Beyond Physical Trauma

Integrating Mental Health Support for Child Amputees and Children with Disabilities in Post-Conflict Iraq

Executive Summary

Iraq's decades of conflict have severely impacted children with disabilities, particularly amputees. This document examines the critical gap in Mental Health and Psychosocial Support Services (MHPSS) for these vulnerable children, highlighting their challenges and proposing actionable solutions to integrate support services into education, healthcare, and community systems.

Background and Context

Decades of conflict in Iraq have left indelible marks on its population, with children bearing a significant portion of the burden. Among the most vulnerable are children who have suffered amputations due to landmines, unexploded ordnance, and other remnants of war. These physical injuries are compounded by psychological trauma, social stigma, and systemic neglect, creating a complex web of challenges that hinder their integration and development.

Iraq illustrates valuable insights as to the challenge a country faces in the wake of the trauma of violent conflict, and when international humanitarian funding is no longer available. There are lessons here for how we respond to other crises such as child amputees in Gaza.

As of 2025, Iraq's total population is estimated at approximately 47 million, with children aged 0–14 years constituting about 34.6% of the population, translating to roughly 16.3 million children. Regarding children with disabilities, data from the Multiple Indicator Cluster Surveys (MICS) indicate that approximately 8% of Iraqi children aged 2 to 17 years experience functional difficulties in at least one domain, such as seeing, hearing, walking, or learning.

Applying this percentage to the current child population suggests that around 1.3 million children in Iraq live with some form of disability. It's important to note that these figures may be underestimates due to factors such as underreporting, social stigma, and limited access to diagnostic services. The actual number of children with disabilities could be higher, underscoring the need for comprehensive assessments and inclusive policies to address their needs effectively.

Current Challenges

Despite various humanitarian efforts, there remains a glaring void in specialised MHPSS services tailored for children with disabilities, especially those with war-related injuries. The transition from emergency response to sustainable development has not adequately addressed the nuanced needs of this demographic. Assessments conducted by actors like International Organization for Migration (IOM) and Save the Children International (SCI) point out this gap. For instance, IOM's 2023 assessment in Al-Qa'im, Anbar, revealed that many returnees, including children, grapple with severe psychological distress, yet have limited access to appropriate mental health services.

Furthermore, the scarcity of data and research on the intersection of disability, childhood, and mental health in Iraq hampers the development of effective interventions. The lack of comprehensive assessments means that many children remain invisible in policy discussions and programme designs. This invisibility perpetuates a cycle of neglect, where the absence of data leads to inaction, and inaction leads to further marginalisation.

The limited number of specialised service providers exacerbates the situation. In many regions, especially those liberated from conflict, there are few professionals trained to address the unique psychological needs of children with disabilities. This shortage is particularly acute in areas like West Ninewa, where IOM's assessments have highlighted the dire need for integrated MHPSS services. Given this gap, Mobile Approach Services Unit (MASU) units could be used to deliver training, thereby strengthening local capacity and expanding access to much-needed support.

Key findings from SCI in Iraq's latest assessment on MHPSS and Children with Disabilities (CwD) in Federal Iraq and Kurdistan brings evidence that children with disabilities in Iraq are among the most psychologically vulnerable groups in the country. Many of these children experience profound isolation, with 23% reporting difficulties in making friends and grappling with emotional distress. The situation is particularly acute for those with communication impairments, where this figure rises to 35%.

These children are routinely subjected to bullying, stigma, and ridicule, all of which contribute to a pervasive sense of exclusion and diminished self-worth. The emotional burden carried by CwD is often invisible but deeply entrenched in their everyday experiences within schools, communities, and homes.

"I don't talk much at school because when I do, the others laugh. Sometimes I wish I could just stay at home." — 12-year-old displaced girl in Duhok

This poignant testimony highlights the urgent need for inclusive mental health support that addresses not only clinical symptoms but also the social environments that shape children's sense of identity and belonging.

Impact on Education

Education, rather than serving as a protective and inclusive space, often becomes a battleground for CwD. According to recent assessments, only 67% of children with disabilities are currently enrolled in school, with a notable disparity for girls and refugee children, who face even higher rates of exclusion. Many report that teachers lack both the time and training needed to address their specific needs.

Expert services are frequently inaccessible, and inclusive life-skills or MHPSS programmes are rarely implemented. Children with mobility, communication, and cognitive impairments are particularly marginalised, facing systemic neglect across every level of the educational experience.

The legacy of conflict in Iraq has compounded the challenges faced by CwD, particularly for child amputees. Physical disabilities resulting from explosive devices, landmines, and other remnants of war are tragically common. However, the psychological toll of these injuries has received far less attention. Evidence from Save the Children case management databases shows that many amputee children suffer from untreated trauma, identity struggles, and chronic emotional distress—often more debilitating than the physical injury itself. Shockingly, no major initiative or briefing has yet focused on the specific mental health needs of child amputees in Iraq, revealing a critical gap in policy and programming.

Compounding the issue is the weakness of MHPSS referral systems in educational settings. Fewer than half of the surveyed teachers are even aware of any referral mechanisms for psychosocial support within their schools. Where mechanisms exist, they are often geared toward non-MHPSS services, leaving affected children without appropriate care.

Stigma around mental health further discourages families from seeking support, and teachers often lack the skills and tools to recognise early signs of distress or disability-related trauma.

Family and Caregiver Support

The role of families and caregivers is equally strained. An alarming 45% of children report that their parents are unable to assist with their learning, often due to a lack of education or resources. Emotional support is even more limited, with parents frequently unequipped to engage in discussions around mental well-being or disability. This disconnect between home and school exacerbates the emotional challenges faced by children and reflects a broader community unprepared to meet their needs.

Opportunities for Action

The current context presents a unique opportunity to act. A promising initiative involves a potential pilot project with the American University of Iraq, Sulaimani (AUIS), under the Restoring Hope banner. This project envisions a multidisciplinary approach that merges MHPSS with prosthetic and educational support for child amputees. Centring children's voices in the design, this initiative aims to develop innovative models of care that blend engineering, psychology, and inclusive pedagogy.

Urgent steps must also be taken to embed MHPSS into the educational system. Data from the SCI-led Multi-Year Resilience Programme (MYRP) assessments clearly show the need for targeted, child-friendly mental health support within both formal schools and Accelerated Learning Centres. Key elements include:

• Tools for early identification of mental health needs

• Anonymous reporting platforms for abuse or distress

• Creation of peer support mechanisms

Designing schools that foster psychosocial resilience—particularly for CwD—must be a national priority.

There is also a need to expand inclusive life-skills programming, which can build confidence, social awareness, and a sense of belonging among children. Such programmes should be rooted in the social model of disability, promoting acceptance and challenging stigma, while offering practical strategies to cope with adversity.

Strengthening systems and partnerships is essential to ensure sustainability. Collaborations with the Ministry of Education, Organisations of Persons with Disabilities (OPDs), and local communities will be crucial to improving referral pathways and ensuring that MHPSS services are accessible, localised, and embedded into routine care. Investment in inclusive infrastructure, community-based support groups, and social protection mechanisms must accompany these efforts.

Advocacy and better data collection are necessary to raise the visibility of child amputees and all children living with disabilities in Iraq. This includes not only statistical data but also human-centred storytelling, case studies, and policy briefs that give children and families a platform to share their experiences. A unified framework for identifying and supporting children with disabilities—especially those living with the long-term consequences of war—is urgently needed to guide policy and inform more responsive programming.

Finally, there is an immediate opportunity to provide child amputees with the prosthetics they need to give them mobility and enable them to engage in both play and learning, building on the Restoring Hope Initiative in Gaza.

Conclusion

Restoring hope for conflict-affected children with disabilities in Iraq needs re-imagining how MHPSS services are defined and delivered. We need to acknowledge the intertwined nature of physical disability and psychological trauma, and addressing the systemic gaps in service provision. If we can do this, then Iraq can pave the way for a more inclusive and resilient future for its youngest citizens.

Iraq's experience emphasises the need to draw from the broadest range of insights and apply them creatively to push the boundaries of what is possible. It's a reminder that effective leadership in crisis recovery hinges not just on addressing immediate needs, but on designing sustainable, forward-looking solutions that integrate physical rehabilitation with comprehensive mental health support.

This paper draws on evidence and insights from Save the Children International's MYRP MHPSS and CwD Assessments, and complementary reports from IOM.