By some counts, the majority of refugees struggle with mental health problems. Wars, displacement, and separation from family often cause trauma and depression. But because of language and cultural barriers, refugees are also among the hardest to serve.

Now, those in Chicago will have even fewer places to go. A clinic that focuses on refugees’ mental health recently closed.

Ahlam Mahmoud’s problems began well before she became a refugee. During the turmoil of the war in Iraq, she says she was briefly kidnapped by a militia group, and fled to several countries including Syria, where she lost a son, and was jailed.

MAHMOUD: I was fighting it by smoking. I was smoking three packets a day, and continue working with frightened, terrifying from what will going on to me.

The stress was compounded when she came to Chicago, alone with her two remaining children. Her husband stayed behind.

MAHMOUD: I’m talking about six years of war, violence, refugee life, and then when I arrived here, it’s like a shock to me.

In the beginning, she was scared to walk outside or ask for directions in this foreign city. Mahmoud credits her mental health doctor here with helping her get over those fears.

In fact, she walks outside so frequently that in some parts of town, nearly all the passersby know her. Mahmoud frequents neighborhoods, like this one near Devon and California Avenues, where waves of recent Iraqi refugees have clustered.

MAHMOUD: They call me the mayor of the Iraqis here. If you want to know anything about the Iraqis, go and ask Ahlam.

Mahmoud’s adjustment is a remarkable success story, because her mental condition on arrival was typical of a refugee’s:

WEINE : As much as 60-70% of the population has above a certain threshold of mental health symptoms that you would say they could benefit from treatment.

Dr. Steven Weine of the University of Illinois Chicago, is a psychiatrist who specializes in the study of refugee mental health. He says refugees not only experience mental health problems in greater numbers, but the traumas they’ve gone through make their conditions particularly acute:

WEINE: Those people who were under siege, were tortured, were beaten, may have the problems that come with post traumatic stress disorder, of nightmares, difficulty sleeping, difficulty concentrating.

Refugees also struggle to find services in their own languages, administered in cultural contexts that are more comfortable to them.

That’s why many people were dismayed to find out that one of Chicago’s two refugee mental health clinics closed in late February. World Relief’s Horizons clinic in Albany Park shut down amid staffing problems. Patients were transferred to Chicago’s remaining provider, Heartland Alliance.

Heartland’s President, Sid Mohn, declined to be interviewed for this story. But in an email he wrote that the closure of Horizons Clinic has not decreased services. In fact, he says the state of Illinois was careful to ensure that no patient would be left behind.

Many others, like Dr. Weine, agree that Illinois has done more than most states to maintain mental health support for refugees.

WEINE: I think there are many cities around the country who are jealous of what Chicago has. And yet, when you’re on the street and you’re in those communities, you may feel that Chicago doesn’t have enough.

BRUNTON: Typically, people do complain about waits, and complain about access wherever they go. So I would be really concerned that that just is going to get worse now.

Steve Brunton is head of the Chinese Mutual Aid Society. He says his organization and other mutual aid groups frequently have to refer clients to mental health clinics that can help them. And there’s usually a waiting list:

BRUNTON: That can be an issue because during those few months, they may decide not to go, or they may decide that whatever problems they were having there, they can deal with something on their own.

Ahlam Mahmoud knows first-hand of those waits. In her first month here, she tried enroll herself at Heartland’s Marjorie Kovler Center, which focuses on victims of torture. It took five months before somebody could see her. She says refugees like herself need help much sooner than that.

That’s why Mahmoud co-founded a group called the Iraqi Mutual Aid Society. She regularly visits other families, often headed by single mothers who don’t speak English. They sit and have tea. Mahmoud removes her headscarf and smokes cigarette after cigarette, and she listens to their problems.

Mahmoud helps where she can. Sometimes it’s as simple as a phone call to a case worker she knows.

MAHMOUD: Ms. Mentice, I have a friend, her name is Wafaa Faleh. ‘Til now she don’t have her food stamp…

But Mahmoud says she can’t treat the underlying trauma that leads many refugees into depression. She refers them to Heartland Alliance. But she knows that they probably won’t be able to get the counseling they need soon enough:

MAHMOUD: This is what I’m pushing on having another mental institute, especially here in north Chicago, because of the amount of people we receive.

Mahmoud says she’s spoken of this need to nearly everyone she’s met in the last six months. But that’s not likely to change the situation soon. They tell her the economic climate has them focused on simply maintaining existing services.