IPC training in Ibn El-Khateeb Hospital, Baghdad
Iraq

Health system struggling to make ends meet in some areas of Iraq

The humanitarian needs in Iraq remain extremely high. Many health facilities lack medical supplies and healthcare specialists, and major public health services are overstretched. The healthcare system was recently subjected to additional pressure due to high influxes of wounded during the violent crackdowns on mass protests that rocked the country from the end of 2019 into the first months of 2020. In addition, the ongoing COVID-19 outbreak caused considerable disruptions to the provision of health services.

MSF has been working in Iraq since 1991. More than 1,500 of our staff provide general and specialist healthcare, services for expectant and new mothers, treatment for chronic diseases, surgery and rehabilitation for trauma patients, mental health support and health education activities.

Our teams are working in Ninewa, Kirkuk, and Baghdad governorates.

Between January and June, 2020, MSF teams in Iraq provided:

Protracted displacement

Since 2014, the conflict in Iraq has forced an estimated 5.7 million children and adults to leave their homes and seek shelter elsewhere. By October 2020, more than 4.6 million Iraqis had returned home, but more than 1.27 million were still displaced.

Those who remain in camps for internally displaced people are often the poorest and most vulnerable, who can't afford to leave the camps and rebuild their destroyed homes. Others say they can’t go home because they don’t feel safe.

Despite this, in October 2020, authorities started closing camps for the displaced and returning people to their areas of origin. Laylan camp, where MSF was running a general healthcare centre and a 20-bed COVID-19 isolation unit, closed in late November 2020.  Several displaced people who were living in the camp told our teams that the sudden closure left them fearful for their own safety and with limited access to shelter and basic services, such as healthcare, running water and electricity.

The displaced are also among the most vulnerable communities facing the threat of COVID-19. The closure of camps without ensuring sustainable solutions are in place is increasing the risk for displaced people to be exposed to high levels of transmission of the disease.

Our teams have also observed an increase in mental health needs caused by the prolonged suffering of both internally displaced people and their host communities.

Laylan Camp: Kirkuk, Iraq
MSF community health educators carrying out a health education session for non-communicable diseases (NCD) patients in the waiting area of MSF's clinic at Laylan 1 camp in Kirkuk Governorate. Iraq, July 2020.
Tetyana Pylypenko/MSF

Diverse medical needs 

The International Organization for Migration estimates more than 50 per cent of the Iraqis who went back home returned to areas with harsh living conditions. Consequently, over two million people endure having little to no access to basic services. Places of return are also often characterised by residual insecurity, damaged property and public infrastructure and fractured social relations.

More than three years since the battle between the Islamic State (IS) group and the Iraqi forces officially ended in Iraq, the healthcare system remains fragile with thousands of families struggling to access quality affordable health care.

A shortage of sexual and reproductive health services places pregnant women among the most vulnerable people. Newborns and children in need of urgent care also face a lack of specialised services close to home. 

To respond to the high needs, MSF runs a specialised maternity unit in Nablus hospital, west of Mosul city. Staff there have provided safe, high quality and free maternal and neonatal care since 2017. Our teams in Nablus hospital assisted 14,103 births and performed 775 caesareans in the first six months of 2020. They are also providing emergency room care and mental health consultations in the same hospital.

In Al-Rafadain general healthcare centre, also in west Mosul, MSF teams have provided routine obstetric and newborn care since July 2019. 

Many people returning home to Mosul have suffered war-related injuries, while others are subjected to violence or accidental trauma. Our post-operative care facility in east Mosul has been providing them with surgical and rehabilitative care as well as mental health services since April 2018.

Treating Mosul’s wounded
Nine-year-old Saif sits on his bed in MSF’s post-operative care facility, in east Mosul, where he receives care for his broken leg. Mosul, Iraq, February 2019.
Elisa Fourt/MSF

Since 2018, we have been supporting Sinuni General Hospital where we run emergency, maternity, and paediatric services. During the first half of 2020, our teams conducted 6,752 emergency room consultations and assisted 473 births.

We also provide mental healthcare, treatment for non-communicable diseases and run health promotion activities in Abassi and Hawija, Kirkurk governorate, for families returning to the area.

Addressing invisible scars

MSF teams have witnessed prevalent mental health needs among our patients in our different areas of intervention in Iraq.

We have incorporated mental health services into our rehabilitative projects in Mosul and Baghdad. Our teams support the invisible scares of trauma patients throughout their recovery process in the two facilities.

We also run a mental health programme in Mosul, ensuring the people have access to high quality care and psychosocial support. Our teams are working in two general healthcare centres, offering counselling, psychosocial first aid, psychosocial support and referral service for psychiatric cases.  

In Sinuni, where we first started supporting maternity care, our teams quickly realised that mental health was a huge unmet need in the area, especially among people returning home. We’ve increased mental health activities to cover psychiatric and psychological services as well as group sessions and mental health activities for displaced people in Sinjar mountain.

In Kirkuk governorate, we provide mental health support, including both psychological and psychiatric care, to displaced people, the host community and people who have returned to their homes in the area.

MSF activities in Sinjar District

Improving diagnosis and treatment of drug-resistant tuberculosis

MSF has supported the National Tuberculosis Programme since 2018. The programme aims to improve case detection, provide better tolerated and effective treatment for drug-resistant tuberculosis (DR-TB) patients, and improve the quality of care.

Our teams donated medical equipment and medication to support the TB testing and treatment efforts in Sadr city, on the outskirts of Baghdad. In addition, we have contributed to the capacity building of TB specialists in Iraq through patient care and treatment training sessions and workshops.

MSF teams have focused their efforts on introducing new drugs for the treatment of DR-TB to replace the old injection treatment, which is painful and has severe and irreversible side effects. As of November 2020, our teams have supported the enrolment of 42 multidrug-resistant TB patients in the oral regimen treatment which includes the two new TB drugs bedaquiline and delamanid.

Emergency responses in the first half of 2020

Mass protests against the Iraqi government's failure to provide basic services, create jobs and stamp out corruption broke out in Baghdad on 1 October 2019 and spread to cities in the south of the country. The violent crackdown on protestors at the end of 2019 in various cities across the country resulted in influxes of wounded in health facilities, leaving some people with injuries that require regular long-term care. 

In Baghdad, MSF increased the capacity of our medical rehabilitation centre (BMRC) to respond to the increased need for rehabilitative care in the city.

MSF cares for wounded protesters in Baghdad
Patient Saif Salman speaks to a medical staff at MSF's Baghdad Medical rehabilitation centre. He was injured when he was hit by a tear gas canister during recent protests in Baghdad. His injuries were so severe his leg was amputated.
Nabil Salih/MSF

In addition, our teams supported the emergency rooms of hospitals in Baghdad in setting up mass casualty plans, donated medical supplies and trained the staff to receive influxes of wounded.

In Najaf, we supported three hospitals that received wounded people. In early 2020, our teams provided training in mass casualty planning to staff and donated triage kits to equip the hospitals' ambulances.

In Nasriyah, Dhi Qar governorate, our teams supported the emergency room of one hospital, providing training on trauma care with a focus on critical injuries and resuscitation. They also helped adapt the hospital's work spaces to accommodate more patients and donated medical equipment to the facility.

In Basra, MSF teams provided training on emergency preparedness and trauma response for paramedics at the city level, in collaboration with the Department of Health operational centre. They also provided trauma training for new graduate doctors as part of their emergency orientation training.

MSF coronavirus COVID-19 response in Mosul

COVID-19 preparedness

Since the beginning of the COVID-19 pandemic, we have maintained our lifesaving medical operations while enhancing infection prevention and control measures in our facilities. We have put in place triage and referral procedures to ensure the protection of patients and staff.

In support of local health authorities, we adjusted some of our activities to respond to the increasing need for COVID-19 treatment facilities.

Baghdad has been the city hardest hit by COVID-19 in Iraq. MSF teams supported two COVID-19 treatment centres (lbn El-Khateeb and Al-Kindy) in 2020, providing training on patient triage and infection prevention and control to ensure the safety of health staff and patients. In late September 2020, our teams continued supporting Al-Kindy hospital with running a 24-bed ward inside the hospital for treating critical cases of COVID-19. 

In east Mosul, between April and October 2020, we temporarily repurposed our post-operative care centre to serve as a COVID-19 treatment centre, expanding it to 62 beds, with inpatient wards and isolation rooms for confirmed and suspected COVID-19 patients. By the end of 2020, the centre had received 969 patients and resumed its everyday activities alongside COVID-19 care. In late November 2020, we opened a 16-bed facility in Al-Salam Hospital in east Mosul for the treatment of patients with severe symptoms of COVID-19.

In Erbil and Duhok, MSF teams provided training sessions on infection prevention and control measures in hospitals to help them protect their health staff and patients during the pandemic. During the first half of 2020, they trained 308 health staff in Rizgary and Emirati Attaya hospitals in Erbil governorate and in Lalav, Cavin and Burn hospitals in Duhok governorate. MSF also donated infection prevention and control supplies and cleaning materials to all five hospitals as well as to Shirkan hospital in Duhok.

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