"He hates life. He just hates life," his mother, Rehab Fayad, said wistfully. "It's affected him not just physically, but psychologically."
The militants detonated 25 oil wells in a desperate and ultimately unsuccessful effort to defend their terrain against Iraqi security forces in 2016 and wreck a prized national asset. For nine months, a thick, blinding cloud of smoke engulfed Qayyarah and the villages that surround it, turning people's skin and sheep's coats black from soot.
The Islamic State footprint on Iraq's environment may be unprecedented and permanent, with a toxic legacy that includes wide-scale cattle deaths, fields that no longer yield edible crops and chronic breathing complications in children and the elderly, doctors and experts said.
Up to 2 million barrels of oil were lost — either burned or spilled — between June 2016 and March 2017, when firefighters put out the final blaze, according to a U.N. report citing Iraq's Oil Ministry. Environmental experts worry that much of the oil has seeped into the groundwater and the nearby Tigris River — a lifeline for millions of Iraqis stretching more than 1,000 miles to Baghdad and beyond.
The militants also torched a sulfur plant north of Qayyarah, spewing 35,000 tons of the stinging substance into the air, the United Nations said. Reportedly containing one of the largest sulfur stockpiles in the world, the plant was set ablaze in part to help hold off Iraqi security forces, according to human rights and environmental experts.
Still unknown is the full extent of the impact. Studies into the long-term health effects have been halting, with Iraq's government putting greater urgency on rebuilding, resettling displaced people and the clearing of explosives.
"The effect of what happened here will be felt for many years and decades, and the worst of it hasn't even shown up yet," said Abdelmeneim Tabbour, the head of Qayyarah's health department. "The government has other priorities."
U.S. officials who have monitored the destruction say that it recalls the environmental damage done to Kuwait by Iraqi President Saddam Hussein's forces when they set fire to the country's oil fields in 1991. But unlike in Kuwait, the toxins emitted around Qayyarah have settled over populated areas and farmers' fields. Qayyarah and the surrounding villages and settlements that abut the oil fields are home to about 100,000 people, according to the last census in 2011.
The fires in Qayyarah were an especially stark case, but the Islamic State carried out a variety of environmental sabotage and degradation that blight a vast area, extending north to Iraq's Hamrin Mountains and west to the farms and oil fields that line the Euphrates River near the Syrian city of Deir al-Zour.
"The damage on the Syrian side is right in the country's breadbasket, and [the Islamic State] contaminated it through industrial practices and deliberate sabotage," said a U.S. official who closely tracked the destruction over the past three years. The official spoke on the condition of anonymity because he was not authorized to discuss the issue publicly.
"You've got trenches filled with oil, oil spilled into the river, and soot from burning oil contaminating the fields," the official said. "All of it makes it harder for the next leaders to govern, or even to provide clean food and water."
"We went through a disaster," said Ramadan Mahjoub, the head of Qayyarah Hospital, recalling the days and months the smoke covered the area.
Children and the elderly rushed to the hospital with breathing problems, up to 600 in a three-hour period, said Ali Farraj, an internal medicine specialist. After the sulfur plant was burned, the cases became more severe, involving skin rashes, severe bronchitis and suffocation deaths, he said.
For months, children playing outside or waiting for a handout from passing Iraqi troops had faces caked with soot. Dead sheep and cows littered fields and roadsides.
"The level of disregard by the Islamic State was pure nihilism," said Wim Zwijnenburg, a Dutch researcher and co-author of "Living Under a Black Sky," a report on environmental destruction in Iraq, sponsored by Pax, a Netherlands-based nonprofit organization. "The burning of the sulfur factory was a real case of using environmental damage as a weapon of war."
Ahmed was 13 when he awoke one humid September night choking from the toxic air. His face and legs were swollen, and he complained to his mother that he couldn't breathe.
His mother rushed him to a nearby clinic run by Doctors Without Borders, the French aid group, where they discovered that fluid was collecting in his lungs. He was taken to a hospital in the Kurdish capital of Irbil, 65 miles to the north.
After he arrived at the hospital, Ahmed suffered a stroke. In a handwritten report given to Ahmed's mother upon his release, doctors noted that he had suffered "severe heart failure," possibly a result of his lungs expanding and putting pressure on his heart.
"He will live with this for the rest of his life," his mother said.
Ahmed's prospects for proper treatment are not good, and his chances of receiving psychological care for his trauma are even worse.
Qayyarah's main hospital is still being repaired from the damage it sustained during the battle to evict the militants. The closest hospitals equipped to deal with delicate cases such as Ahmed's are in Irbil and Baghdad — a lengthy and costly trip. Ahmed's father is a municipal employee who does not receive a regular salary.
"We can only afford his heart medicine," his mother said, adding that psychological care is out of the question.
A toxic legacy
In the village of Ijhala, an hour's drive from Qayyarah's center, farmers have struggled to grow their traditional crops of okra, tomatoes, cucumber and watermelon. Herds of sheep that once numbered up to 50 are now limited to about a dozen.
"The smoke destroyed us; people are not working," said Ibrahim al-Agedi, a 52-year-old farmer. The meager crops that do grow are useless. No one wants fruits and vegetables "that have been poisoned," he said.
"Other cities and towns have had physical destruction when they were liberated," Agedi said. "But none are going through what we are going through. Our land, our air and our water have been destroyed."
For Agedi, the loss of income is compounded by the health issues afflicting him and his family. There are 16 children in his household, all with various respiratory ailments.
"I don't have money to go to a doctor; I'd rather feed my children," he said.
Instead, Agedi and others in his village rely on Amin Youssef, a 40-year-old nurse who treats people free in a humble one-room clinic.
During a recent sandstorm that lasted several days, Youssef said he was seeing 100 patients a day with persistent coughs and difficulty breathing.
"This never happened before, and we can only guess that is a result of the smoke," he said.
"I can only provide a simple service," Youssef said, noting that many of the people he serves can't afford the treatment they need.
He blamed the Islamic State for the condition of his village.
"They claimed to be Muslims," he said. "They left behind a symbol of their Islam: a toxic environment that will affect future generations."
An unknown future
Mahjoub, the head of Qayyarah Hospital, said the long-term health concerns from the toxicity in the soil and water are many. He worries most about birth defects, cancer and malignant tumors.
Local and international experts say a sustained study of the contaminated area is urgently needed to prepare for future health effects and contain any spread of toxins. The United Nations said in a report last year that ongoing efforts to remediate the environmental impact of the 1991 Kuwait oil fires are expected to last until 2020.
Saif al-Badr, a spokesman for Iraq's Health and Environment Ministry, said the government is aware of the matter but is overwhelmed by the magnitude of the post-Islamic State reckoning — with land mines and mass graves receiving most of the attention.
Human rights groups that work in war-ravaged areas say environmental contamination from military conflict is a problem that is often far down the list of priorities for governments.
"With other threats, such as land mines, there are funding streams and a well-developed legal mechanism. There's nothing like that for toxic remnants of war," said Doug Weir, manager of the Toxic Remnants of War Project, a research organization based in Britain. "Most of the time, it's just left to the affected state, where there are lots of competing needs."
As usual, he said, the most vulnerable groups in society are also most likely to experience harm.
"It's children, it's the elderly, it's people with existing medical conditions," he said. "At this stage in Iraq and Syria, there's not enough data to know what's safe."
Warrick reported from Washington. Mustafa Salim in Qayyarah contributed to this report.