DAKAR, Senegal (AP) — When armed men entered Safi’s village in northern Burkina Faso and began firing, she hid in her home with her four children. The gunmen found them and let them live — to suffer the guilt of survival — after killing her husband and other relatives.

Safi, whose last name has been withheld for security reasons, is among 2 million people displaced in the West African country by growing violence between Islamic extremists and security forces.

About 60% of the displaced are children. Many are traumatized, but mental health services are limited and children are often overlooked for treatment.

“People often think that the children have seen nothing, nothing has happened to them, it’s fine,” said Rudy Lukamba, the health coordinator for the International Committee of the Red Cross in Burkina Faso.

He works on a program to help identify and treat traumatized children. It often relies on mothers to spot signs in children as young as 3 or 4. The chances of a successful outcome after treatment is greater when the children have a parental figure in their lives, he said.

Mass killings of villagers have become common in northern Burkina Faso as fighters linked to the Islamic State group and al-Qaida attack the army and volunteer forces. Those forces can turn on villages accused of cooperating with the enemy. More than 20,000 people have been killed since the fighting began a decade ago, according to the Armed Conflict Location and Event Data Project, a U.S.-based nonprofit group.

Mental health services in Burkina Faso are often reserved for only the most severe cases. A U.N. survey published in 2023 showed 103 mental health professionals in the country of more than 20 million people, including 11 psychiatrists.

Community-based mental health services by social workers are expanding, now numbering in the hundreds and supported by a small team of U.N. psychologists. In addition, traditional medicine practitioners in Burkina Faso say families are increasingly turning to them for help with traumatized children.

But the need is immense. The U.N. said surveys by it and partners show that 10 out of 11 people affected by the conflict show signs of trauma.

With no money and fearing another attack, Safi set off on foot with seven children, including her own, across the arid plains in search of safety. They settled in a community in Ouahigouya, the capital of Yatenga province, and sought help.

It was there that Safi learned how post-traumatic stress can affect children. They had nightmares and couldn’t sleep. During the day, they didn’t play with other children. Through the ICRC, Safi was connected with a health worker who helped through home visits and art, encouraging the children to draw their fears and talk about them.

Traditional medicine practitioners are also helping traumatized children. One, Rasmane Rouamba, said he treats about five children a month, adapting the approach depending on the trauma suffered.

Children in Burkina Faso also have lost access to education and basic healthcare in fighting-affected areas.

The closure of schools is depriving almost 850,000 children of access to education, the U.N. children’s agency has said. The closure of hundreds of health facilities has left 3.6 million people without access to care, it said.

Burkina Faso's government has struggled to improve security.

The country's military leader, Capt. Ibrahim Traoré, seized power in 2022 amid frustrations with the government over the deadly attacks. He is expected to remain in office for another five years, delaying the junta's promises of a democratic transition.

Around half of Burkina Faso’s territory remains outside government control. Civic freedoms have been rolled back and journalists expelled.

And the country has distanced itself from regional and Western nations that don’t agree with its approach, severing military ties with former colonial ruler France and turning to Russia instead for security support.

Safi, adrift with her children, said she plans to stay in her new community for now. She has no money or other place to go.

“There’s a perfect harmony in the community, and they have become like family,” she said.

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