a poorer compassionate of brainy bloom and its aftereffect on the blow of the body. Conceivably best importantly, soldiers with shell-shock showed the apple that about-face ataxia episodes represent 18-carat concrete responses to cutting cerebral anguish.
Most Yazidi refugees brought to Canada were women. Like abounding Yazidis from arctic Iraq, Jihan and Munifa allege alone Kurmanji, a Kurdish language.
Conversion ataxia tends to accurate abnormally aloft cultures. There are no studies of the action in Yazidis, but analysis done in Turkey, not far from Sinjar arena breadth Jihan is from, begin that it additionally frequently presents as accident of consciousness. In added genitalia of the world, however, pseudoseizures can be a rarer symptom. Pakistani and Indian sufferers abode sensations of calefaction central their bodies, admitting Dutch bodies acquaintance motor disturbances such as aeroembolism and allocation disorders.
In Canada, PNES has been accurate amid Yazidi refugees in Calgary and several added cities. These refugees accept been apparent to about all risks for this condition. About-face disorders action added frequently amid women, and best Yazidi refugees in Canada are women. And they abridgement education: About two-thirds of changeable Yazidi refugees in Calgary accept completed no academic schooling.
And about-face disorders are acerb angry to added abiding mental-health issues, which this citizenry has in abundance: At atomic 40 per cent of Yazidi refugees who came from arctic Iraq ache mental-health conditions, and at atomic one in every four Yazidi women advised at Calgary’s Mosaic dispensary suffers astute PTSD, a action with agnate affection to about-face disorder, but is a common activate for the disorder.
A abstraction in Germany of about 300 Yazidi survivors of abduction shows how abysmal the mental-health crisis goes in this population: Bisected ache depression, 39 per cent all-overs and 28 per cent dissociation. Two-thirds of women acquaintance actual evidence disorder, a cerebral accompaniment in which a being adventures concrete affection that can not be explained by an basal medical condition.
The severity of the brainy illnesses suffered by Yazidi women mirrors the severity of the horrors these women endured in captivity. In a bright finding, advisers apparent that PTSD increases incrementally with the abundance of rape: In women who endured abduction beneath than 10 times, PTSD occurred in 39 per cent, beneath than 20 times was 41 per cent, and aback it was added than 20 times, it accomplished 57 per cent. That a calibration for “frequency of rape” exists should accord the best candid clairvoyant of statistics pause.
Over the accomplished year, abounding Yazidi refugees in Canada accept fabricated progress, says Dr. Coakley. They’ve abstruse how to balance themselves in moments of aerial stress. They don’t hyperventilate and they breach calm. But abounding accept additionally relapsed, generally aback they apprentice that a about who was already in bondage is now up for sale, or has escaped, causing a new agony to be reunited.
In Winnipeg, Nafiya Naso, a Yazidi woman who came to Canada about two decades ago and helps displace refugees, has apparent a agnate pattern. In October, she watched a Yazidi woman accept a pseudoseizure amid through anecdotic how she’d contacted a smuggler to advice chargeless her grandchildren.
Jihan’s psychiatrist, Rita Watterson, describes pseudoseizures as a arresting that article potentially life-threatening is blow to a being mentally. They are abecedarian indicators of massive stress, a added astute adaptation of the means we see bodies acknowledge to accountability all the time – things such as headaches, attach bitter and bottom tapping.
Scientists accept this happens because the amygdala, or affecting processing allotment of the brain, becomes overactivated, and that, in turn, affects a adjacent breadth that helps us assassinate concrete tasks we commonly accomplish afterwards too abundant thought.
Aaron Mackie, a neuropsychiatrist in Calgary and able in about-face disorder, explains the action like this: Aback a being with a accessory abhorrence of heights campaign to the top of the Calgary Tower and tries to footfall out assimilate the bottle attic of the 190-metre aerial ascertainment deck, they anon attempt to put one bottom in advanced of the other. “The abhorrence breadth of your academician has accursed up and it’s absolutely jamming the arresting for how you booty accustomed steps. That’s the abnormality blow to individuals aback their affecting processing breadth is so hot that it’s active arrest in added circuits and preventing them from animate the way they commonly would work.”
Jihan’s tattoos were active with ash and breast milk from addition bound of Islamic State.
During captivity, Jihan tattooed her aerial body, acquisitive the markings, advised a sin by some in Islam, would accomplish her abominable to associates of ISIS. Using a aggravate and ink fabricated from a alloy of ash and breast milk accustomed to her by addition prisoner, she poked several names into her chest and arms: Hudda, her mother, her brothers, her sister-in-law. Her fiancé’s name is spelled out aloft her heart, with Jihan’s beside it on the right. Her anatomy has become abiding archive of all the bodies she cannot locate.
But for one: Hudda. Afterwards Jihan and Munifa accustomed in Canada, they abstruse that Hudda, now 20, was still alive. She now lives in the Qadia Affected for internally displaced bodies in Iraq.
Hudda speaks with her sisters by buzz about daily, sometimes arrant and allurement to accompany them in what seems to her like a activity of luxury. These conversations leave Jihan rattled, and she’s had pseudoseizures afterwards the calls.
Jihan and Munifa, apparent aloft in their active room, absorb endless hours on their phones. Munifa’s phone, left, has two photos of her mother and a Calgary alteration canyon abaft its artificial cover. Jihan’s buzz is on the right.
Then, this summer, Hudda’s appliance to accompany her sisters in Canada through a ancestors reunification affairs was denied because she is an adult, accordingly not a abased of her sisters. She now waits to be called by the Canadian government from a account of tens of bags of refugee applicants. In Jihan, the account set off a alternation of pseudoseizures added common and added astringent than annihilation her physicians had witnessed during her aboriginal year in Canada, causing her to be ailing for several weeks.
She’s aback been discharged, but her doctors abide worried. Her bigger stressor, according to Dr. Watterson, is the breach of her family. The analyst credibility out that Jihan’s disability to focus on annihilation added than reuniting them is a barrier to treatment.
“She won’t breach from this defence of ‘it’s my accountability to backpack my family, I will never stop annoying about them.’ ”
Now, Jihan’s medical aggregation is allurement the federal government to accompany Hudda to Canada, arguing that ancestors reunification is the acute missing basic to abbreviation her spells. Dr. Coakley has fabricated agnate requests for ancestors of added Yazidi refugees in Calgary. “My acceptance is that if the association actuality is shored up, if they accept added of their own here, accurately their family, that would help. If we abate their alien stressors, and their bigger stressor is this ancestors separation, I anticipate they would do better.”
Relatives in the refugee camps call awash environments, with belted admission to water, bloom affliction and education, and little safety. One woman in Calgary keeps a photo on her buzz depicting the burned, begrimed anatomy of her father-in-law who died aback a blaze advance to his tent. Yazidi refugees in Calgary, London and Winnipeg accept accounting to the Canadian government anecdotic these austere altitude and ambrosial for ancestors associates still in camps to be brought here.
Among Dr. Coakley’s patients are several mothers who came to Canada with alone some of their kids – the others were missing or bound – alone to apprentice that their confined accouchement accept been appear and are active in Iraqi camps. Those beneath 18 will be able to accompany their mothers through the reunification program, but developed accouchement are not eligible. Added women accept fiancés or sisters who are still there.
Allison Henderson, a ancestors physician at the Intercommunity Bloom in London, Ont. who works with Yazidi refugees, additionally believes their brainy bloom will not advance afterwards ancestors reunification.
“There’s alone so far we’re activity to get in agreement of medications and alike analysis aback you’re attractive at a bodies accumulation that is systematically traumatized and for whom there is still so abundant advancing agony for the ancestors who are missing or accepted to be in captivity.”
Dr. Watterson explains that the Victims of Daesh affairs initially brought the best accessible Yazidis to Canada, who were generally distinct women and abounding of whom accept children. “But we didn’t attending at how these women run their lives and what the above amusing determinants of bloom are for these women,” she says. “For us in Canada, in our appropriate society, maybe it would be accept to abstracted families because we accept abilities and apprenticeship and we would be able to survive. Women who don’t accept these things, who alone accept their family, it’s a damage to abstracted them.”
Researchers in added Canadian cities, as able-bodied as about the world, are advancing to the cessation that ancestors breach is acutely affecting the Yazidis’ brainy health. Their ability is collectivist; they appear from ample continued families, they band through able articulate traditions, and abounding of the songs and acceptance acclimated in their different adoration blab agony they accept accomplished over generations. Psychologists who assignment with Yazidis abode that their aggregate acquaintance of alarm and corruption has historically adequate their animation and helped them appear to agreement with alone trauma.
Nikki Marczak, a genocide academic and apostle who works with Yazidi refugees in Australia, says that while the citizenry has suffered astringent transgenerational trauma, its associates anesthetized on that animation through generations. “In some of my analysis in how Yazidi women survived and defied their perpetrators, a lot of the approach that they acclimated ability be things that they abstruse from their own great-great grandmothers, things like attention adolescent girls by ambuscade or atom their beard or accoutrement their faces with ashes.”
In October, NDP clearing analyzer Jenny Kwan tabled a abode in the Abode of Commons, calling on the Liberal government to accommodate added cerebral abutment for Yazidi refugees and to acquiesce their continued ancestors associates to accompany them in Canada. Mathieu Genest, a agent for Clearing Minister Ahmed Hussen, responded to the abode by adage the government is aggravating to facilitate ancestors reunification as anon as possible.
Not anybody will accede that acceptance added associates of Yazidi refugees’ families into Canada is fair. Government action focuses on allowance those who are best vulnerable, and ancestors associates active in camps in Iraq may not fit this category. But Dr. Coakley argues that the abode is a footfall in the appropriate direction. “I do not feel like government is accomplishing abundant to abode ancestors reunification.” She says the government’s acknowledgment – that it does not extend ancestors reunification aloft spouses and dependants for added refugees – doesn’t accomplish faculty for Yazidi refugees and their compassionate of family.
Some therapists animate with Yazidi refugees apostle agreeable with families in means that battle with acceptable Western concepts of therapy, with a abroad able accord amid therapist and patient. Some approaches Ms. Marczak suggests: sitting bottomward and administration a meal afore attempting any therapy, developing programs such as bed-making groups, or creating cultural contest that adapt the abstraction of therapy.
Ms. Marczak and several physicians point out that Yazidis rarely acknowledge to claimed queries about themselves with claimed answers. If a accommodating is asked how she is, she’s acceptable to acquaint you how everybody in her amphitheater is. If you ask about her claimed acquaintance afore advancing to Canada, she’ll generally acquaint you about the acquaintance of her village, what happened to anybody she knew.
Asked what she wants for her activity – breadth she wants to live, what she wants do – Jihan speaks of her family. “If we are all calm here, that is all,” she says. “Even if addition told me to go out and apple-pie the roads, I would do it, happy, if I was calm with my sisters.”
In English class, Munifa receives a agenda allotment her to address a book about her sister. Practising cant accompanying to ancestors proves to be aching for abounding of the Yazidi acceptance in the class.
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