Between war and regime oppression, Iran trapped by trauma cycle

On the first day of the US - Israel strikes on Iran, a US Tomahawk missile strike in the southern port city of Minab killed at least 175 people, including dozens of children - many of them schoolgirls.

In the days that followed, I briefly connected with a young member of the Iranian Red Crescent despite the crippling internet blackout that continues well into the third week of this escalating war. “It’s as if death has taken over our country,” she told me. “For four days, I worked in the field supporting families of the children killed in the strike. We were, and still are, under immense mental pressure,” she added, before the line abruptly dropped.

This week, under what many in the capital called a “drone rain” and “pounding airstrikes”, another source in Tehran sent me a stark image - a man riding a motorbike with a courier box that read, “Kidney for Sale.” Iran remains the only country in the world where private kidney sales are legal - a grim reflection of a collapsing economy, where more than half the population now lives below the poverty line and purchasing power has been reduced to the minimum for the majority of Iran’s 90 million population.

Today, millions of Iranians find themselves trapped in a devastating and in ways mind-numbing duality. On one hand, they seem themselves caught in deep anger, grief and mistrust toward a ruling system many blame for decades of repression, and on the other, fear and uncertainty over what US and Israeli strikes will ultimately bring - and what, if anything, will be left when it ends. Their worst fear - to be left in a “burnt field, with remnants of an even more repressive regime.”

With hundreds of civilian casualties and thousands of destroyed civilian infrastructure, Iranian people are caught in yet another psychological war between a now more hardline governing regime at home and Donald Trump’s lack of clarity on his strategy for the Iranian people who he once promised to help. Yet beneath the visible torment, a deeper, quieter collapse is unfolding. Crushed under decades of socio-political and economic repression, Iranians are suffering from a devastating, escalating, existential mental health crisis.

Bodies piled in an overcrowded morgue, black covers unzipped so families can search for the face of someone they love. These were the scenes replayed in Mona’s head the whole of January in the immediate aftermath of the deadly protests where thousands of civilians were killed by state forces, with many more injured and detained. The 35-year-old journalist based in Tehran has participated in every anti-government protest since 2009; and today, she’s more hopeless than ever before. “In whatever direction you turn, there is no bright horizon ahead. Everything is unclear. Everything is a haze,” she explained through tears.

Like millions of young Iranians, she shakes with the restless feeling of watching the country’s already dark clouds collapse in front of her powerless eyes. “People went out, so many were killed, so what? What’s the next stage supposed to be?” she asks. “More than ever, we’ve been proven to be alone.”

In Kerman, a teacher I spoke to in the aftermath of the deadly January protests said that he sees the crisis most clearly in his teenage students. “What lies ahead will be Iran’s most difficult days, whether there is war or not,” he explains. “Young people need strength of heart and hope. Today, they have neither. You ask them how they are in the morning and they laugh - it’s hysterical laughter. I see the anxiety in their faces, as though they see no future.”

Though these deeply rooted wounds predate January’s massacre and the US-Israel war that followed, what ensued has only deepened the pain.

For years, through my reporting on the wars in Syria, Iraq and Lebanon, and through my charity, Art of Hope, which strictly focuses on trauma relief and mental health support for war-torn refugees and displaced communities, I have spent countless hours with children and adults bearing the invisible wounds of war.

I have witnessed trauma in Ghouta, Douma, across Lebanon, and among families still haunted by life under ISIS in Mosul and Raqqa.

Today, the collective trauma witnessed among Iranians mirrors much of that same hopelessness, but just like in Syria, the brutalization is homegrown, carried out by their own regime. Indeed, there is something especially unfathomable when you know you are being killed by those who share your soil, your language and your roots - brainwashed and conditioned to choke, contain, and crush your voice, your dreams and your life.

This is a crisis.

Long before January’s mass killings, Iran was already grappling with a severe mental health crisis. It is estimated that more than a quarter of the population struggles with some form of psychiatric disorder. With an estimated 5.2 million Iranians living with depressive disorders by 2021, depression has more than doubled over the past 25 years, where women are disproportionately affected.

Furthermore, limited data on Iran’s outrageous suicide rates reflects that deterioration. Official figures show suicide attempts rising by 51% in just seven years, reaching nearly 120,000 annually by 2022. That makes it roughly one attempt for every 750 people in a nation of 90 million, and 82% of suicides are among those under 50.

“Before 2021, officials published suicide statistics,” says Dr. Rashid, a psychologist in Tehran. “But when rates continued to rise - while globally they were declining - the government here stopped releasing the numbers out of sheer embarrassment.”

He frames the crisis through what psychologists call entrapment theory, which is when people feel they’re left with no possibility for change and death is the only means of escape.

Addiction, divorce, and domestic violence are also said to have risen in parallel with economic issues and the deterioration of quality of life across the country.

However, for a nation that boasts one of the highest education rates in the region - home to one of the most sophisticated, vibrant and youthful societies in the Middle East - one essential element now feels profoundly absent: hope itself.

“Some of the psychological damage of the past few weeks may be reversible; but what about the trauma of the past few years?” Asks Dr. Shahi, a physician who participated in the January protests who of the erosion of hope, especially among youth. “When grief does not complete its stages, it becomes permanent. Much of our society today, lives in grief - with no energy left in the tank.”

These are not abstract diagnoses, but daily realities for millions of Iranians who have been deprived even of the dignity of mourning those killed in the protests.

A clinical psychologist and head of a psychology department at a prominent university in Iran explained to me that when grief and guilt go untreated, the risk of post-traumatic stress disorder (PTSD) rises sharply. She added that when the environment continues to be traumatic and uncertain - as it is now - healing does not take place. Even if things calm down, unless proper treatment is received, the damage continues for years, and is likely to have generational consequences.

However, the burden is not only on patients and the civil society. Medical professionals too are drowning in guilt, at a time when many doctors feared treating wounded protesters openly - with some even detained.

Then there are the physical scars. Doctors reported staggering numbers of eye injuries and amputations  January, which are tactics that were also seen in previous crackdowns. Those who want to speak up are navigating being intimidated by pro-regime colleagues, and worrying about being arrested for speaking to a foreign journalist.

In Iran, what defines this moment is not only trauma, but the absence of a visible path forward for a nation that knows what it wants and, more importantly, what it has been robbed of by those in power. Today, millions of Iranians grieve the bombardment of their country, while at the same time, many welcome the deaths of regime figures they have long regarded as their oppressors - officials they hold responsible for the dismantling of civil society and the enduring misery they have faced for years.

All of this is intertwined with a deep anxiety about the unknown that lies ahead, tempered only by the faint, fragile hope that perhaps - just perhaps - at the end of this dark tunnel, there may be a glimmer of light. All the while, they endure the constant anxiety of coping with these contradictory emotions, compounded by the weight of past trauma and a lived history in which, to the east, they see Afghanistan, and to the west, Syria and Iraq - and are left wondering, what lies ahead for us?

Tara Kangarlou is an award-winning American journalist, television host, and author who has reported, written, and produced for NBC-LA, CNN, CNN International and Al Jazeera America covering some of the most pressing issues in the United States and around the world.

Follow her on X: @tarakangarlou

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