I saw something new in Baghdad recently. At one of the city’s many checkpoints, men in white coats and N95 masks were standing in front of the soldiers, checking whether passengers in minivans were wearing their masks. The cigarette vendors that wind their way through the waiting cars had added a sideline in selling surgical masks.

Apart from that, however, it is difficult to see the effect COVID-19 has had on the city. The pain I witness every day at the hospital we at Médecins Sans Frontières (MSF) are running is hidden from most of the people who crowd the streets. But that suffering has now redoubled as Iraq is in the grip of a ferocious second wave, with Baghdad again its epicentre.

Since the end of September we have admitted around 350 critical and severe patients, but 120 of those have been in the last month alone. To cope with the influx, we have expanded from 36 beds to 51, but the death rate remains frightening. On a single day recently, despite the best efforts of our team, seven patients died.

We are all tired now, medical and non-medical staff alike. The first peak in Baghdad was long, from July to November, straining the supply of oxygen in the city and leaving the health system teetering on the brink of collapse.

The number of cases only briefly went down in December and January before mounting precipitously from February onwards. There were 714 cases on 31 January, and 3,428 on 28 February. March 25 saw the highest number of cases since the beginning of the pandemic – 6,513 – but even that number is likely to be underestimated. The virus did not leave us long to draw breath before being submerged by this second wave.

“The death has affected me mentally,” says Dr Yassin Hassan, who works with us in intensive care, “but I try to overcome it, for the sake of other patients. I listen to music, or talk with my family about it and then come back to work.”

The false hope of the end of the first wave hit him hard.“The curfew was lifted, and the city came back to life, and then the numbers sky-rocketed again. It’s sad now, we don’t have beds for everyone.”

I have been here in Baghdad for a year now, working to help the Iraqi authorities with their response to the virus. At first we started to work inside the respiratory care unit in al-Kindi hospital, but we quickly found that the hospital was unable to cope with the number of patients and the close follow-up they required. Many senior doctors were only present in the hospital for a brief period in the morning, and their junior colleagues were often unwilling or unable to take decisions without them, placing them – and us – in an untenable position as the outbreak progressed.

We opened our own unit in the hospital in September, first with 24 beds, before moving to a new building and expanding the capacity to 36 beds in December. We found new ways of working with our Iraqi colleagues and managed to bring the mortality down for the serious and critical cases we are treating.

Although this remains a brutally deadly disease in its severe forms, we are now discharging around 40 per cent of our patients – a vast improvement on the rate of survival from when we initially took over. But we never expected to still be here, one year after we began what we thought would be temporary support to the Iraqi health system.

Without vaccination the end of COVID-19 is hard to see. Yet the country has so far received just 386,000 doses of the vaccine, a number totally inadequate for a country of 40 million. According to the Ministry of Health there are around 216,000 doctors, nurses and paramedical staff in the country.

Newly delivered doses may allow some of those medical workers to be vaccinated, but many of the doctors we work with do not know when their turn for vaccination will come, and in the meantime our colleagues continue to fall sick.

While other doses are supposed to arrive in the coming months, much more needs to be done to help Iraq get vaccines into arms. The country should be considered one of the priorities globally for vaccination efforts, and a priority in the Middle East where it has been one of the hardest hit nations.

With a health system weakened by years of conflict and its associated ills, and an economy struggling in the wake of the crash in the price of oil, the government will struggle to vaccinate all those who need it without substantial assistance from other countries in the procurement of vaccines and other international organisations in their distribution.

Until that happens we will continue working to save lives in our hospital. We know, however, that even when this wave recedes it will not be the end unless Iraqis get the vaccines they so desperately need.