Long-term Mental Health Outcomes of Kurdish Chemical Gas Attacks

ONE STORY still stays vividly in Ibrahim Mohammed’s mind. A man suffering from acute respiratory problems due to chemical exposure, his scars as deep in his mind as in his body. Mohammed and his team arranged for him to see a mental health professional. Just a week later came the news: the man had died from complications related to his lung issues. Even decades after the 1988 attack on Halabja, lives are still lost.

“Even decades after the attack, lives are still lost,” says Mohammed, a clinical psychologist at the University of Duhok in Iraqi Kurdistan. The chemical weapons attack on Halabja in March 1988 officially killed around 5,000 people that day, when Saddam Hussein’s forces dropped mustard gas and nerve agents on the Kurdish city. But the toll keeps rising, slowly, person by person. And the survivors carry wounds that refuse to heal.

Mohammed and his colleagues have spent the last year documenting just how deep those wounds run. Their findings, published in Frontiers in Psychiatry, paint a sobering picture of what happens to people after surviving a chemical weapons attack. Nearly 79% of the 534 survivors they studied met the threshold for post-traumatic stress disorder, even 35 years after the fact. More than half experienced severe physical symptoms like chronic pain and exhaustion. And about 65% had clinically significant depression or anxiety.

The numbers are striking, but they miss something crucial. What the study really shows is how trauma doesn’t simply fade with time. It evolves. It embeds itself in the body as headaches and back pain, manifests as panic when something triggers a memory, shapes the architecture of daily life. For many survivors, the symptoms aren’t getting better.

Halabja was part of the Anfal campaign, a genocidal assault on Iraqi Kurdistan in which an estimated 182,000 Kurds were killed. Villages were destroyed, families separated, entire communities shattered. The chemical attack on Halabja became the campaign’s most notorious episode, partly because of the scale and partly because chemical weapons carry a particular horror. They don’t just kill. They linger, corroding lungs and vision, causing cancers years later, passing effects possibly to the next generation.

Mohammed’s team found that women showed higher symptom severity across every measure. That pattern aligns with global research on trauma and gender, though the reasons are complex. In Kurdish culture, as in many societies, women often face additional vulnerabilities (economic dependence, limited education, social expectations that can compound the impact of catastrophic events). Lower education and income also predicted worse outcomes, suggesting that resources and opportunities matter profoundly in recovery.

What’s perhaps most troubling is the treatment gap. Fewer than 17% of participants were receiving any psychotropic medication. About 57% had never visited a healthcare provider for mental health concerns at all. The Kurdistan region simply lacks adequate psychiatric services, and those that exist aren’t reaching most survivors. Effective treatments for PTSD and depression are well established, but they require trained professionals, funding, and infrastructure that aren’t there.

Mohammed notes that physical symptoms were sometimes more obvious than psychological ones. People reported joint pain, fatigue, sleep problems, things that might seem unrelated to a chemical attack decades ago. But research increasingly shows that trauma lives in the body. Stress responses alter physiology in lasting ways. The boundary between mental and physical suffering isn’t nearly as clear as we once thought.

The study also captured the sheer accumulation of traumatic events survivors had endured. Participants reported experiencing anywhere from 2 to 30 distinct traumatic incidents during and after the attack. Witnessing bombing, severe food and water deprivation, losing family members, being displaced. Trauma compounds. Each additional event appears to heighten vulnerability to long-term psychological distress.

Some survivors have left Halabja, scattering to other cities and districts across Kurdistan. Recruiting participants meant tracking people down, explaining the project over phone calls, visiting homes. It took seven months to complete the assessments, with each survivor spending up to 90 minutes answering questions about their experiences and current state. Many were willing to participate despite the difficulty of revisiting painful memories, which speaks to something important about acknowledgment.

This research fills a gap. Few large-scale studies have examined the very long-term psychiatric consequences of chemical weapons exposure. Most trauma research focuses on war in general or on acute aftermath, not on what happens 30 or 40 years later. The findings suggest we’ve underestimated how persistent these effects can be, especially when survivors lack access to care and continue living in economically strained communities.

Mohammed emphasizes that the work is about more than documenting suffering. It’s a call for action. Survivors need culturally sensitive mental health services, social support programs, and official recognition that goes beyond sporadic compensation. The study provides evidence that policymakers can’t ignore (though whether they’ll act on it remains to be seen). At the very least, it honors the courage of people who agreed to share their stories, knowing their pain would be measured and categorized but hoping it might lead somewhere.

Halabja isn’t just history. It’s a living reminder that the effects of war echo across generations, that trauma doesn’t respect calendars. Perhaps the most important thing the research shows is that recovery isn’t about returning to some version of normal. For survivors, it means finding ways to carry memories that won’t fade while still managing to live, day after day. That requires understanding, resources, and the kind of sustained care that Kurdistan’s survivors have largely been denied.