The present study examined the QOL of 380 Kurdish female relatives of martyred individuals. Each of the women included in this study lost a male family members (e.g., husbands, sons, brothers, or fathers) in the last 50 last years. These men, called Peshmerga, died defending Kurdistan from threats by Iraqi regimes and attacks of neighboring countries. Some were the victims of the 1970 genocide, while others were war prisoners who were hung or tortured to death. Still others left as part of the Kurdish exodus in 1991 or were killed during the fight against Da’ish, the Islamic State’s (i.e, ISIS) militant group [7,8]. According to their WHOQOL-BREF score, the results of this study show that the QOL of surviving women in this region is not desirable, even poor, depending on age, educational level, occupation, marital status, and relationship to the martyr. Women of older age, low educational status, unemployed and married/widowed women had a lower QOL, as well as those women who were the mother or wife of the martyr. The quality of physical health and psychological health of the study sample were low, which may be due to lack of support by governmental health organizations and the lack of provision of healthcare to this group of women, as well as limited financial support. In addition, sociodemographic factors – especially low economic status and lack of education—may further worsen QOL for these women, as challenges such as illiteracy complicate everyday life.
Other studies have shown that QOL deficits in both veterans and refugees have been consistently linked to war-related post-traumatic stress symptoms [9,10]. One study done in Western Europe on Balkan residents and refugees showed that employment and finances were among the strongest factors of dissatisfaction by participants and that social QOL (SQOL) was strongly affected by post-traumatic stress symptoms. Lower SCOL were directly dependent on traumatic war events and post-war environment [11].
Further, the results of the present study show that quality of the social relationship domain of the interviewed women was higher than other domains. This may be due to strong social relationships among Kurdish people, specifically in the Mediterranean East countries. Culturally, the relationship between family members and relatives is strong and there tends to be a strong sense of religious heritage. What’s more, close family relationships among Kurdish people are an important part of traditional value systems. Typical family structures in this region include extended family members and it is very uncommon for Kurds to live alone. Families tend to be large, as several generations of affiliated family members tend to live together. Family networks remain tight even in cases where family members live far from one another [12]. In nuclear and extended Kurdish families, familial loyalty, kinship, strong marriage relationships, cooperation in work, and strong support systems are the norm. Large kin groups are of higher importance than ethnicity, social class, and sectarian lines. Further, family members are mutually protective of one another. An individual’s status within a family group is determined by the family's position and the individual's position within that group [13]. As the vast majority of Kurdish people are Muslim, family is of utmost importance and the family unit is regarded as the cornerstone of a healthy and balanced society [14].
Given the importance of stable family structures, the Kurdistan Region Government (KRG) has tried to support those families who have lost members to conflict, especially those who lost their breadwinners. Support includes a monthly salary and support for healthcare, education, and housing [15]. Despite this support, it seems that these families continue to struggle to meet basic needs. As the results of this study show, only 10.5% of the study sample scored in the 4th quartile of total QOL according WHOQOL-BREF. It is worth mentioning that the poorest families of individuals who had been martyred attend the Medical Center of Martyr Families to seek healthcare services. However, results of this qualitative study indicate that women were not satisfied with the health services offered at this center. Specifically, they expected that more assistance would be provided from the government, and that services would respect them and provide emotional, social, economic, and physical support [16].
There are a number of limitations to this study. While prior studies have assessed quality of life among specific groups of women with particular diseases, such as those with cancer, age-related illnesses, and conditions such as menopause, few-to-no studies have addressed how war affects these populations. As thus, there was limited literature to support this study. Another limitation of the present study was interviewing women who live inside Erbil City, the capital of the Erbil governorate. Many families of martyred individuals live in small towns and villages, which were not included in this study. These women may have worse health than those included in the study because they have less access to adequate healthcare. Another major limitation of the present study is the absence of a control group , which should be included in future studies of this nature.