Iraq: Latest MSF Updates
- Babies Impacted by Violence in Mosul, Iraq
- Iraq: Babies Suffering from Severe Malnutrition in Mosul Region
- Scores of War-Wounded Patients Treated in Western Mosul, Thousands More Trapped
- Families Escaping Western Mosul Describe Life Under Siege
This information is excerpted from MSF’s 2016 International Activity Report.
Since 2014, over 3.3 million people have been displaced across the country, and many were still living in unstable areas. MSF steadily increased its response during 2016, deploying teams across 11 governorates to provide emergency and basic medical care, as well as essential relief items to displaced families, returnees, impoverished host communities, and Syrian refugees.
MSF started running mobile clinics in the city of Tikrit and surrounding areas in August in response to an influx of people displaced by expanded military operations. Teams conducted more than 15,000 consultations. In Al Anbar province, MSF opened a secondary health care center in Amriyat Al Fallujah camp, which hosted around 60,000 Iraqis displaced by conflict.
In October, teams in Kirkuk governorate began providing health care, including psychological and psychosocial support, for displaced people and war-wounded patients. They also ran mobile clinics offering primary health care, first aid, and emergency referrals to hospitals in Kirkuk city.
In November, MSF mobile teams were deployed to new camps west of Erbil established to accommodate people fleeing the battle of Mosul. As well as primary health care, they provided treatment for chronic diseases and psychological and psychiatric care. In Qayyarah, south of Mosul, MSF set up a hospital with an emergency room, operating theater, and 32-bed inpatient department. During the first month alone, the hospital treated over 1,000 emergency patients and carried out more than 90 surgical interventions. Teams also worked in a field surgical unit and advanced medical posts in unstable areas around Mosul.
MSF increased psychological support for the growing number of Iraqis and Syrian refugees traumatized by recurrent violence and precarious living conditions. In 2016, mental health teams provided more than 23,000 consultations.
MSF continued to run its maternity clinic in Domiz camp for Syrian refugees and opened a new one in the village of Tal Maraq, Ninewa. In the first three months, the team assisted over 400 deliveries.
In Sulaymaniyah governorate, MSF supported the emergency hospital, providing hands-on training to improve medical services in the intensive care unit and the emergency trauma ward. MSF teams worked in the emergency rooms in Kirkuk and Azadi hospitals, focusing on triage and staff training.
MSF provided around 9,000 medical consultations at the primary health care center in Bzeibiz between February and October 2016, closing the project in November as patient numbers decreased.
June 2017 Update: Crisis in Mosul
Ongoing conflict across Iraq has caused widespread population displacement, with the United Nations Office for the Coordination of Humanitarian Affairs reporting that three million people are now internally displaced within the country. Eleven million people—30 percent of Iraq’s 2015 population—are in need of humanitarian assistance. With many local health facilities destroyed by fighting, obtaining medical care has become a difficult and often costly undertaking; for many people the closest health facilities are miles away. In response, MSF provides much-needed medical care throughout the country, including emergency surgeries, inpatient services, mental health and post-operative care.
Years of fighting have taken an especially heavy toll on the people of Mosul, Iraq’s second largest city, particularly on those still trapped inside western Mosul, where ongoing fighting continues to result in high numbers of civilian casualties. MSF has already seen an influx of patients at its newly opened project in western Mosul, which provides lifesaving trauma assistance for war-wounded patients. “This influx of wounded patients is yet another example of the horrific suffering and indiscriminate violence suffered by civilians, including women and children, throughout the battle for Mosul,” says Jonathan Henry, MSF Emergency Coordinator for West Mosul.
Camps for Internally Displaced People
Following the Iraqi-led offensive into western Mosul in February 2017, the total population of the four camps west of Erbil currently hosting internally displaced people (IDPs) from Mosul sharply increased, reaching 80,000 people by the end of March. Soon after, some IDPs started leaving the camps to move in with relatives or rent houses in retaken areas of eastern Mosul, and the combined camp population decreased to approximately 70,000.
Today, MSF mobile teams provide treatment for chronic diseases (mainly diabetes and hypertension) in Chamakor and M2 camps, and psychological and psychiatric care in these two camps and in the M1 and U3 camps. An MSF team of psychologists, counselors, and a psychiatrist also provides health care to those suffering from moderate to severe mental health conditions. Activities include psychological and psychiatric consultations, group therapy, psychosocial counseling, and child therapy.
Since the beginning of 2017, MSF has carried out more than 19,400 medical consultations and 12,200 mental health consultations in the IDP camps near Mosul.
In June, MSF opened a project in western Mosul to provide lifesaving trauma assistance for war-wounded patients in the conflict area of the Old City, where an estimated 60,000 residents still live under siege. The project includes surgery, emergency Caesarean sections, short-term post-operative and maternity care, an emergency room, and a mass casualty intake room for triage in case of an influx of wounded patients.
Emergency and Post-Operative Care, Al-Taheel
MSF opened a 24/7 emergency room in Al-Taheel Hospital on March 26 and also set up a surgical unit and a 32-bed post-operative ward to provide medium-term care to those suffering from violent trauma injuries in and around Mosul. Cold cases, surgical follow-up, and other types of surgical issues are also treated in this facility. Since the facility opened, MSF has received over 1,000 patients in the emergency room and conducted more than 175 surgical interventions.
Al-Khansaa Teaching Hospital, East Mosul
MSF recently started supporting this Ministry of Health (MoH) facility, located in the Al-Sukkar neighborhood, which has been heavily damaged by fighting. The hospital currently has a 120-bed capacity (down from an original 500) to respond to the massive needs in Mosul. Discussions are ongoing with the local authorities to rehabilitate the emergency room. Mental health support for all patients will also be provided.
Maternal Health, Karama
MSF opened a 15-bed, 24-hour maternity hospital in Karama, eastern Mosul, on March 19. Since then, the MSF team, made up of both expatriate staff and Iraqi midwives and obstetricians, has assisted 376 women in safe deliveries.
OUTSKIRTS OF MOSUL CITY
Trauma care and primary health care, Hammam al-Alil
Eighteen miles from Mosul, Hammam al-Alil (known as HAA) is the closest IDP camp to the city’s south. The town has received a large influx of IDPs, with more people arriving daily to be settled in different camps. Many pass through to return to eastern Mosul. Here, MSF opened a field trauma hospital with 22 beds, an emergency room, two operating theaters, a seven-bed ICU/recovery room, and a 32-bed inpatient department (IPD) on February 16. For more than a month, Hammam al-Alil was the closest surgical facility to western Mosul.
The emergency room received 3,144 patients from February 19 to June 10, 56 percent of whom were women and children. The team has performed 305 major surgical procedures and 67 minor procedures. The majority of cases were emergency surgeries.
Since April 15, MSF has also supported the local department of health’s primary health care center (PHCC) in Hamman Al-Alil town; as of June 10, MSF has already carried out over 18,000 consultations for both the host population and IDPs. MSF also runs an ambulatory therapeutic feeding center for children suffering from acute malnutrition, a rapidly increasing cohort. As of June 10, this ambulatory center had 142 patients, primarily individuals from two nearby IDP camps . Psychosocial support is offered to the patients in the trauma center and the primary health care center.
Post-operative and rehabilitation care, Al Hamdaniya
MSF provides post-operative care with rehabilitation and psychosocial support in Al Hamdaniya Hospital in collaboration with Handicap International. Activities started on March 15, and, to date, MSF has admitted 255 patients, around 46 percent of whom were women and children. The facility now has 43 beds in order to respond to the huge need for post-operative care and is almost constantly full. An advanced dressing room, with the possibility to perform debridement under sedation and other minor surgical procedures, should be ready within days.
In December, MSF opened a 32-bed hospital in Qayyarah, 37 miles south of Mosul, with an ER and an operating theater to provide surgical and medical emergency care. The facility has now been extended to 46 beds to accommodate the growing and diverse needs. As of June 1, the team has treated 7,100 patients in the ER, around 10 percent of whom were admitted to the IPD.
A total of 1,350 surgical interventions were performed from December 2016 to June 1, 2017. A four-bed intermediate care unit was opened in mid-April to provide care to patients in critical condition, and seven observational beds and two resuscitation beds are also now available. In March, MSF set up a 12-bed intensive therapeutic feeding center to provide care to children recently displaced from western Mosul or Shirqat Region, as well as those from IDP camps in Hammam al-Alil and Qayyarah. In May 2017, there were 178 admissions, including 91 for children under six months old. The center regularly works over capacity, with as many as three babies per bed.
Since February, MSF has run a mental health clinic for patients admitted to the hospital, as well as for patients referred from the Qayyarah camps. The team consists of a psychiatrist, two psychologists, and two psychosocial counselors.
ELSEWHERE IN IRAQ
MSF teams are providing medical and mental health services to people displaced from Hawija District. MSF runs a non-communicable diseases (NCDs) clinic and mental health activities, including referrals for psychiatric care, in Daquq IDP camp, which houses 8,328 people. At Maktab Khalid entry point and at Debes screening site, MSF mobile clinics ensure the sickest IDPs fleeing Hawija receive treatment in a timely manner. MSF also supports the emergency rooms of the two main Kirkuk hospitals with training for Iraqi Directorate of Health doctors and nurses.
MSF runs a maternity clinic in the village of Tal Maraq that has assisted more than 500 safe deliveries since it was opened in November 2016. The ongoing conflict around the cities of Tal Afar and Mosul limits access to secondary health care. The clinic offers pre- and post-natal consultations and basic emergency obstetric services and neonatal care, manages minor obstetric complications, and refers patients with more serious obstetric complications to hospitals in Zakho and Dohuk. A small pediatric ward was added to the clinic in February 2017. MSF also runs mobile clinics in surrounding villages, offering general and mental health consultations and follow-up and treatment for NCDs patients.
In the Domiz camp for Syrian refugees, MSF runs a maternity unit where women can deliver their babies safely and access reproductive health care. Since January 2016, MSF teams have assisted more than 1,000 deliveries in Domiz.
MSF works with the health authorities in Sulaymaniyah Emergency Hospital and provides hands-on training to improve the quality of medical services in the ICU and the emergency trauma ward. The project has completed the rehabilitation of the ER and ICU wards, which are now fully functional and have an improved layout and patient flow. Since the start of the project, more than 200,000 patients were seen in the emergency room, and over were seen 500 in the ICU.
MSF has also worked in internally displaced people (IDP) camps in the governorate since 2015. The teams conduct health promotion activities and provide psychological and psychosocial care.
Salah Al-Din Governorate
With military operations expanding in northwestern Iraq, thousands of Iraqis continue to flee to relatively safer areas. In response to the growing needs, MSF started running mobile clinics in the city of Tikrit and surrounding areas in June 2016. The clinics offer outpatient and mental health consultations. In January 2017, MSF established a primary health care center in one of the camps.
MSF has been working in Diyala Governorate since 2015, supporting displaced populations in three IDP camps in Khanaqin District by providing medical and mental health consultations in collaboration with the Department of Health. In 2016, more than 20,000 individual and group counseling sessions were provided. MSF teams also conduct health promotion activities in all camps. Since May 2016, approximately 100,000 IDPs have returned to the towns of Sadiya and Jalawla, which were retaken from the Islamic State (IS) group.
MSF supports the primary health care clinics in Sadiya and Jalawla, focusing on chronic diseases, sexual and reproductive health, and maternity, mental health, and health promotion services for IDPs, returnees, and the host community. In Sadiya and Jalawla, MSF provided treatment for chronic diseases to nearly 800 new patients and conducted almost 1,200 follow-up consultations. In addition, 913 ante- and post-natal consultations were provided in 2016.
In June 2016, MSF started running mobile clinics in Amariyat Fallujah, Habbaniyah, Khaldiya, and Ramadi (Kilo 18) to assist people who were forced to flee the areas of Fallujah and Ramadi in Al-Anbar Governorate. Later the same year, a health care center was established in the camp in Amariyat. The camp currently has a population of around 60,000 people, and the facility offers primary health care consultations, emergency care, inpatient care, and mental health, stabilization, and referral services. More than 10,000 medical consultations were provided by MSF in the area in 2016.
In Abu Ghraib, MSF teams provide medical and mental health services to people displaced from central Iraq, mainly Al-Anbar, Salah Al-Din, and Diyala. A mobile medical team operates in impoverished neighborhoods in Abu Ghraib District, where many displaced people have settled in the past two years. A second medical team is based in a primary health care clinic in the Al Shuhada II area. Lately the team is assessing the needs of thousands of people who were displaced and are now returning to their homes in villages in northern Abu Ghraib and Karma districts in Anbar. In 2017, MSF has provided over 12,700 consultations, more than 2,300 consultations for NCDs, and over 450 mental health consultations.
Since the spring of 2017, MSF has been fully supporting the Ibn Saif Pediatric Hospital in Musayib. The team will concentrate on supporting this 60-bed hospital through capacity-building, training, and logistics support. Support for psychosocial services will be provided in the hospital and within the community.
SHRINKING AID FOR GROWING NUMBERS OF PEOPLE IN NEED
Iraq is currently experiencing its worst humanitarian crisis in decades. Increasing violence since 2013 has resulted in the displacement of over three million people, who often have very little access to health care services. A further 250,000 Syrian refugees have fled to Iraq since 2012. Infrastructure and medical facilities in some war-torn areas have been destroyed, leaving the local population with no access to medical care.
Humanitarian response has so far been insufficient—mostly short-term and concentrated in safer areas. Recent cuts in funding have increasingly affected the level of assistance offered to Syrian refugees, displaced populations, and host communities. Some areas are completely neglected, and many people have no access to even basic health care. In those areas, populations affected by the crisis are in urgent need of neutral and impartial humanitarian aid.
Doctors Without Borders'/Médecins Sans Frontières' (MSF’s) response to the successive large-scale waves of displacement has been made possible by its established operational presence—it has been working in Iraq since 2006—and its independent funding. MSF is constantly adapting and increasing its medical and humanitarian response to the crisis, which shows no signs of ending. MSF is currently working in 11 governorates across Iraq in order to provide impartial and free medical care to people affected by the conflict.
In the first six months of 2015, MSF teams in Iraq carried out 126,722 medical consultations. From the onset of the current crisis, MSF has deployed mobile medical teams to reach the most vulnerable groups of people. They provide free-of-charge general health care with a focus on chronic diseases, reproductive health, and mental health. Where needed, they also refer patients to hospitals for specialist care.
Most of the health problems seen by MSF’s medical teams are related to poor living conditions, including respiratory and urinary infections, gastro-intestinal problems, diarrhea, arthritis, and skin diseases. Others patients suffer from chronic diseases, particularly hypertension and diabetes, but had seen their treatments interrupted due to the security situation and/or displacement.
A team of MSF psychotherapists offers mental health support to people traumatized by recurrent violence. Many face protracted harsh living conditions, fear, and an uncertain future, and still cannot access medical care because their movements are restricted and their security is at risk.
Since September, MSF has worked in collaboration with the Ministry of Health to contain the cholera outbreak in Baghdad district (Abu Ghraib area) and the governorates of Diwaniya, Najaf, and Babil.
Mobile Teams Provide Health Care in Hard-to-Reach Areas
MSF’s medical teams are working in northern Iraq across Ninewa, Erbil, Dohuk, Kirkuk, Sulaymaniyah, Diyala, Salah Al Din, and Baghdad governorates, in collaboration with local health authorities. MSF’s mobile teams work as close as possible to front lines, where infrastructure has been badly damaged and services are lacking. They provide much-needed health services to displaced people, returnees, and host communities who otherwise have limited access to health care and who often need to travel great distances and potentially risk their lives to access medical assistance.
MSF also works in the southern governorates of Babil, Kerbala, and Najaf, providing humanitarian aid and mental health care to thousands of displaced people from governorates including Ninewa and Anbar. MSF is also contributing to the fight against an outbreak of scabies among the displaced people there.
Ensuring a Comprehensive Humanitarian Response
MSF is also supporting people living in villages and precarious urban settings by distributing essential relief items, such as hygiene kits and tents, and providing clean water and installing latrines, showers, and washing areas. Emergency interventions are carried out in response to epidemics that range from scabies to cholera. Good sanitation is particularly important in the summer months, when rising temperatures increase the risk of epidemics. As temperatures drop in the winter months, MSF teams have distributed blankets to people in Salah Al Din, Diyala, Anbar, Baghdad, Kirkuk, Kerbala, Najaf, Wassit, and Babil governorates.
Health Care for Syrian Refugees
Since May 2012, MSF has been the main humanitarian organization providing medical services, in collaboration with the Directorate of Health of Dohuk, to Syrian refugees in Domiz Camp, the largest refugee camp in Iraq.
In its clinic in Domiz, the MSF team provides round-the-clock emergency care, with referrals for patients who need specialized treatment. MSF also provides general medical consultations, sexual and reproductive and mental health care, treat non-communicable diseases, and run health promotion activities.
In August 2014, in response to increasing needs, MSF opened a maternity unit in the camp where women can deliver their babies safely and access reproductive health care.
In Erbil governorate, a team of MSF psychologists and psychiatrists provide mental health care to Syrian refugees in the Kawargosk, Gawilan, and Darashakran camps.
Secondary Health Care
Since August 2006, a network of Iraqi doctors has been referring victims of violence from all over Iraq to MSF’s reconstructive surgery hospital in Amman, Jordan. The surgical team specializes in highly complex surgery requiring multiple stages of treatment, in particular maxillofacial surgery (dealing with the head, neck, face, jaw, and sinuses), orthopedic surgery, and surgery for patients with severe burns. Patients also receive physiotherapy and psychosocial support.
Training of Iraqi Medical and Para-Medical Staff
Periodically, MSF also organizes medical training programs for Iraqi doctors in association with the Iraqi Ministry of Health. In early 2015, 12 Iraqi physiotherapists attended a 10-week training in early physiotherapy.
Over recent years, MSF has also supported the Baghdad-based Poisoning Control Centre (PCC) by providing antidotes that are difficult for the Ministry of Health to obtain.
Raoof and his extended family of 17 arrived in Abu Ghraib, near Baghdad, in April 2014 in search of security. It was not the first time they had to flee violence since they left Dyala Province two years ago. “We left our home when the fighting started," says Raoof. "The worst thing was the bombing, it killed most of our cattle. So we left everything behind, and ran for our lives with just the clothes we were wearing." The family eventually moved to Zeidan, closer to Baghdad, in 2014 "We built a house, moving 1,500 cement blocks. It was hard work, but when we finally finished the rooftop again we were asked to leave—the landlord didn’t want us there."
So the family moved again, this time to an unfinished house in Abu Ghraib. "Several families live under the same roof," says Raoof. "Nobody has money or a job. It’s a skeleton of a place, and there is no air conditioning, and yet the landlord keeps raising the rent. How are we to manage? We survive on handouts from more fortunate relatives who live in this neighborhood, but it’s hard."
Several of Raoof’s family members visit the MSF mobile clinic nearby. "When we fled, my father lost all his prescriptions. Now he has been given a health card and gets his regular check-up and medication. Two of my kids have fallen ill since we arrived and I also took them to the clinic, where we don’t have to wait all day to see a doctor."
The following is an excerpt from the 2014 in Review update. Click here to download the document.
2014 Activity Highlights
MSF’s Care for Displaced Populations
Since IS launched its offensive in Iraq in late 2013/early 2014, MSF has been responding to the humanitarian needs of displaced people who fled en masse from Anbar, Salah–ad-Din, and later Ninawa governorates. MSF teams first supported four referral hospitals in the towns of Tikrit, Hawija, and later Sinjar to ensure a 24-hour emergency service. In June, MSF also began to assist Heet Hospital, and in July, several mobile clinics offering basic health care were established in Kirkuk.
In August, following a massive influx of people from Sinjar and Ninawa, MSF teams provided urgent medical care on both side of the Syrian Iraqi border. Entire communities had fled the violence, and MSF teams ran mobile clinics to offer primary health care and water and sanitation services to thousands seeking refuge.
As the conflict spread across Anbar governorate in October, triggering more displacement, MSF mobile teams provided health care in the cities Al-Qadisiyyah, Kerbala, and Babil Governorates.
Working on the Front Lines
In Dohuk, many displaced have been resettled in new camps, so MSF is now focusing on the sizable population still living outside the tented facilities. Simultaneously, MSF medical teams are spreading their reach across buffer areas in Ninawa governorate, where and when security allows, offering much-needed medical care to the local populations in places where most of the medical infrastructure has been destroyed.
Last July, in spite of the very volatile security environment, MSF started deploying mobile clinics in Kirkuk governorate, Salah ad Din, and Diyala governorates to provide health care to the displaced. Our medical services focus on primary health care, with an important emphasis on non-communicable diseases, reproductive health, and mental health care.
Medical Facilities Under Fire
Throughout MSF’s response to the current crisis, teams have had to adapt or close several projects at different times because security worsened and risks increased, health structures were damaged, or staff no longer felt safe working in certain locations. Projects in Hawijah and Tikrit were abruptly shut down due to the deteriorating security situation. In June, the day after MSF completed its primary health care unit in Tikrit, the city was overrun by rebel forces and MSF’s clinic was destroyed by an explosion. MSF medical staff had to be evacuated.
A few weeks later, MSF offices in the hospital compound of Hawijah, where MSF had been working since 2010, were severely damaged during fighting, prompting the closure of the project.
Medical staff fled Sinjar Hospital in August when IS militants seized the town; some staff later joined our teams in Dohuk and are still working to provide medical services to their communities. In October, MSF withdrew from Heet Hospital after IS took control of the city, forcing thousands from Al-Anbar who had already fled their homes once to take flight again.
NFI Distributions for Vulnerable Populations
In addition to health services, MSF teams also distributed medicines, non-food items, blankets, and construction kits to the most vulnerable and difficult-to-reach populations across Kurdistan and in Ninawa, Al-Anbar, Salah ad Din, Diyala, Kirkuk, Baghdad, Kerbala, Najaf, Babil, Wassit, and Al Qadiyiah governorates. In total, MSF teams distributed 37,183 relief items and 46,772 blankets in 2014.
Health Care in Syrian Refugee Camps
In August 2014, MSF opened a maternity unit in Domeez, the largest Syrian refugee camp in Iraq. As the population swelled to 60,000 and more and more pregnant women needed proper assistance, MSF augmented its primary health care center to include a delivery room for safe delivery and gynecological services.
Teams had also been providing general health services and mental health care in the Kawargosk and Darashakran refugee camps, until handing over activities (aside from mental health care) at the end of 2014.
Secondary Health Care
MSF has had a network of doctors across Iraq since 2007 and currently works with eight doctors to refer patients in need of specialized reconstructive surgery to MSF’s hospital in Amman, which offers orthopedic, maxillofacial, and plastic surgery, along with physiotherapy and psychosocial support.
MSF had also provided assistance to Al-Zaharaa Hospital in Najaf since 2010, helping to improve the quality of the neonatal and obstetric care, until it ceased working there in October 2014.