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The desperate plight of a generation of children is in the balance as the bloody battle for the city of Mosul threatens to become a humanitarian catastrophe, Amnesty International said today following a field investigation.

On a visit to the region this month, the organization met children of all ages who had suffered terrible injuries after being caught in the line of fire between the armed group calling itself Islamic State (IS) and government forces, who are backed by a US-led coalition.

“Children caught in the crossfire of the brutal battle for Mosul have seen things that no one, of any age, should ever see. I met children who have not only sustained horrific wounds but have also seen their relatives and neighbors decapitated in mortar strikes, torn to shreds by car bombs or mine explosions, or crushed under the rubble of their homes,” said Donatella Rovera, Amnesty International’s Senior Crisis Response Adviser, who returned from a 17-day mission to northern Iraq.

“War-wounded children then find themselves in hospitals overflowing with patients, or in camps for displaced people, where dire humanitarian conditions make their physical and psychological recovery even more difficult. Many others remain trapped in areas where the fighting is raging. There is an urgent need for the Iraqi authorities and their international partners in the battle for Mosul to set up better care, rehabilitation and protection systems for affected civilians. Looking after civilian victims, particularly the most vulnerable, should be an absolute priority – not an afterthought.”

“Our homes have become our children’s graves”

In a hospital in Erbil, Amnesty International spoke to Umm Ashraf, who described how she and her seven children were injured when a car bomb exploded outside the house where they were sheltering in east Mosul on December 13, burying scores of people under the rubble of several houses destroyed in the blast. Her eldest daughter, 17-year-old Shahad, lost both her eyes in the attack.

“Our homes have become our children’s graves,” Umm Ashraf told Amnesty International. “My neighbors are still buried under the rubble; no one has been able to dig them out. I dragged my wounded children from under the rubble one by one. But my sister was killed, I could not help her. My neighbor was decapitated in the blast, so many others killed.”

Eight-year-old Teiba and her 14-month-old sister Taghreed were killed and their parents seriously injured when a mortar landed by the courtyard of their home in east Mosul on November 12. The children’s mother, Mouna, told Amnesty International:

“I was telling the girls to go inside. There was shelling and shooting 24 hours a day in our area. Just then a mortar landed by the house. I collapsed on the spot, my daughter Teiba fell with her head against the gate, and the little one crawled and crawled till she reached me and collapsed on my lap”.

Medical facilities at breaking point

With few or no functioning or accessible hospitals left in the conflict-affected areas of east Mosul, the epicentre of the fighting, the best hope for the wounded to receive medical care is in Erbil, the capital of the semi-autonomous Kurdistan Regional Government (KRG).

Though it is only 80 kilometers away, getting to Erbil is almost impossible for residents of Mosul. Only the few who manage to get a special permit can enter the KRG, and even then it is difficult or impossible for their relatives to join or visit them. 

Some families fleeing the fighting find themselves stuck between frontlines, unable to cross into territory controlled by the KRG and forced to wait in unsafe no-man’s-land areas for days.

Among those who did reach Erbil is two-year-old Ali, who was injured in a strike in the Hay al-Falah neighbourhood of Mosul on December 14. When we met him he was barely breathing, his face an unrecognizable bloody mess of torn flesh. The doctors told his grandmother, Dokha, that they weren’t sure if he would pull through. 

Dokha has already lost two granddaughters, 14-year-old Zaira and 16-year-old Wad’ha, who were killed in the same strike, and she was beside herself with grief at the thought of losing Ali too.

“Please God protect him, don’t take him from me,” Dokha implored.

“My grandchildren had fled their home and had been staying in a neighbor’s basement for the past 30 days,” she explained. “They had run out of food and water completely. The area was recaptured by the army two days earlier so they thought it was safe to go out, but they were bombed as they reached the gate of the courtyard.”

Even though only some of those injured in the Mosul battle have been evacuated to Erbil, hospitals there have been overwhelmed by the large number of casualties. 

“The military campaign to recapture Mosul had been long in the making and the Iraqi authorities – including the Ninewa Governorate – and their international partners in the Mosul battle could and should have made better provisions for the inevitable civilian casualties, especially knowing that hospitals in the KRG would likely come under strain from a high influx of war-wounded,” said Rovera.

“If there are resources for the war there must also be resources to deal with the consequences of war.”

Children traumatized and scarred

Beyond the physical wounds they suffer, children are left scarred and deeply traumatized by the extreme violence they have experienced and witnessed. Out of the thousands of children who have been exposed to sustained violence, only a fraction have access to the psychological care and support they desperately need.

“My children saw my sister being killed in front of them; they saw our neighbor who was decapitated in the strike; they saw body parts on the ground. How can they ever recover from that?” Umm Ashraf told Amnesty International.

At a camp for Internally Displaced People (IDPs), four-year-old Mohammed rocks to and fro, slaps himself and bangs his head on the floor. He cries inconsolably every time he soils himself, which happens several times a day. 

His mother, Mouna, says he has been behaving like this since the mortar strike on November 12 which killed two of his sisters.

“He and his little sister Taghreed were inseparable. He used to carry her all the time. Now he does not understand that his sisters are dead. He thinks we left them behind and gets sad and angry. I think he needs psychotherapy but there is nothing here in the camp,” says Mouna, who is immobilized by a fractured leg and has not been able to get up from a thin mattress on the floor since she arrived in the camp.

The family’s two surviving daughters, aged 10 and 12, have to attend to all the chores – getting water, cooking, washing clothes and dressing their injured parents’ wounds. They have no time to play or study.

Since their arrival at the IDP camp, the children have received no psychological support to help them deal with the trauma of seeing their siblings killed in front of them. While the humanitarian response has provided limited psychosocial support activities in some IDP camps, they are woefully inadequate to deal with the sheer number of children who have been affected by the conflict and in many cases are direct victims of violence.

“The scars left by these unimaginably traumatic experiences are psychological as well as physical, but these life-altering wounds are being neglected by the Iraqi government and its allies, who have so far failed to ensure adequate medical facilities are in place,” said Rovera.

“The international community must prioritize the resourcing of a robust child protection response, including comprehensive mental health support for those who have been exposed to extreme violence, as part of the humanitarian response to the Iraq crisis.”

Meanwhile, Yazidi children, returning from IS captivity, have endured unspeakable suffering. Girls as young as 11 were raped, while boys were forced to undergo military training, taught how to decapitate people, and made to watch executions. 

Jordo, a 13-year-old boy who spent two years in IS captivity, gave a chilling account of what he learned.

“You grab the guy by the hair to pull his head up so you can cut his throat, and if he has no hair you stick two fingers in his nostrils to pull his head up. They taught me this and they taught me to kill in many other ways,” he told Amnesty International.

AK, 10, returned from IS captivity in November, more than two years after being abducted along with his parents and seven siblings. Only two of them, aged six and seven, have returned. The rest of the family remain in IS hands.

The children are being cared for by two distant cousins who are already providing for 23 other women and children. One told Amnesty International about the difficulties of coping with the erratic behaviour of the traumatized children.

“AK is very difficult to control,” he said. “He breaks and sets things on fire, and the other day he went out in the cold in his underwear and got sick. All three of them wet themselves all the time, so we make them sleep in a separate tent because of the smell. These children are very traumatized and need professional help, but we have found no help so far.”

Broken promises

Humanitarian workers told Amnesty International that children displaced from the Mosul battle and other areas affected by the conflict show signs of trauma such as excessive crying, mutism and violent behavior, and have difficulty leaving their parents’ or caregivers’ sides.

However, seemingly due to a lack of resources, these children are not receiving adequate mental health care and the support that would help them to process such traumatic incidents and begin to restore a sense of normality in their lives.

Donor governments committed in September to ensure “access to lifesaving assistance” and “facilitate the rapid, unimpeded passage of impartial humanitarian relief.” It is imperative that the protection and care of children affected by the armed conflict be made a priority in the humanitarian response.

The rising costs of basic necessities, as well as the lack of food, fuel, medicines and clean water inside Mosul have left children at extreme risk of malnutrition, dehydration and water-borne and other diseases.

“Despite Iraqi and coalition forces’ assurances that they are doing their utmost to protect civilians, every day children are dying or being injured – in their homes or as they risk their lives to flee to safety. All parties involved in the Mosul battle must take all feasible precautions to spare civilian lives, including by avoiding using artillery and other indirect fire into densely populated urban areas,” said Rovera.

“Without more efforts by the Iraqi authorities and their allies to create safe avenues for civilians to get out of conflict-affected areas of the city and to provide essential services to residents trapped under fire inside Mosul, a humanitarian catastrophe could unfold.”