Healing after Genocide: A Cross-Sectional Study on Emotion-Focused Coping and Psychosocial Recovery among Yazidi Survivors
Main Article Content
Abstract
Background: A decade after the 2014 genocide, Yazidi survivors in Northern Iraq continue to face intersecting challenges of psychological distress, displacement, and inadequate access to care. While prior research has documented elevated symptom burdens, little is known about current coping preferences and structural risk factors in this population. This cross-sectional study investigates the relationships between emotion-focused coping strategies, psychotherapy access, structural vulnerabilities, and mental health symptoms among Yazidi survivors.
Methods: A total of 346 Yazidi adults, both displaced and non-displaced, participated in structured interviews across various settings in the Kurdistan Region of Iraq. Participants completed validated measures of posttraumatic stress disorder, depression, and anxiety, and rated the perceived helpfulness of culturally relevant coping strategies. Statistical analyses included group comparisons, repeated-measures analysis of variance, and correlational analyses.
Results: Only 36.4% of participants had any contact with mental health services, with psychotherapy rated as one of the least helpful strategies. Spiritual and internal coping mechanisms—such as prayer and belief in personal or collective strength—were perceived as most helpful. Psychotherapy use was higher among those with the greatest symptom burden. Structural vulnerability (camp residence, unstable income) significantly predicted elevated distress.
Conclusion: Yazidi survivors rely primarily on culturally grounded coping strategies rooted in spirituality and community, while access to formal care remains limited and stratified. Psychosocial support must be integrated with structural assistance, justice mechanisms, and cultural traditions to foster sustainable recovery.
Keywords:
Yazidi, Genocide, Recovery, Resilience, Cultural Coping, Mental Health Access, Transgenerational Trauma
Article Details
How to Cite
KIZILHAN, Jan Ilhan; WEIGELT, Anna.
Healing after Genocide: A Cross-Sectional Study on Emotion-Focused Coping and Psychosocial Recovery among Yazidi Survivors.
Medical Research Archives, [S.l.], v. 13, n. 7, july 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6772>. Date accessed: 05 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i7.6772.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. Six-Hohenbalken M. May I be a sacrifice for my grandchildren—Transgenerational transmission and women’s narratives of the Yezidi ferman. Dialectical anthropology. 2019;43(2):161-183. doi: 10.1007/s10624-018-9506-9
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5. Jäger P. Stress and health of internally displaced female Yezidis in Northern Iraq. Journal of immigrant and minority health. 2019;21(2):257-263.
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9. Goodman A, Bergbower H, Perrotte V, Chaudhary A. Survival after sexual violence and genocide: Trauma and healing for Yazidi women in Northern Iraq. Health. 2020;12(06):612.
10. Al Shawi AF, Hassen SM. Traumatic events, post-traumatic stress disorders, and gender among Yazidi population after ISIS invasion: A post conflict study in Kurdistan–Iraq. International Journal of Social Psychiatry. 2022;68(3):656-661.
11. Ahmed DR, Mesbah SM, Al Diab Al Azzawi M, Heun R. Trauma and mental health problems among Iraqi IDPs following the 2014 ISIS Invasion: a systematic review. Medicine, Conflict and Survival. 2024;40(4):366-387.
12. Schouler-Ocak M, Laban CJ, Bäärnhielm S, Kastrup MC, Dein S, Wintrob R. Transcultural psychiatry: Refugee, asylum seeker and immigrant patients over the globe. Advances in Psychiatry. 2019:637-655.
13. Hassan G, Ventevogel P, Jefee-Bahloul H, Barkil-Oteo A, Kirmayer LJ. Mental health and psychosocial wellbeing of Syrians affected by armed conflict. Epidemiology and Psychiatric Sciences. 2016;25(2):129-141.
14. Kizilhan JI, Friedl N, Neumann J, Traub L. Potential trauma events and the psychological consequences for Yazidi women after ISIS captivity. BMC Psychiatry. 2020/05/24 2020;20(1):256. doi:10.1186/s12888-020-02671-4
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17. Al Shawi AF, Hassen SM. Traumatic events, post-traumatic stress disorders, and gender among Yazidi population after ISIS invasion: A post conflict study in Kurdistan – Iraq. International Journal of Social Psychiatry. 2022;68(3):656-661. doi:10.1177 /0020764021994145
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19. Pagotto LF, Mendlowicz MV, Coutinho ESF, et al. The impact of posttraumatic symptoms and comorbid mental disorders on the health-related quality of life in treatment-seeking PTSD patients. Comprehensive Psychiatry. 2015;58:68-73.
20. Kizilhan JI, Sennhauser L, Wenzel T. Suicidality after the genocide against the Yazidi in Iraq in 2014. Psychological Trauma: Theory, Research, Practice, and Policy. 2024:No Pagination Specified.
21. Syrian Civic Platform. Syrian Refugees in the Kurdistan Region of Iraq: Harsh Conditions and Marginalization. 2018. https://www.scplatform.net/en/wp-content/uploads/2018/11/Syrian-Refugees-in-the-Kurdistan-Region-of-Iraq-.pdf
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23. Kurdistan Regional Government. Kurdistan Region a shelter for about one million refugees and IDPs. Kurdistan Regional Government,. Accessed 09.08.23, 2023. https://gov.krd/dmi-en/activities/news-and-press-releases/2023/january/kurdistan-region-a-shelter-for-about-one-million-refugees-and-idps/
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27. Tawfik-Shukor A, Khoshnaw H. The impact of health system governance and policy processes on health services in Iraqi Kurdistan. BMC International Health and Human Rights. 2010/06/ 08 2010;10(1):14. doi:10.1186/1472-698X-10-14
28. Shabila NP, Al-Tawil NG, Tahir R, Shwani FH, Saleh AM, Al-Hadithi TS. Iraqi health system in kurdistan region: medical professionals' perspectives on challenges and priorities for improvement. Conflict and Health. Nov 30 2010;4:19. doi:10.1 186/1752-1505-4-19
29. United Nations Office of the Iraq Programme Oil-for-Food. Implementation of the Oil for Food: a chronology. Accessed 01.08.23, 2023. http://www.un.org/Depts/oip/background/chron.html
30. Al Hilfi TK, Lafta R, Burnham G. Health services in Iraq. The Lancet. 2013;381(9870):939-948. doi:1 0.1016/S0140-6736(13)60320-7
31. Price RA. Iraqi State Capabilities. 2018. 18.05.2018. https://core.ac.uk/download/pdf/286048575.pdf
32. Karadaghi G, Willott C. Doctors as the governing body of the Kurdish health system: exploring upward and downward accountability among physicians and its influence on the adoption of coping behaviours. Human Resources for Health. 2015/06/04 2015;13(1):43. doi:10.1 186/s12960-015-0039-x
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34. Koya University. Koya University facilitates a mental health and psychological support center. Accessed 01.08.23, 2023. http://koyauniversity.org/ar/node/138
35. Murakami NJ, Akilova M. Integrative Social Work Practice with Refugees, Asylum Seekers, and Other Forcibly Displaced Persons. Cham Springer International Publishing AG 2022; 2022.
36. Böge K, Hahn E, Strasser J, Schweininger S, Bajbouj M, Karnouk C. Psychotherapy in the Kurdistan region of Iraq (KRI): Preferences and expectations of the Kurdish host community, internally displaced- and Syrian refugee community. International Journal of Social Psychiatry. Mar 2022;68(2):346-353. doi:10.1177/0 020764021995219
37. Shukor AR, Klazinga NS, Kringos DS. Primary care in an unstable security, humanitarian, economic and political context: the Kurdistan Region of Iraq. BMC Health Services Research. Aug 23 2017;17(1):592. doi:10.1186/s12913-017-2501-z
38. World Health Organization. MHPSS Situation Analysis: Anbar province and KRG, Iraq. 2016. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjT-4KSrcCAAxXM6aQKHQ3OAvgQFnoECA8QAQ&url=https%3A%2F%2Fwww.mhinnovation.net%2Fsites%2Fdefault%2Ffiles%2Fdownloads%2Fresource%2FWHO.UNHCR%2520KRG.Iraq%25202015%2520MHPSS%2520Situation%2520Analysis%2520KRG.docx&usg=AOvVaw06QjAmmNUY4mmacnMNhK8c&opi=89978449
39. Ali H, Ari K. Addressing Mental Health and Psychosocial Needs in Displacement: How a Stateless Person from Syria Became a Refugee and Community Helper in Iraq. Personal Reflection. Intervention. January 1, 2021 2021;19(1):136-140. doi:10.4103/intv.Intv_46_20
40. Bolton P. 1 - Global mental health and psychotherapy: Importance of task-shifting and a systematic approach to adaptation. In: Stein DJ, Bass JK, Hofmann SG, eds. Global Mental Health and Psychotherapy. Academic Press; 2019:11-24.
41. World Health Organization. Problem management plus (PM+): individual psychological help for adults impaired by distress in communities exposed to adversity. 2016. 7521738403.
42. Dawson KS, Bryant RA, Harper M, et al. Problem Management Plus (PM+): a WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry. 2015;14(3):354.
43. EPIC. Iraq’s Quiet Mental Health Crisis. Enabling Peace in Iraq Center. Accessed 08.08.23, 2023. https://www.epic-usa.org/iraq-mental-health/
44. Kizilhan JI. Stress on local and international psychotherapists in the crisis region of Iraq. BMC Psychiatry. 2020;20:1-8.
45. Poloju KK, Naidu VR, Rollakanti CR, Manchiryal RK, Joe A. New method of data collection using the kobo toolbox. Journal of Positive School Psychology. 2022:1527-1535.
46. Tsang S, Royse C, Terkawi A. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi Journal of Anesthesia. 05/25 2017;11:80-89. doi:10.4103/sja.SJA_203_17
47. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. Sep 2001;16(9):606-13. doi:10.1046/j.1525-1497.2001. 016009606.x
48. Kroenke K, Spitzer RL, Williams JB, Löwe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. General Hospital Psychiatry. Jul-Aug 2010; 32(4):345-59. doi:10.1016/j.genhosppsych.2010.03.006
49. Martin A, Rief W, Klaiberg A, Braehler E. Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. General Hospital Psychiatry. Jan-Feb 2006;28(1): 71-7. doi:10.1016/j.genhosppsych.2005.07.003
50. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. Journal of Traumatic Stress. Dec 2015;28(6):489-98. doi:10. 1002/jts.22059
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