Security issues limiting MSF development in Iraq

Conditions in Iraq remain tense for humanitarian action. On August 15, the situation in Basra had climbed to the point that the MSF team stationed there had to evacuate and are now evaluating the situation for continuing the project and returning to the area. 

One of the key concerns is the confusion between humanitarian and military action as viewed by the Iraqi population.

There have been several security incidents involving either MSF or other NGOs in the country.

An ICRC expat was killed in an attack on July 22. During riots, an MSF vehicle was stoned as it tried to pass through a make-shift checkpoint on the outskirts of Basra. There have been other severe security incidents to other NGOs.

These security concerns are limiting MSF expansion in the country.

Saddar City

An MSF team has been working in the Al Thawra hospital in Saddar City since May 2003 with one doctor working on the male surgical ward, focusing on giving lectures to nursing staff, organising practical training sessions and supervising nurses and junior doctors on the wards. MSF has produced two booklets; one on dressings; and the other on vital signs. Copies have been distributed to all nursing staff.

An MSF team continues to supervise the primary health care programme at the Al Muntadhar Clinic. They are currently undertaking 700-800 consultations per week.

MSF is also continuing work at the Al Ma'amil Clinic where staff do around 2,000 consultations per week for adults and children as well as collecting morbidity data and providing a basic vaccination package for children. The clinic also houses a pharmacy.

During June and July, the team undertook a rapid assessment for malnutrition using a 'mid-upper arm circumference' (MUAC) screening of 1,343 children between six months and five years old in the two clinics. The results showed that 1.4% of the children were severely malnourished and 6% moderately. This is considered quite low, especially as the children screened were already ill. According to the team, there was thus 'probably no major food problem', although further research will have to be done to ascertain this for sure.

The team is in the process of renovating a building in Al-Obiedi that will house a third Primary Health Centre (PHC) and, in Al Ma'amil, maternal activities such as a birthing room are to be added to existing facilities.

A further objective is the opening of a nutritional programme in the PHCs.

Baghdad

MSF is re-establishing diagnostic testing facilities in the public health laboratories of Baghdad and nine other governates, in the upper area of the southern region of Iraq, through the provision of equipment, reagents and materials.

In southern Iraq, MSF supports three primary health care centres in Basra and 13 in Maysan governates with supplies in order to make up for the current shortages in drugs and laboratory equipment for the treatment of chronic and infectious diseases. Also the central public health lab in Amarah (Maysan) is being rehabilitated.

Distribution of the Kala Azar treatment, SSG (Sodium Stibogluconate), has been carried out in paediatric and selected district hospitals in the Governates of Al Anbar, Karbala, Al Najaf, Al Qadisiyah, Al Muthanna and Thi-qar.

In the near future, MSF activities in southern Iraq will focus on delivering basic health care and ante-natal care health in more remote primary health centres in locations around Amarah. In these areas, many women do not have access to maternity or women's health care.

Recent assessments have been carried out concerning the situation of displaced people in the Diyala governate, who are moving from the north of the country. Currently, many of these families are living in disused former military camps, where over-crowding and lack of water, sanitation and hygiene pose public health problems. It is hoped that basic health and mother and child health care can soon be provided in these areas once security concerns are met.