HARVARD TRAUMA QUESTIONNAIRE


   
   

Iraqi Version- Arabic

_______________________ :/Name

_______________________: /Sex

_______________________:!  "
/Date of Birth

_______________________: /Marital Status

_______________________:"
 /Date

1
 :#
01  (1(  23
 () .%
& '( ) *  + ,  -(  - .  
 *6 
&  :17( - - 3 6 . &(   8( 19+ 23
    .456 
7 
 -
8

 *6 ?@& A 19+ 23
01 - #  () .- ; <( *6 =>
 3
 9(7 . 
.(

Instructions:
We would like to ask you about your past history and present symptoms. This
information will be used to help us provide you with better medical care. However, you
may find some questions upsetting. If so, please feel free not to answer. This will
certainly not affect your treatment. Your responses will be kept confidential.

:
PART 1: TRAUMA EVENTS

 "" & F(  (  *6 () (; E5) 
  B&  ( C+ 5  ) # )3   
.("!"
Please indicate whether you have experienced any of the following events (check "YES"
or "NO" for each column).

 /Yes !/No  /Yes !/No

/1 -
3(  -
 I- F '75; 5 4

Oppressed because of ethnicity, religion, or sect

/2 J
  K  %=& -5& - L
@  4

Present while someone searched for people or things in your home.

/3  6 4

Searched
/4 

(  '(  
  -)1(( F'  4

Property looted, confiscated, or destroyed

/5 (  '
6 4, M ,7( *6 )   -
( - -
1 6 4

Forced to leave your hometown and settle in a different part of the

country with minimal services
/6   4

Imprisoned
/7 -5( 4; J   
7  
  01 4&  
)(  ( 
 4

Suffered ill health without access to medical care or medicine

2
 /8 *6  J(   7     ( 
 4

Suffered from lack of food or clean water

/9 -7 ( F'  01 75 4

Forced to flee your country

/10 -
3(  -
 I-  4 01 %J -7 (  '  -
1 56 4

Expelled from country based on ancestral origin, religion, or sect

/11 M.( -
 )
 4

Lacked shelter
/12  -
   
(
1 8)(   ,(   
(  (& -' 
 4

-
3(
Witnessed the desecration or destruction of religious shrines or places
of religious instruction
/13 -@97  -
 I-
 ( ('( 
   F
3  4, 
 4

Witnessed the arrest, torture, or execution of religious leaders or

important members of tribe
/14 

(1 %
( %(# 
 4

Witnessed mass execution of civilians

/15 
+  
)  )(+ 
(  :&N  A 
 4

Witnessed shelling, burning, or razing of residential areas or

marshlands
/16 
+  
)  :7(  01 
9
(
) (

 4

Witnessed chemical attacks on residential areas or marshlands

/1 O +  (&1+ *( I*6( A I @) F&  
( 5 4

Exposed to combat situation (explosions, artillery fire, shelling) or

landmine.
/1 O + F&  
(   F 
7 
( N  4

Serious physical injury from combat situation or landmine

/1 C Q) (
P 4

Used as a human shield

/20    F 
7 
( N -9  -19 6  & F
 4

O +  F& 
Serious physical injury of family member or friend from combat
situation or landmine
/21 @( %== 
 4

Witnessed rotting corpses

/22 R  *6 A  05@  F   *6 J,  01   4

Confined to home because of chaos and violence outside

/23 (" #...I7  IF5 ) *(  M3S 
( % 
 4

Witnessed someone being physically harmed (beating, knifing, etc.)

/24 FT!  
  J 
1( 
 4

Witnessed sexual abuse or rape

/25 F
3  & 
 4

Witnessed torture
/26 4  & 
 4

Witnessed murder

3
/27 (    7 U5V (( W K  01   4

Forced to inform on someone placing them at risk of injury or death

/28 W K )1(( 
( 01   4

Forced to destroy someones property

/29 ( K (" N...I7  IF5 ) *(  M3+ :& # 01   4

Forced to physically harm someone (beating, knifing, etc.)

/30 A  
 ( (" ...I- 8 I-1@7) -19 6 ( & 4 4

Murder or violent death of family member (child, spouse, etc.)

/31 A  
 ( -,
 4 4

Murder or violent death of friend

/32 I-1@7) -19 6 & 4, ((  ,17  (
 E6 01   4

(" ...I- 8
Forced to pay for bullet used to kill family member (child, spouse, etc.)
/33 
( (#  J)  ( ( I(" ...I- 8 I-1@7) -19 6 & = (1
U
1 6  4

Received the body of a family member(child, spouse, etc.) and

prohibited from mourning them and performing burial rites
/3 (" #...I- 8 I-1@7) -19 6 & 0@ 4

Disappearance of a family member (child, spouse, etc.)

/3 -,
 0@ 4

Disappearance of a friend
/3 

) 3  (" N...I- 8 I-1@7) -19 6 & A7
P 4

family member (child, spouse, etc.) kidnapped or taken as a hostage

/3 

) 3  -,
 A7
P 4

friend kidnapped or taken as a hostage

/38 (    7 -19  -5 (( -Y& XV1 4

Someone informed on you placing you and your family at risk of injury
or death.
/39 (" N...I7  IF5 ) *(  M3S 5Z 4

Physically harmed (beaten, knifed, etc.)

/40 

) 3  @7
PN 4

Kidnapped or taken as a hostage

/4 T  
  J1 5 4

Sexually abused or raped (i.e., forced sexula activity)

/42 4) 
   
@  (  0 # 5 + *6 -  J= 0() -
3 
(?( ((
Tortured (i.e., while in captivity you received deliberate and systematic
infliction of physical and/or mental suffering)
/43 71 5( -
& . 
   @
( M A( C &   
Please specify any other situation that was very frightening or in which
you felt your life was in danger:

4
 *  A  :*=  J8 
PART II: PERSONAL DESCRIPTION
)( 
& J   = .F   +  (  
 *   ' 5 *  B&  )3  J  
.B&  23
(8
Please indicate what you consider to be the most hurtful or terrifying events you have
experienced. Please specify where and when these events occurred.

 *
( (" #...I0@(  (   I
7  # 1 I
9 ;  
(
V :%;=() 
&  -
( A? &
.=&  23
(8 )( 
& J   .2; U)3 ( A1 23
) # I' 5 =&
Under your current living situation (i.e. refugee camp, country of resettlement, returned
from exile, etc.) what is the worst event that has happened to you, if different from above.
Please specify where and when these events occurred.

5
   # :B =  J8 
PART III: HEAD INJURY
. (8  ( 6 C+ *  ,6  ) N )3    I
  B&  01 ""  +  & *6
If you answer YES to the following trauma events, please indicate if you lost
consciousness and for how long.

5 4
[*  ,6 4

S6 I"" F  ) 3#
[B&1 Loss
[(
Experienced? of
Consciousness? If yes, for how long?
Yes No Yes No Hours Minutes
 !  !  :9
/1   01 F5 
Beatings to the head
/2 :  &(
Suffocation or strangulation
/3 :O  - 01
Near drowning
/4 -( F 01 @! 
   *6 #
Injury to the head from nearby explosion
/5 I7 IC :17 I
?)   *6 M #
(" N...I:&
Other types of injury to the head (e.g.,
shrapnel, bullet wound, stabbing, burns,
etc.)
/6 E
  
Starvation
/6a ______ :E
    -8 ______:*
7  -8 
(6 I\  01 "" - ) 3N
If yes to item 6, what was your Normal weight:______ Starvation weight:______
/6b ______ :! ______ : [E
   
 (  - 01 ) 4'6 I\  01 "" - ) 3#
If yes to item 6, were you near death due to starvation? Yes:______ No:______

6
    :E  J8 
PART IV: TRAUMA SYMPTOMS
.'
& *6 8@(  ( >( B& 5 
3  K+ 
& ' 
 *

  + #
.(  Q+ 4; + 23
( -( M( 
& I  4) J J  
The following are symptoms that people sometimes have after experiencing hurtful or
terrifying events in their lives. Please read each one carefully and decide how much the
symptoms bothered you in the past week.

(/1) (/2) (/3) (/4)

 ! ;
1 
=) & 0 N 
V
Not at all A little Quite a bit Extremely
/1 86  (  B&  =)+ )6+ 
)3  - 4

Recurrent thoughts or memories of the most hurtful or

terrifying events
/2 M ( =&  L
 -.)   4

Feeling as though the event is happening again

/3 )( (@
( ;&) 
) -
. 4

Recurrent nightmares
/4    48!  4@!  4

Feeling detached or withdrawn from people

/5 A7  & 01  
T -@   4

Unable to feel emotions

/6 =!  ;@  E
 -@   4

Feeling jumpy, easily startled

/7 -)6 8
) *6    4

Difficulty concentrating
/8   *6    4

Trouble sleeping
/9 3& 01   ( -@   4

Feeling on guard
/ F5O  (  -  4@! E
 -@   4

10 Feeling irritable or having outbursts of anger

/ ( >(  =&  -Z)3 *  4(+ F  4

11 Avoiding activities that remind you of the hurtful event

/  -  *  B&   )3 01 
T -@   4

12
 +
Inability to remember parts of the most hurtful events
/ 
(
 4(+ ((
 4 -@   4

13 Less interest in daily activities

7
/ - 4,( ! U.)  4

14 Feeling as if you dont have a future

/ ( >(  B&  7(  (   )6+ F  4

15 Avoiding thoughts or feelings associated with the

hurtful events
/ ( >(  B&  -
)3  *@7 *( 46   4

16 Sudden emotional or physical reaction when reminded

of the most hurtful events
/ )3  A5  4

1 Poor memory
/ 
  F   -'+  4

1 Feeling exhausted
/ 
( 4)(  !W ( * 4

1 Troubled by bodily pain or physical problems

/ %, ) (( 4 *
] -'(   4

20 Feeling that you have less skills than you did before.
/ 2! *6    4

21 Difficulty paying attention

/ 
(
 -
& *@  C 3 01 
T -@   4

22 Feeling unable to make daily plans

/ ^_
  A(  ' ( *6    4

23 Having difficulty dealing with new situations

/ B&  23
( 0 C3  
&  K  -  4

24 Feeling that you are the only one who suffered these
events
/ - M ( '6 01 
 
T 
]   4

25 Feeling that others dont understand what happened to

you
/ 
&  
 01  8 (    -+ F3   4

26 Feeling guilty for having survived

/ B& ( -@ 1 4

27 Blaming yourself for things that have happened

/ B&  23
4=( U   - ` 
V 3( 4J 4

28 Spending time thinking why God is making you go

through such events
/ ,! 0   &  4

29 Feeling a need for revenge

/ -
  
9 
]   4

30 Feeling others are hostile to you

/ -  U ,= C3  K    4

31 Feeling that someone you trusted betrayed you

/ 
] ,=    4

32 Feeling no trust in others

/ ` !N U
1 ( & ( -

  4

33 Feeling that you have no one to rely upon but god

8
/ 4(+ ,6 4

3 Hopelessness
/ 
] ( 8  -  4

3 Feeling powerless to help others

/ ' 5 *  ( >(  B&  F    4

3 Feeling ashamed of the hurtful or traumatic events that

have happened to you
/ - M ( F 
+  4

3 Feeling humiliated by your experience

/ -19  c -@ 0  b1a F1  -  4

3 Feeling that you are a jinx to yourself and your family

/ 2)3  E
7 ! 4( ( - & -  -@ @) 4

3 Finding out or being told by other people that you have

done something that you can't remember
/ ] U1@
( F
(
&  I
 0 # (, -  4

40 Feeling as though you are split into two people and one
of you is watching what the other is doing
/ <
5  4

4 Dayeg(ruminations, poor concentration, lack of

initiative, boredom, sleep problems, tiredness, and
somatic complaints)
/ ,( -1 4

4 Qalbak maqboud (sensation of the heart being

squeezed)
/ *  4

4 Asabi(irritability, nervousness, lack of patience, and

anger outbursts)
/ :! - 01 -.) @  :
5  4

4 Nafsak deeyega and makhnouk (feeling of tightness in

the chest and a choking sensation)
/  -
@ 4

4 Nafseetak tabana (tired soul)

dgde   (1(  ( 
8(1 4
    ( J  

1

For further explications of items 41-45, please refer to the manual

9
 F
31   "

TORTURE HISTORY
(; E5) "%
3"   ( 
=) 

*  
  B&  ( C+ 5  ) # )3   
.("!"  "" & F(  (  *6 ()
Please indicate whether you have experienced any of the following events that many
people consider torture (check "YES" or "NO" for each column).

 /Yes !/No  !/No

/Yes
/1 
,
,& 
T  @
Z8( 6# ) 01   4

Forced to write false confessions

/2 
'  
 5 4

Humiliated and threatened

/3 -

 
7O -'  01  5 4

Blindfolded
/4 (8  ( 1
7 ( A  01   4

Forced to stand for long periods of time

/5 

& 4;  4&  

V  4

Chained or tied
/6 % :
5 )(  : I
h *6 5 4

Placed in a sack, box, or very small place

/7 
'  &( I;( C  C@   *6 5 4

Placed in an isolation cell with no clothes, toilet, or ventilation

/8   ( (& 4

Deprived of sleep
/9 ((  + 5 4

Exposed to continuous and piercing noise

/10 C,  J5   &(  (   
   &1 5 4

Exposed to strong heat, sun, or light

/11    7(1 5 4

Exposed to rain or cold

/12 1
7 ( J(   7  ( (& 4

Deprived of food and water for long periods of time

/13 -5( 0 N  3/
& 
T A? 5 4

Exposed to dirty conditions leading to ill health

/14 - & J5 ( ( 4

Prevented from urinating or defecating

/15 
7  
  ( (& 4

Deprived of medical care

10
/16 ;  J  J5  ( ( 4

Prohibited from ablution and prayer

/1  4( J 01   4

Forced labor
/1 (8  ( 1
7 @ F
5, 
1   

 ( ,V1 4

Suspended from a rod by hands and feet for long periods of time
/1 (8  ( 1
7 @ F
3  7( 01 ( 4

Stretched on a rack for long periods of time

/20 I  :F5  :7( 
& J  ) 1 . 5  1)  @  ()  4

(" #...I
1  J5+ I'?  IQ3 

Punched, slapped, kicked, or stricken with objects (please specify targeted areas:
head, torso, back, genitalia, etc.)
/21 (,16) 7
   *  
(,  7 01 5 4

Beaten on soles of feet with rods or whips (Falanga)

/22 :O ) 0& J(  *6 - 
7O  4

Head submerged in water with near drowning

/23 (&+     &  
8   %
9') (  F
5,   9   F,. & 4

J5+ I'?  I Q3  I 

 :- 3 5 *  :7(  
& J  ) F8
/
9
(
) 

(" #...I
1 
Burned by cigarettes, electrically heated rods, hot oil, fire, or corrosive acid/tizab
(please specify targeted areas: hands, torso, back, genitalia, etc.)
/24 J5+ I'?  I Q3  I 

 :- 3 5 *  :7(  
& J  ) %
9') , 4

(" #...I
1 
Electrocuted (please specify targeted areas: hands, torso, back, genitalia, etc.)
/25 
V  A -  -
(/-

6? Q8  4

Fingernails, toenails, or teeth forcefully extracted

/26 () (; -'   4

Forehead branded with an ()

/27 (" #...
1  J5+ IA7+ I

=  I

 I1  IA+ I
3+) -( ( J8    4

Body parts mutilated (ears, nose, tongue, hands, breasts, limbs, genitalia, etc.)
/28 ;
=( ) U  (
6 
   A( 0 # 5 4

Subjected to mock executions

/29 
] ( C  01   4

Forced to undress in front of people

/30 
  Q5+ '
6 (  3( Q5 3 01   4

Forcibly arranged in various humiliating or sexually explicit positions

/31 [%
6T6 -
  4
I ( kl) 01  +  & *6
If YES to (31), were you photographed?
/32 W K F
3  
1( FT! I
  J 
 4

Witnessed the sexual abuse, rape (i.e., forced sexual activity), or torture of someone
/33 W K F
3   FT! I 
  J 
1( *6 )(  01   4

Forced to participate in the sexual abuse, rape, or torture of someone

/3 T  
  J1 5 4

Sexually abused or raped (i.e., forced sexual activity)

11
/3 :F
3  ( M A( C 0 N 
   
Please specify any other torture situations:

12
   - E  J8    4

Scoring Part IV-Trauma Symptoms

'
1 F
 *  19+  E(  .

A. Sum the number of answered items
U
1 F
 4> 4) 
  
,  F . F
B. Assign the following numbers for each answered item

1 = Not at all " !" 3 = Quite a bit "
=) & 0 N "
2 = A little ";
1" 4 =Extremely "
V "

'
1 F
 *  19+  01 '(

V = '1)    E( .
C. Add up item scores and divide by the total number of the answered items

DSM-IV PTSD SCORE = ITEMS 1-16  = DSM-IV PTSD  

16
e\

TOTAL SCORE = ITEMS 1-  = (  
 

.PTSD  '
 
nIg ( =)   01 1& 
3  6+

.(1(  ( 
8(1 4
   ( J  
Individuals with scores on DSM-IV and/or total > 2.5 are considered symptomatic for PTSD.
See manual for additional information.

F
 (  M3S 5 
3  
9 ; 
   ( (<

7
Developed by: Harvard Program in Refugee Trauma, Iraqi Mental Health Professionals, and Marwa Shoeb

2006 by Harvard Program in Refugee Trauma

?@&( :,&  E
( /All rights reserved

13