Jinan Alnasrawi's family fled to the USA, where her daughters received medical treatment. / Nina N. Greipel for USA TODAY
LOUISVILLE - News of renewed violence and airstrikes in her native Iraq brings the whole terrible nightmare back: the crash of a wall collapsing on her sleeping family. Then the silence. Then her own screams as she groped in the dusty dark for her young daughters and sister.
"Nobody heard me," Jinan Alnasrawi recalls through an interpreter. "When I walked, I fell down. I was numb."
An al-Qaeda bomb targeting her family had blown apart their Baghdad apartment, seriously injuring two daughters and leaving her 21-year-old sister to die slowly from a deep, open head wound.
Three years after that devastating morning in June, Alnasrawi is haunted by daily reminders â?? her 13-year-old's prosthetic arm, the brace on her 9-year-old's leg, the memorial photo of her sister hanging on the wall of her new apartment here where she, her husband and their four children settled as refugees.
They go on with help from the Survivors of Torture Recovery Center at the University of Louisville, one of more than 30 little-known programs across the country that quietly and sensitively provide medical, mental health, social and other services to help heal those who have endured humanity's worst.
"Like you see in Iraq now, torture is a tool of annihilation. â?¦ Violence is used to annihilate another person's personality, their family," says Richard Mollica, a psychiatrist who directs the Harvard Program in Refugee Trauma, one of the nation's first. "For victims, everything they believed in has been turned upside-down. You lose your world. And when you lose your world, you're lost."
The National Consortium of Torture Treatment Programs estimates that 600,000 to 1.2 million torture survivors have come to the USA since the end of the Vietnam War. The group's centers can help only about 6,000.
"Typically, what we see is if there's upheaval in a certain part of the world, a few months or a year later, we see a trickle of refugees from that country," said Kate Martin, operations and media manager for Bellevue-New York University Program for Survivors of Torture.
That's happening with Iraqis, and center professionals expect to see more.
"We have many Iraqi patients. They experience unspeakable violence. Their families are being beheaded and murdered," Mollica says.
He says treatment can help them survive their scars. "They can get better, but there's an element that they have to live with, that's not going to go away."
MEETING THE NEED
Mollica knows this from experience.
The psychiatrist helped launch Harvard's center in 1981 after working as director of the Indochinese Psychiatry Clinic and seeing many Cambodian refugees. He could barely believe what some told him; one Khmer Rouge victim described being beaten and thrown onto a pile of 60 relatives' bodies.
"The stories were so horrendous. We were in a state of shock," says Mollica, author of Healing Invisible Wounds and a pioneer in the field. "We had no idea how to deal with this."
The key, he discovered, was listening deeply and creating an environment where patients felt safe to tell their stories. Their profound sense of humiliation had to be met with privacy and empathy. Their cultures had to be respected. He found that rebuilding a worldview required more than therapy and medications; patients needed meaningful work, volunteer opportunities and spirituality.
Over the years, other centers emerged - the Heartland Alliance Marjorie Kovler Center in Chicago in 1987, NYU's center in 1995, and a dozen in the past six years. UofL's launched in 2012 with a three-year, $975,000 grant from the U.S. Department of Health and Human Services Office for Refugee Resettlement.
The resettlement agency helps fund many centers across the nation, which receive donations from corporations, foundations and individuals. Chicago's program, which treats mostly asylum-seekers, depends on an army of community volunteers to help staff.
Patients are referred to centers by health care workers or service agencies or hear about them through word-of-mouth. Many have survived beatings, burnings and bombings, or slow, personal horrors such as having teeth pulled out. One of Mollica's recent Iraqi patients was sent her son's head in a bag.
Victims suffer lasting pain from such indelible memories, and Alnasrawi's experience reflects why.
Innocent choices become fateful ones, leaving a lifetime of guilt. The night her apartment was bombed, Alnasrawi, her sister Raghad and their children slept side-by-side on bedrolls in the front room because it was the only one with air conditioning, placing them in the path of the falling wall. Raghad asked to switch places with Alnasrawi before going to sleep. Thus, she was the one to die.
There are incongruent experiences that can't be reconciled: One moment, Alnasrawi was pulling a cover over her eldest daughter Ghadeer, the next she was screaming for help after the wall had cut the girl's arm in two.
And there's the seemingly permanent extinguishing of hope by grief: Alnasrawi felt the squeeze of her sister's hand as she cradled her head during the pickup ride to the hospital, only to get up and see white spots on her dress, "her brain all over my clothes."
RECOVERY'S LONG ROAD
Only with compassion and intense care can victims of such horrors begin healing.
Alnasrawi's family arrived in the USA in May 2013 after fleeing their homeland for Turkey and gaining refugee status. Through UofL's survivor program, clinical social worker Molly Bush visits their home regularly and provides talk and art therapy, advice, support and connections to charities. Their care team includes a psychotherapist, a registered nurse and a case manager.
"We're trying to address the whole person," center director Bibhuti Sar says. "Torture and suffering has an impact on a person's worldview, an impact on behavior. These folks have just been hit with all kinds of issues."
Mollica insists that treatment works, that victims can recover by integrating their memories into their lives and in many cases transforming their pain into hard-won wisdom.
"Despite how horrific these experiences are, people can do better," says Mary Lynn Everson, senior director of the Chicago center. "There's some light at the end of the tunnel."
Alnasrawi and her husband, Ali Sabah, are hopeful. They describe their adopted home as a "paradise" full of opportunity. Alnasrawi says she's learning to live with her sister's death and feels her gentle presence daily, "eating and drinking with me."
But their life in America is bittersweet. Medical needs are so intense Sabah can't work because he must attend to his family; the most severely injured girls need physical therapy, and Alnasrawi suffers from back problems and post-traumatic stress disorder. Her 9-year-old, Ghasaq, who recently had surgery on her leg, wishes she could jump on a trampoline and run like other kids she sees.
The news from Iraq keeps reopening the family's wounds, leaving Alnasrawi longing to go back and save relatives unable to escape.
"I can't leave them like this, facing death," she says. "If something else would happen to them, I might die."
Laura Ungar reports for The (Louisville, Ky.) Courier-Journal and can be reached on Twitter @laura_ungar.
Read the original story: Centers aid conflict survivors from Iraq, other nations