Iraq: “Hospitals must always be prepared; you never know what will happen.”

Patrick Durrant was the Project Coordinator for Médecins Sans Frontières (MSF) in Sulaymaniyah, northern Iraq. MSF started working in Sulaymaniyah in 2015 when a huge influx of people escaping violence in their towns and cities arrived in the area. Initially, we provided water and sanitation services in Arbat camp for displaced people, and then extended the project to provide mental health services in Ashti camp, and rehabilitation and staff support for the Sulaymaniyah Emergency Hospital. The project closed on 30 November 2017. As the project finished, Patrick reflected on the challenges, achievements and the state of healthcare in Iraq. 

What is the state of healthcare in Iraq?

Iraq has a decent health system, but after decades of conflict, instability and economic hardships, the system is under a lot of strain. And although the areas held by the Islamic State (IS) group have been re-taken, Iraq remains a volatile place – bombings and conflict are still a regular occurrence.

Hospitals in Iraq must always be prepared. You never know what will happen the next day, hour or minute. Many hospitals don’t have the resources to cope with these situations and this is where MSF comes in. 

Why did MSF start working in Sulaymaniyah?          

MSF started working in Sulaymaniyah in 2015 when a huge influx of people escaping violence in their towns and cities arrived in the area. People felt Sulaymaniyah was a safe haven.

In the beginning, we provided water, sanitation and hygiene activities in Arbat camp, and then assessed health services in the surrounding areas. We realised the main emergency hospital – the only trauma hospital in all Sulaymaniyah – was really struggling with the sharp increase of internally displaced people coming through the door. They went from admitting 400 patients per day to 800 per day.

The region was also facing an economic downturn and the hospital didn’t have enough staff to deal with the situation. They lacked adequate equipment and parts of the building were falling apart. As a result, there had also been an increase in the number of people dying at the hospital, so we decided to intervene and provide support. 

We also identified mental health as a key need for internally displaced people due to the violence they had witnessed. In response, we set up mental health services in Ashti camp in September 2016.

What did the project involve?

At the Sulaymaniyah Emergency Hospital, we focused on the Emergency Room (ER) and the Intensive Care Unit (ICU). We concentrated on building the capacity of staff and bringing the hospital in line with international procedures and standards. We also totally refurbished both the ER and ICU, and there’s now a vast difference in the facilities. We had a positive partnership with the Iraqi Directorate of Health (DoH) and we’ve seen a large increase in the number of lives saved at the hospital.
MSF trained a large number of the DoH staff in areas such as life support and mass casualty planning. We also started to train other medical professionals in the region. We had a wider impact than we first intended.

MSF also worked in Ashti camp conducting health promotion and mental health activities. The camp is home to people who have fled the ongoing conflict and cannot return home. Many people have witnessed very traumatic events and need psychosocial support in the camps.

In Ashti camp, we had a team of counsellors who provided consultations in private rooms, and we also had community mental health workers who went tent-to-tent identifying people who need help and provided support to existing cases. We created a safe environment for people to talk with counsellors and to receive psychosocial support.

Mental health is stigmatised in many places in Iraq and people often feel embarrassed about seeking help. We tried to reduce this stigma through awareness-raising and group sessions in the camp so people felt comfortable accessing our services.

Why are you finishing the project?

MSF finished the project at the Sulaymaniyah Emergency Hospital and Ashti camp on 30 November 2017. In the camp, the number of households has decreased to around 2,500 as more people have returned home. We have worked closely with the camp management to handover the mental health activities to other local organisations who will continue to work in the camp.

We’ve trained a lot of staff, we’ve refurbished the intensive care unit and the emergency room, and we’ve built capacity up to a level that we feel the hospital is strong enough to continue by itself without the support of MSF.

MSF will continue to work across Iraq. As we finish some projects, we’re assessing other areas and will set up new projects where the needs are greatest.