As of August 2021, nearly 1.2 million people are still internally displaced*. Factors like the slow reconstruction of homes and infrastructure, a lack of job opportunities, and the inability to access essential services are preventing the displaced from returning to their homes; some have been living ‘temporarily’ in camps for years, without adequate access to basic services.
Many of those who have managed to return home desperately lack access to medical care and other basic services. Mass protests and the COVID-19 pandemic have had a significant impact on the ongoing health system recovery and on people’s ability to access healthcare.
*http://iraqdtm.iom.int/ - IOM
MSF provides antenatal and postnatal care, neonatal and paediatric care, as well as family planning services. We assist births, including those with complications; our teams in Mosul and Sinjar assisted a total of 14,442 births in 2020. We also support the maternity department, at the Hawija General Hospital in Kirkuk, with emergency obstetric and neonatal care.
Many patients with physical injuries need specialised care. MSF provides surgical and rehabilitative care at Al-Wahda hospital in Mosul. We also run a medical rehabilitation centre in Baghdad, aiming to reduce long-term physical and psychological impairment of trauma patients through early physiotherapy, nursing care, pain management and mental health services care. Even after surgery, we continue to work closely with patients to help them recover and to prevent complications.
The psychological and emotional consequences of war, displacement and instability are still immense; the COVID-19 pandemic, with its additional burden, has only added to it. That's why mental health is a key component of many of our projects in Iraq. MSF psychiatrists, doctors, psychologists and counsellors give vital care and support to people with moderate or severe mental health issues.
As of August 2021, close to five million people have returned to their places of origin in Iraq over the last six and a half years (IOM). But nearly 1.2 million people remain internally displaced; they often lack access to adequate services, including healthcare, and water and sanitation. MSF teams have worked in displaced people’s camps and in areas where displaced people lack essential services.
According to the World Health Organization, Iraq is among the seven countries in the eastern Mediterranean region with a high burden of tuberculosis (TB). MSF has been supporting the National Tuberculosis Programme since 2018. We aim to improve case detection, provide better tolerated and effective treatment for drug-resistant TB patients, and improving the quality of care for patients.
In 2021, we ran a wide range of medical and mental health services, as well as emergency responses. We also worked to build capacity by training staff and constructing new facilities.
The impact of the pandemic
Iraq continued to be severely affected by the COVID-19 pandemic, with many people falling ill and dying, and hospitals diverted from their regular activities in order to treat the severely sick.
Baghdad, the capital, was particularly hard hit. In response, we expanded the dedicated COVID-19 intensive care unit (ICU) we run at Al-Kindi hospital to 52 beds to accommodate the large number of critically ill patients. Our staff worked in close collaboration with the hospital’s management and medical teams to provide lifesaving care, physiotherapy and mental health support.
Our team reported that most patients admitted to the ICU were already in a critical condition on arrival because they preferred to be treated at home and only sought care at the hospital as a last resort. Unfortunately, this meant that many people had already developed severe complications by the time they arrived, and the death rate in our unit was high.
Al-Kindi restarted its normal activities in October 2021 and we moved our COVID-19 project to Baghdad Medical City, where we supported care for severe and critical COVID-19 patients in the ICU and raised the levels of preparedness of healthcare workers by providing training and on-the-job coaching.
During the year, we also ran a COVID-19 unit in Mosul and a ward for mild and moderate patients at Sinuni general hospital in Sinjar. In addition, we supported Tel Afar general hospital with essential infection prevention and control training, and donated personal protective equipment to one of Baghdad’s COVID-19 hospitals to support their efforts against the outbreak.
Treating the after-effects of violence
During the armed conflict between the Islamic State group and the Iraqi security forces between 2014 and 2017, many healthcare facilities in central and northern Iraq were damaged or destroyed, and several healthcare providers were forced to flee. This has complicated access to and provision of sexual and reproductive healthcare services for thousands of women living in these regions. Our teams supported the maternity department at Hawija district hospital and continued to deliver much-needed maternity services, as well as paediatric and neonatal care, in Mosul.
In areas affected by conflict both recently and in the past, mental health remains a critical issue. Despite the pressing need, Iraq faces a severe shortage of qualified mental health professionals, and the few mental health services available are principally located in big cities. For this reason, mental healthcare is an essential part of MSF’s activities in Sinuni, Mosul, Kirkuk, Baghdad and other parts of Iraq.
MSF also works to address the long-term effects of physical injuries sustained during decades of war and violence, as well as trauma and burns from accidents and fires. MSF teams in Baghdad and Mosul provide comprehensive post-operative care to ensure that patients have the best chance of recovering fully from their wounds with physiotherapy, treatment for infections and mental health support.
In Mosul, our post-operative care hospital returned to its regular activities in early 2021 after having been temporarily transformed into a COVID-19 treatment facility in 2020. The upgrades made to treat COVID-19 – for example, replacing the 33-bed inpatient ward with 40 individual isolation rooms – proved useful for post-operative care, too. Indeed, many of the patients at our hospital arrive with multidrug-resistant bacterial infections, so ‘contact precautions’ are fundamental.
We also built two additional operating theatres so that we could carry out advanced surgery. This enabled us to expand our admission criteria and take on some of the patients from the struggling local healthcare system.
In Baghdad, we have begun to implement a new strategy for our activities at the Baghdad Medical Rehabilitation Centre. We are aiming to replicate our model of care in other hospitals across the city, and are working with surgeons to strengthen the post-operative care protocols in public hospitals. This not only improves outcomes for individual patients, but also helps to rebuild capacity for a struggling healthcare system to respond to everyone’s needs.
In September, ahead of the parliamentary elections, which were called early in response to a mass protest movement, we ran a three-month training course in mass-casualty planning to support Sheikh Zayed hospital, one of the major medical facilities in Baghdad. A month later, when protests against the election results turned violent, we helped the hospital to activate the plan.
Tackling the burden of non-communicable diseases (NCDs)
Improving care for NCDs such as hypertension, diabetes and cardiovascular disease, which are highly prevalent and a leading cause of death in Iraq, is another key priority for MSF. As well as treatment, we provide mental health support and health promotion services for NCD patients in our projects in Hawija and Al-Abbasi towns in Kirkuk governorate. At the end of 2021, more than 6,000 patients were receiving treatment for NCDs.
Our teams also continued to support the Iraqi National Tuberculosis Institute to detect and diagnose tuberculosis (TB) and multidrug-resistant TB (MDR-TB) in Baghdad. MSF introduced an innovative treatment regimen for MDR-TB patients, involving the use of newer, more effective drugs called bedaquiline and delamanid. This new, World Health Organization-recommended regimen uses all-oral drugs, which means that patients no longer need to have painful daily injections. Today, all new patients diagnosed with MDR-TB in the country are treated with the oral regimen, with only a few exceptions based on medical requirements.