Psychological scars of genocide: a systematic review of post-traumatic outcomes in Kurdish Anfal survivors

Abstract

The Anfal genocide, including the infamous Halabja chemical attack, has imprinted deep scars on the Kurdish community in Iraq that lasted for decades. Despite significant historical documentation, the enduring psychological impact on survivors is less examined. This systematic review synthesizes existing research to address this gap. Adhering to the PRISMA guidelines, this review systematically searched databases for scholarly articles examining the mental health of Kurdish survivors following the 1988 Anfal genocide, with a focus on PTSD, depression, and anxiety. Of the initial 201 articles identified, seven met the inclusion criteria. These studies were subjected to a thorough data extraction and qualitative synthesis, and their quality was appraised using the Mixed Methods Appraisal Tool (MMAT). The selected studies encompassed a combined sample of 760 participants, ranging in age from 7 to 92 years. The findings revealed high prevalence rates of PTSD, particularly in children, with a prevalence rate of 87%. In adults, PTSD and depression prevalence rates in unselected samples were estimated at 86.2% and 49%, respectively. Qualitative findings from survivors reveal a complex interplay of depression, intrusive memories, and societal isolation, compounded by poverty and discrimination, with health concerns like respiratory and ocular problems further exacerbating psychological distress. However, non-representative samples and absence of control groups limit result generalization. The literature reviewed indicates substantial psychological distress among the Anfal genocide survivors, underscoring an urgent need for targeted mental health interventions. Future research needs representative samples and validated tools for precise prevalence assessment and comprehensive impact understanding.