Years after the battle against the Islamic State (IS) group ended in Mosul, Iraq, the city’s health system has not yet recovered. It’s still difficult for many patients with violent or accidental trauma injuries to access adequate secondary health care services. In response, Médecins Sans Frontières (MSF) has been working in Mosul’s Al-Wahda hospital since 2018, providing comprehensive post-operative care to patients from the city and surrounding areas.
“In Ninawa governorate there is a shortage of skilled surgery staff and post-surgical care,” says Dr. Yuely Capileno, MSF medical team leader. “MSF is trying to fill this void in Mosul and offer these patients a chance to recover.”
Few options for treatment
Many people in Mosul are living with debilitating injuries that have dramatically affected their lives. Most patients who were wounded during the conflict and treated on the front lines did not receive the follow-up needed for their injuries to properly heal. For some, this has resulted in complications like infection, limited mobility, and in severe cases, amputation.
But conflict and violence are not the only reason why people need MSF’s services in Mosul. Injuries like traffic accidents or falls, for instance, can cause physical trauma. The lack of sufficient orthopaedic services in Mosul’s public hospitals, coupled with Iraq’s struggling economy, have made it challenging for injured people to access the care and follow-up they need. In many cases, even those who can afford care struggle to find adequate treatment in private hospitals.
“I was treated by the medical posts on the front lines and was sent to a hospital to be stabilised,” says Saqr Badr, who was shot in the leg by a sniper as he tried to flee Mosul in 2017. “After that, I was discharged, but still had a big wound in my leg that would regularly get infected. I stayed in my bed for a long time not able to move my leg.”
In 2018, Badr spent two months at MSF’s Al-Wahda hospital in Mosul before being referred to our reconstructive surgery hospital in Amman, Jordan, to complete treatment. “I came back to Iraq and was finally able to walk,” he says. “But four months ago, I had an accident at work and broke my leg again in the same place. I ended up coming back to MSF’s hospital in Mosul. That’s the only place where I could be treated.”
Adapting to the needs
In 2020, when the COVID-19 pandemic reached Iraq, the hospital was temporarily transformed into a COVID-19 treatment facility for suspected and confirmed cases. “We wanted to continue to support the healthcare system and, at the time, it felt logical to temporarily switch the services in our facility,” says Capileno. From March to December 2020, almost 1,000 patients suspected or confirmed to be suffering from COVID-19 received care at the hospital.
When the hospital returned to its regular activities in early 2021, the upgrades made to treat COVID-19 –replacing the 33-bed inpatient ward with 40 individual isolation rooms, for instance – proved useful for post-operative care.
“The isolation rooms made sense when we were treating COVID-19 patients, but these are also very useful for our regular activities,” says Capileno. “Many patients admitted to the post-operative care hospital arrive with multidrug-resistant [bacterial] infections, and antibiotic resistance is a problem throughout the country, so ‘contact precautions’ are fundamental. Patients with multidrug-resistant infections are given single rooms, rather than staying in open-plan wards, to avoid the spread of infection to other patients and medical staff.”
Two additional operating theatres were also built to make room for advanced surgery. “At the beginning of 2021 we expanded the admission criteria,” says Capileno. “Now we treat a variety of cases ranging from fractures requiring fixation, complex fractures, corrective surgery, all types of chronic osteomyelitis [bone infections], and medical complications associated with amputation.”
Since the beginning of the 2021, MSF teams have conducted more than 400 surgical interventions and provided more than 2,600 consultations to patients in the outpatient department. We also provide mental health services, health promotion, and physiotherapy for patients coming to the hospital.
“Patients staying at our facility often tell us that they don’t know what they would have done if we weren’t here,” says Capileno. “By adapting and expanding our activities, we hope to serve even more people in Mosul and to continue offering relevant medical services for the people who need it.”
To support the recovery of the health system in Mosul, MSF also provides comprehensive and basic maternity services in the city. In June 2017, MSF opened Nablus hospital in west Mosul to provide safe, high quality, and free maternal and neonatal care to in a part of the city where the community and the health system continue to struggle. In July 2019, MSF opened a smaller facility at Al Rafadain Primary Health Care Center, also in western Mosul, to provide routine obstetric and neonatal care, and offer a safe place to deliver babies. Combined, these two facilities welcomed more than 11,500 babies in 2020. Our teams also provide high-quality care to sick and premature newborns, family planning services, and gynecological consultations.