Surgical assistance for victims of war

Said, 30: "When you are in the street you never know, when a bomb or a car might explode next to you. We always knew that one day or another something like this could happen to us. We have always expected it. I have a wife and eight children. I tell them to stay at home and not come and see me. It is too dangerous to be on the roads. I am in a constant worry about my family. But what can we do, this is our life.”

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War and conflict in Iraq have led to one of the world’s biggest humanitarian crises today, with dead and wounded civilians every day. The Iraqi health system is no longer able to give proper care for these victims of violence. Thousands of doctors have fled the country and those who stay are often faced with harassment, arrest or the threat of kidnapping and assassination. Humanitarian actors have become targets in the conflict and, as a result, most international relief agencies have left the country. MSF is providing medical assistance to the population in different regions inside Iraq as well as operating from neighbouring countries such as Jordan. In hospitals located in the more secure north of the country, programs have been established to deliver surgical assistance as well as psychological support to patients from the conflict zones.

Interview with Volker I., MSF Head of Mission in Iraq* (1) For security reasons full names of MSF staff in Iraq are not disclosed

What kind of support can MSF provide within the Iraqi-health system?

MSF is supporting hospitals and health facilities all over Iraq with medical supplies and trainings. Through the collapse of the health system and the permanent lack of medicines and medical material, the hospitals are often not able to give the right treatment to the patients. MSF is supporting hospitals in the conflict zones with adequate supplies, helping to save the lives of war victims. A strong network of committed people assures us that the supplies are reaching the hospitals. This good network allows us also to conduct assessments of the humanitarian situation in the war-affected areas. But MSF also has the means to bring specialists to the reference hospitals in the Kurdish region in the north of the country, which can give special medical training, especially in surgical fields, to the local doctors.

MSF left Iraq in 2004 because of the deteriorating security-situation. What made you decide to return? 

Iraq is a state deeply affected by war. Violence is extremely intense in various parts of the country, mainly due to sectarian conflicts and insurgency against civilians. The humanitarian consequences for the civilian population are severe with a high number of civilian casualties as well as large-scale displacements of populations. Displacement is also happening in the more secure Kurdish-controlled region in the north of the country. With many doctors and medical personnel leaving the country, the health infrastructure is collapsing under the number of war-wounded patients. Adequate medical care is more and more difficult for the population to access. MSF has been observing the evolution of the conflict, and the deterioration of the humanitarian situation, since 2004. We were constantly looking for ways to continue to assist the desperate Iraqi population, despite the poor security situation. At the end of 2006, we decided to establish projects in the relatively safe Kurdish part – a development that can provide care for the population trapped in the conflict zones starting only about a hundred kilometres further south. The challenge is to make it possible for them to access the areas where we work.

How can these patients from the conflict zones access the more secure areas of the country where MSF is present?

This is actually one of the main challenges for MSF in northern Iraq. For security reasons, it is impossible to access the wounded within the war zones so we have to find ways for patients from the conflict zones to reach the hospitals where MSF works. Some reference hospitals in the Kurdish controlled region are supported by MSF teams through medical supplies and provision of training by our international medical specialists. Currently we are working on establishing a referral system for patients from the more war-affected areas to these hospitals. To be able to do that, and also to support hospitals in the conflict zones, we are working to establish a very good network with key actors from both sides. This network is, on the one hand, crucial for safe referrals to the hospitals in the relatively secure area. On the other hand it ensures that medical supplies are reaching the hospitals. But it is a critical issue because, in Iraq, just the fact that a person works on provision of basic services such as health care is already at risk for his or her life. This is also the dilemma MSF faces.

What are the most common medical problems?

Due to the on-going violence - mostly explosions caused by car bombs or roadside bombs targeting civilians and attacks by gunmen - wounded people often arrive with very complicated and severe wounds. Most of the hospitals located in the war zones do not have the capacity to give them quality treatment. Due to the collapsed health infrastructure, there is a lack of medical drugs, surgical material, dressing material etc. Many of the wounded patients that arrive in the reference hospitals in the Kurdish region have been inadequately treated in the hospitals in the conflict zones. One of the most common medical problems are skin-burns, caused by explosions, but also often by suicide attempts. The condition of burn patients is usually very severe, often with more than 50 percent of the body-surface burned. Two hospitals in the Kurdish region have managed burn units quite well. They are supported by MSF through the training of doctors and nurses, supply of material and plastic-surgery especially for burn-patients supervised by international specialists. In one of the burn units, psycho-social and psychiatric support is provided.

Determined to do all it can to provide medical care to the Iraqi people since 2006 MSF has implemented different programs: Twelve hospitals in central and northern Iraq receive supplies, including drugs and medical equipment. In eight hospitals in central and northern Iraq MSF is providing training for medical staff and psychological counsellors. The direct intervention of surgical teams has been set up in three hospitals of northern Iraq. In Jordan a surgical program provides maxillo-facial and reconstructive surgery for war-wounded Iraqis. Also from Jordan MSF supplies numerous hospitals in Iraq with medical drugs and material and has set up a training-program for Iraqi medical staff.