"Doctor, why is it that people can be so evil? Why did they kill my mother and father? Why did they torture me like that? Doctor, why are humans doing this?"
This is a series of questions that German psychologist, Dr Jan Ilhan Kizilhan, has heard since 2015 from children as young as nine years old when he started bringing the Yazidi survivors of Daesh assaults to Germany.
Dr Kizilhan is still searching for the answers to these questions, to one day be able to respond to those who have suffered cruel fates under the control of Daesh, and are still grappling to make sense of the trauma to this day.
Intense experiences lead to intense emotions, he explains, and the prevalence of psychological trauma among refugee youth should be an issue of utmost urgency.
Dr Kizilhan personally interviews and counsels Yazidi women who were tortured, raped and captured as Daesh slaves. He has made many trips to refugee camps in northern Iraq, looking for the most vulnerable survivors, and often faced difficult choices regarding who was able to return to Germany with him for treatment, and who was to stay behind.
He is on a mission to help people rebuild their lives as part of a program to bring Yazidi women and girls to Germany, funded by Baden-Württemberg minister-president, Winfried Kretschmann, in November 2014, months after the Sinjar district in northern Iraq was attacked by Daesh.
In what the United Nations described as a genocide of the Yazidi people, tens of thousands of members of religious and ethnic minorities were expelled – Christians, Yazidis, Shias and Turkmen – who had been living side-by-side for centuries.
A long-persecuted minority, the Yazidis are a majority Kurdish-speaking religious group living mostly in northern Iraq. They amount to a population of less than one million worldwide. This ancient faith, one of the world's oldest monotheistic religions, has survived for centuries by living apart in a tight-knit community.
"They were not comfortable in Arab society because they were a target for many radical Islamic groups. This is why most of the Yazidis in Iraq were living in villages and not in cities, because they know their community will be attacked in society. So, they have a distance with the general Muslim society," explains Dr Kizilhan.
Those who managed to escape the brutal attacks have ended up in displacement camps scattered around Iraqi Kurdistan, with a small number relocating to neighbouring countries or Western countries as refugees. In Germany, their numbers are estimated at 25,000.
Meanwhile, the fate of more than two thousand women who were kidnapped in the same year is still unknown.
One eight-year-old girl, Dr Kizilhan's youngest patient, was repeatedly sold and raped, while another girl set herself on fire to make herself less attractive to her Daesh captors.
"They wake up at night, have nightmares and are afraid that Daesh will come and take them again. They suffer frequent fainting fits or flashbacks when they relive their rape and torture. They are frightened, unsure, nervous, tense, have no hope, are embarrassed about their rape and often entertain suicidal thoughts," reveals Dr Kizilhan.
However, Dr Kizilhan believes that child victims are not helpless nor hopeless. For example, one nine-year-old girl he examined was trapped in the hands of Daesh for ten months.
"I asked her if she was ready to come with me to Germany, to which she asked me, 'do you have schools in Germany?' I responded 'Yes, we have schools, why?' 'because one day I want to sit on your chair and want to be a doctor and help my people.' "
"This showed me that human beings have so much power if they believe in it," recounts the doctor.
In the report, "UN Action Against Sexual Violence in Conflict," the United Nations asserts that: "Rape committed during war is often intended to terrorise the population, break up families, destroy communities, and, in some instances, change the ethnic makeup of the next generation."
For centuries, rape has been used as a weapon – possibly the most brutal weapon of war – in order to exercise power and dominance over women and undermine the social fabric of society.
Even after the end of wars and conflicts, rape and sexual violence perpetrated against women and girls leaves a permanent mark, both physically and psychologically: unwanted pregnancies, victim shaming, stigmatisation and the ostracising of women.
Five years following the war, Dr Kizilhan found that 58 per cent of the Yazidi women at the time of the interview, out of a total of 268 Yazidi women – living either in a household or in a refugee camp – still suffer a very high existence of post-traumatic stress disorder (PTSD). Also, that sexual exploitation often is accompanied by severe alienation, humiliation, hopelessness and loss of control. This, in turn, could explain the link to PTSD.
"They worry most about the associated humiliation experienced through ostracism in front of the other members of their community," Dr Kizilhan interprets.
He also explains that these women who managed to escape from Daesh found themselves back in their deeply conservative communities in northern Iraq, with little to no access to psychological help to work through the unspeakable horrors that they had experienced.
He found that they are not primarily worried about the events themselves or having broken social rules, instead, they worry most about the associated humiliation experienced through ostracism by the other members of their community.
Dr Kizilhan uses specific interviewing techniques to ensure that the women and children feel in control during the interview, as well as to minimise distress, as they struggle from feeling irrevocably changed by their trauma.
In the Middle East therapy is still a relatively new concept, with more of a focus on physical well-being. Psychological disorders still bear some stigmatisation, according to the doctor.
Arab tradition regards doctors, religious figures and family members as the proper alleviators of distress and illness.
"People who need help fear that they will be labelled as 'abnormal' if they go for psychotherapy, much research shows post-traumatic disorders bear shame in the Middle East, so we needed to find a way to accommodate that," he stresses. "Healing requires empathy."
After extensive research, he labelled it "transcultural psychotherapy", a relatively new field that takes such cultural and contextual factors into account.
Dr Kizilhan has been advancing the field for decades in Germany, and later founded the Institute for Transcultural Health Science at Baden-Württemberg Cooperative State University, which focuses on the "internationalisation" of health research.
Its mission is to train the first generation of psychotherapists in Iraq and to integrate licensed psychotherapy into the nation's health system, and eventually the broader Middle East.
"In a 'shame culture', it is not so much the incident itself and the perpetration of a possible violation of the norm that plays a part, but rather how one can 'save face' in front of others," he clarifies.
"Also, we know from studies, this trauma is being passed on from one generation to the next, we have to take this into account. It is not just the individual issue. We have to remember, the Yazidis witnessed 74 genocides."
For example, after treating thousands of Yazidi women, the family – whether it's the grandfather, father or mother – are always talking about the massacres of their ancestors.
In the view of Dr Kizilhan, the children grow up with the foreboding idea that something as tragic awaits them too, referring to this as "transgenerational trauma".
Regarding the 1,000 survivors he brought to Germany in 2014, Dr Kizilhan shares that they have integrated well and that 35 women have already married and had children.
Dr Kizilhan emphasises: "This is very important for the traumatised Yazidis – to have security, orientation and stabilisation. The main idea of treatment is not to teach them how to forget it. It's a part of their lives."
How the issue is addressed in post-conflict periods is what is vital according to Dr Kizilhan. Therefore, the prevalence of psychiatric morbidity in the Arab region requires significant improvement.
He adds: "If you don't have a perspective for tomorrow's future or an idea of a future, you will remain in the past, and the past for the Yazidis, contains only terror and trauma."