Iraq crisis update – November 2017

Iraq has endured years of disastrous conflict. Since 2014, 5.3 million children and adults in Iraq have been forced to leave their homes and seek shelter from the fighting. More than 2.2 million people have now returned home but years of conflict have severely impacted the health sector and the needs are great.

As the last remaining cities are re-taken from the IS, more and more people are returning home. MSF has observed an increased number of families leaving the camps.

Although life is returning to eastern Mosul and other retaken cities, unemployment is high and most children have missed years of school. In west Mosul, Anbar, Kirkuk and Salaheddin, homes, infrastructure and services have been almost completely destroyed. In west Mosul, the healthcare system remains in a dire situation. Most hospitals and clinics were bombed and there is still a severe lack of services, equipment, medical staff and medication.

A significant number of displaced people are still living in camps. Many, especially people from west Mosul, have nowhere to return and can’t afford to sustain themselves and their families without the assistance they receive in the camps

On 25 September, Kurdistan held an independence referendum. Since then, the Iraqi government has moved to retake disputed territories, including Kirkuk and its surrounding oilfields. Clashes between Iraqi forces and Peshmerga forces have taken place in several areas, causing displacement and road closures.

A 7.3 magnitude earthquake struck several regions near the Iraq-Iran border on 12 November. There were six reported fatalities and more than 500 people injured in Iraq. The Sulaymaniyah Emergency Hospital, where MSF supports the emergency room and the intensive care unit, received 80 cases related to the earthquake. MSF also donated supplies to a primary healthcare clinic in Darbandikhan, which was used as a hospital in the aftermath of the earthquake.

The scars of war

Accessing healthcare is a daily challenge for thousands of children and adults in Iraq. After years of conflict and instability, the health sector in certain areas has almost ground to a halt. Many health facilities have been destroyed and there are often gaps in the availability of medical supplies and qualified health workers.

The needs in Iraq remain extremely high. Many cities retaken from the Islamic State (IS) group are severely damaged or destroyed. Thousands of people returning home confront a desperate lack of access to medical care. In addition, many are living without clean water or electricity.

The security situation is still very fragile. Violence is still being recorded daily. In many places, it’s dispersed and unpredictable.

Many trauma patients will need several surgeries, regular sanitary dressing changes, pain management and in many cases, physiotherapy, to regain use of damaged limbs and muscles. MSF, alongside other actors, is providing post-operative and rehabilitation services in Mosul and early physiotherapy in Baghdad, but the needs far surpass the availability of services.

The psychological and emotional scars of war are immense and thousands of people need mental health assistance. Mental health is a key component of many MSF projects. Our teams of psychiatrists, psychologists and counsellors provide vital care and support for moderate and severe cases, including post-traumatic stress syndrome, depression, schizophrenia and severe anxiety.

MSF offers neutral and impartial assistance regardless of race, religion, gender or political affiliation. To ensure its independence, MSF does not accept funding from any government or international agency for its programmes in Iraq, relying solely on private donations from the general public around the world to carry out its work.

MSF project update

MSF works across Iraq in the governorates of Dohuk, Erbil, Sulaymaniyah, Diyala, Ninawa, Kirkuk, Salaheddin, Anbar and Baghdad. Below is an update on the latest operations.

Updates on existing projects 

  • At Nablus Hospital in west Mosul, war-related trauma cases have decreased. We are expanding our maternity, new-born and paediatric care activities. We are running the emergency room and a paediatric inpatient department with a new-born unit, and providing services for complicated and non-complicated deliveries. We have also introduced new activities including prenatal care, antenatal care and family planning services. In October, we treated 1,764 people in the emergency room, 111 in the inpatient department and performed 126 deliveries and 14 caesareans.
  • MSF has seen a significant increase in patients at its maternity clinic in the village of Tal Maraq, Zummar. The recent change of context between Iraqi and Peshmerga forces has led to an increase in returnees and people accessing the MSF maternity unit. Our team in Zummar has been working around the clock to keep up with the demand for medical care. We provide services for normal deliveries, ante- and prenatal consultations, basic emergency obstetric cases and a small paediatric unit. Complicated cases are now transferred to west Mosul.
  • During the recent clashes between Iraqi and Peshmerga forces:
    • In Erbil, MSF provided a hospital with drugs and dressing kits. The hospital admitted 90 wounded patients.
    • In Qayyarah, where MSF is running an emergency field hospital, we treated 42 wounded patients and donated items to support another 35 wounded patients.
    • In Zakho and Dohuk, we supported hospitals with medical supplies and trauma kits.
  • MSF continues to run primary healthcare, non-communicable diseases and mental health services for internally displaced people in Anbar Governorate. We provided more than 10,000 consultations during October in response to the increase in displacement caused by military operations in western Anbar.

New projects

  • MSF has built a post-operative care facility at the Al Salam/Al Shifa hospital in east Mosul and is supporting the hospital with waste management zones and the emergency room. The team is preparing to start the medical activities in collaboration with the Directorate of Health and hopes to expand the activities. 
  • MSF has conducted several exploratory visits in Hawija district, since the area was retaken from IS, to assess the healthcare needs. We will start an intervention in Abbassi sub-district with an initial focus on providing primary healthcare, rehabilitating primary healthcare facilities and water and sanitation activities. 
  • MSF recently open the Baghdad Medical Rehabilitation Centre (BMRC). The project provides comprehensive care for post-operative patients including physiotherapy, nursing care, pain management and psychological support to civilian war victims. Improving the post-surgical recovery process will prevent short-term medical complications and long-term physical and psychological impairments. The BMRC includes a 20-bed inpatient department for the first weeks of treatment, and an outpatient department for the patients’ follow up after discharge. Between August and October 2017, 37 patients were admitted in the inpatient department and the outpatient department.

Projects closures 

Al Khansaa Paediatrics Teaching Hospital in East Mosul

  • MSF started supporting the Al Khansaa Paediatrics Teaching Hospital in east Mosul in July 2017. The hospital sustained extensive damage during the conflict and was reduced from a 400-bed capacity facility to just 120 beds. MSF restored four essential services at the hospital:
  • constructed and equipped a 20-bed emergency room
  • re-established a four-bed capacity intensive care unit - the only one of its kind in Mosul
  • rehabilitated a 14-bed inpatient therapeutic feeding centre and set-up an ambulatory therapeutic feeding centre.
  • partially rehabilitated the medical paediatric ward and established a minimum capacity of 32 beds
  • MSF conducted general rehabilitation works in the engineering department of the hospital and renovated wash rooms and the plumbing system in the inpatient department.  
  • Between August and October, 2,532 patients were treated in the emergency room and 746 patients were admitted into the paediatric ward.
  • MSF handed over this project to the Directorate of Health on 31 October 2017 following a successful collaboration with the health authorities of the Ninewa Governorate.

Domiz refugee camp

  • After more than four years, MSF is finishing its sexual reproductive health and maternity project in Domiz Syrian refugee camp (population approx. 30,000), close to the city of Dohuk. The project will be handed over to the Directorate of Health on 30 November.
  • In close coordination with the Directorate of Health, the project was launched in 2013 with prenatal care, antenatal care and family planning services. In 2014, the project was expanded to a full maternity unit with a 24-hour delivery room, triage and gynaecological consultations. We have provided more than 27,400 gynaecological consultations and delivered more than 3,400 babies.

Sulaymaniyah Emergency Hospital and Asthicamp for internally displaced people

  • Over the past two years, MSF has worked in the Sulaymaniyah Emergency Hospital and Asthi camp for internally displaced people. We started the project due to the sharp increase in displaced people in the area and the subsequent strain on health services.
  • We have renovated the emergency room and intensive care unit at the Sulaymaniyah Emergency Hospital, implemented various medical protocols and management improvement processes and provided many training sessions for medical staff in support of and in collaboration with the DoH. In Ashti camp, and previously in Arbat camp, we have been conducting health promotion and mental health activities.
     
  • The project will finish on 30 November 2017. In the camp, the number of people is decreasing and local partners will take over the activities. At the hospital, we had a positive partnership with the DoH and we’ve seen a large increase in the number of lives saved at the hospital.

Qoratu camp for internally displaced people, Diyala

  • MSF’s activities in Qoratu camp for internally displaced people will close at the end of November. Numbers of displaced people in the camp have decreased and the need for mental health services has reduced. MSF will donate materials to camp management.