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According to the United Nations, one in five Iraqi refugees living in Syria experience torture or other violence back in Iraq.
NPR's Deborah Amos reports the physical wounds may heal, but the long-term, psychological damage can be profound.
And a warning, this report contains graphic descriptions that some listeners may find disturbing.
DEBORAH AMOS: Nibras Naseer, a rail-thin 18-year-old, fled Iraq more than a year ago after he spent 10 days in a hospital, he says, for injuries - the result of severe beatings.
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He now lives in a fifth-floor walk-up in Damascus, a spare space he shares with his uncle's family. The only decoration is a picture of Jesus on the wall. The apartment building fills up with the laughter of children when school lets out, but even when his nephew bounds into the apartment, Naseer does not smile.
Mr. NIBRAS NASEER: (Through translator) I told you, I'm just trying to forget what happened to me. I can't say that I can sleep. Sometimes I can; sometimes I can't. But I am trying my best to forget what happened to me.
AMOS: What happened to Naseer has happened to many Iraqis, but very few are willing to talk about it. In 2006, Nibras Naseer was kidnapped from his Baghdad neighborhood; shoved into the trunk of a car; subjected, he says, to weeks of a so-called investigation, along with six other Iraqi men and an 11-year-old boy.
Mr. NASEER: (Through translator) Three of them, they were telling the 11-year-old helped the Americans. Other three - they told them that you're in the Iraq National Guard, and other people - they kidnap them to get information from them about other people.
AMOS: His kidnappers identified themselves as al-Qaida in Iraq, says Naseer, and they made clear that for any of their captives who work for the U.S. military or for the Iraqi government, the punishment would be beheading.
After more than a week of repeated interrogations and beatings, three of the Iraqis were executed says Naseer; the others were forced to watch.
Mr. NASEER: (Through translator) I told you we were together when they took those three guys away from us. And we were watching everything, and they forced us to watch the whole procedure. And for me, I couldn't watch the whole thing. I started to cry, and I collapsed on the floor. And maybe I prefer to die at that moment.
AMOS: Naseer spent the nights talking to his fellow prisoners, Iraqis who shared their life stories and their terror. A few days later, the jailers condemned three more prisoners to the same gruesome death - men he had come to know.
Mr. NASEER: (Through translator) And I remember names, like Hammed, Ali, Omar.
AMOS: And you must have thought by the second time that you were next.
Mr. NASEER: (Through translator) For sure, and I watched the second time, I was thinking, like, I'm the next, and I mustn't have any hope in life, like even less than one percent.
AMOS: U.S. soldiers have dismantled a number of torture houses in Iraq. In places like these, few are spared, says Naseer, including an 11-year-old boy. The kidnappers accused him of spotting for U.S. soldiers; pointing out explosive devices hidden in his neighborhood. They forced him to admit he had helped the Americans.
Mr. NASEER: (Through translator) Well, this little kid, they were beating him, but not like us, because he's a little kid. And what you can expect from a little kid - 11 years old? He was just crying all the time.
AMOS: And what happened to him? What happened to the 11-year-old boy?
Mr. NASEER: (Through translator) They took him out, and they killed him the same way, and I went crazy. I lost my mind.
AMOS: As Naseer tells his story, his shoulders hunch slightly. The only outward flicker of emotion comes when he recounts his unexpected release after his family paid a $30,000 ransom. He has no idea why he is alive or if he will ever get over what happened to him.
Naseer's case is far from unique. U.N. officials say more than 20,000 Iraqis have defined themselves as torture victims when they signed up for refugee status. A more recent study of the refugee community in Syria reveals that the overall numbers are likely to be many thousands more; that means Iraqi refugees will need more than the basics of food and housing say U.N. officials.
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AMOS: This clinic opened in December in Lebanon. The United Nations pays for the mental health professionals from a nonprofit group called Re-Start.
Suzanne Jabbour, the chief psychologist, says more than 50 patients are already in the new program.
Ms. SUZANNE JABBOUR (Psychologist): The majority - new, come recently. New Iraqi refugees.
AMOS: But only refugees in Lebanon are treated, says Jabbour. Because of tight border restrictions, she cannot take on cases from Syria where the need is much greater.
Ms. JABBOUR: (Through translator) There is no way that a person who has been through whatever these people have been through can survive unless they have treatment. And even after that, they need people to help them make a life to establish themselves, to find jobs, to - unless that person can find that amount of help, then he will reach a stage where his life will become meaningless, and he might turn suicidal.
AMOS: Jabbour says the people being treated in Lebanon have a chance of recovery. But she is not at all optimistic about the refugees in Syria who have little or no access to mental health services now.
Ms. JABBOUR: (Through translator) The worst is yet to come for these people in Damascus. Yeah, the worst yet to come, yeah. Yeah.
AMOS: And that may be the fate of Nibras Naseer. In a small apartment in Damascus, Naseer ignores his cell phone when it rings. He struggles alone with his nightmares.
There are thousands more like him — refugees who often cut themselves off from the rest of their community.
Mr. NASEER: (Through translator) All the time I am sitting at home, I don't work; I don't do anything. Well, I can't trust anybody, and I don't know what will happen.
AMOS: Deborah Amos, NPR News.
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