• One boy: "They killed my father and uncle in front of my eyes"
• Hundreds of thousands of children no longer attend school
• Hospitals too strapped with casualties to deal with mental toll on children
CNN
BAGHDAD, Iraq (CNN) -- Mustafa Karim, a fourth-grader, now lives with family members in a squalid camp in eastern Baghdad where displaced Shias go after fleeing their homes, often after relatives have been killed.
The young boy's eyes fill with tears when he recalls the circumstances that led to his exile.
"They killed my father and uncle in front of my eyes," he says.
He then breaks down sobbing. He can no longer speak. The anguish is unbearable.
Such stories are not uncommon in Iraq four years after the U.S.-led invasion. Health officials say the daily hardships -- bomb blasts, gunfire, killings of family members and sectarian violence -- are taking an increasing toll on Iraq's children.
Hundreds of thousands of children no longer attend school. Others have been forced from their homes to camps, while others have fled the nation with family. (Audio slide show: 'All they've ever known is conflict')
For those that remain behind, there is the constant fear of being killed and the mental toll that warfare takes on its most vulnerable victims.
"Our children are surrounded by violence," said Dr. Saied al Hashimi, a professor of psychiatry at Baghdad's Mustansriya University. "Most of them are traumatized."
He says mass displacement, the death and murder of family members and the constant presence of heavily armed troops, militias and death squads have a long-term impact on the children, especially those in and around Baghdad where violence is most intense. (Watch boy feign death, carried away like martyr)
"I call them the silent victims. Our Iraqi children are the silent victims," he told CNN.
Children face post-traumatic stress disorder
It is nearly impossible to quantify exactly how much the war and violence has impacted these children or just how many are affected.
The humanitarian organization Save the Children, in a report last year about children in conflict zones, estimated that 818,000 Iraqi children, ranging in age from 6 to 11, were not in school. That's roughly one in every five children in that age group.
"Conflict disrupts normal life, forces millions of families to flee their homes, separates children from their families and reduces schools to rubble," the report said. "Every day, these children wake up to a life characterized by hardship and work, and a bleak outlook for their future."
From January to March of last year, the World Health Organization worked with Iraqi psychiatrists on a series of studies on the mental health of children in the cities of Baghdad, Mosul and Dohuk. (Watch the effects of war on children
)
One of the studies on primary-school-age children in Baghdad found that nearly half of the 600 children surveyed had experienced a major traumatic event since the war began. Just over one in every 10 suffered from post-traumatic stress disorder, the study found.
Another of the studies found that older children in Mosul suffered even worse. Thirty percent of the 1,090 children surveyed showed signs of post-traumatic stress disorder. Nearly all of those with PTSD symptoms, 92 percent, had not received any treatment, according to the study.
In fact, the doctors aren't immune to the dangers of the conflict. Fifty percent of Iraq's psychiatrists have fled the country or been killed since the war began, said Dr. Naeema Al-Gasseer, the WHO's representative for Iraq.
"That's something that's really worrying," she said.
Among those killed was Harith Hassan, one of Iraq's most prominent psychiatrists who often talked to the Iraqi media about the effects of the war -- shot to death as he drove to work last December.
Girl has seizures at sound of warfare
Such attacks have contributed to the atmosphere of fear that has created a shortage of professional help in Iraq. Most major aid organizations no longer have a presence in the country after being forced to leave due to the violence and lack of security.
Save the Children UK, which had been in Iraq for 15 years, was among the last major groups to leave, closing its Iraq office earlier this month.
Iraq's health care infrastructure is reeling from victims of the physical brutality of war, too overwhelmed to properly deal with victims of psychological trauma. In addition, many of the nation's best and brightest doctors have fled the country or have been murdered.
That has left caring for the psychological welfare of children up to a small team of local doctors, like Dr. Hashimi. He trains pediatricians and teachers -- those who have the most contact with children -- to recognize signs of mental distress.
Dr. Ali Hussein, a general practitioner, is among those trying to help.
"A little girl came to my office. She was screaming all the time," he said. "Her mother said they heard bombs every day but just recently she started to panic. It finally got to her. She couldn't take it anymore."
Such effects were evident in one young girl at a psychiatric clinic run by Dr. Haidar Abdul Mohsen, who operates the only psychiatric outpatient clinic in Iraq.
Eight-year-old Zahrah was dressed in a pink track suit and matching sneakers, her boundless energy matched only by her infectious sweetness.
But Zahrah's mother told Dr. Mohsen this calm demeanor vanishes as soon as bombs explode in their neighborhood. The young girl suffers from seizures when the blasts go off.
Another patient, 13-year-old Khitam, has a different reaction to the sound of explosions: She strikes her mother.
"Our children became very violent, became very aggressive. They talk badly. They behave in a bad manner. And we think this is one of the effects of war," said Mohsen.
Girl forced to sleep next to dead body
Mohsen says he hears similar stories every day. He treats up to 15 patients a day. Despite meager resources, he says, he doesn't get any government financing.
One of his patients is 16-year-old Zaman. She was kidnapped outside her school in the Sunni neighborhood of Al Mansour. She says she was held for nine days in a windowless room with 20 other girls.
When one girl's family didn't pay for her release, the abductors raped and killed her. Zaman says she was beaten and forced to sleep next to the girl's dead body. Zaman's family says it paid $20,000 for her release.
The 16-year-old now suffers from deep depression. She screams and cries in the middle of the night. Her nightmares are so intense she's too afraid to sleep.
Her mother begs Dr. Mohsen to help her daughter.
"It's OK. It's OK," he said. "Calm down."
But away from her, he confides that he believes this is a lost generation.
"They live in real tragedy. They have many psychological problems," he said. "What we can do to them is just try to help them by simple things. And so I think our children have big problems."
What does he make of it all for Iraq's youngest generation?
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