Why are we there?
- Armed conflict
- Health care exclusion
Iraq: Latest MSF Updates
- Voice From the Field: The Massive Logistical Challenges of Working in Iraq
- Displaced by Conflict in Iraq: "How Can You Live in Such a Place?"
- Pilgrims in Wartime
- The Fight Against Antibiotic Resistance
Update: October 2015
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.
This is an excerpt from MSF's 2014 International Activity Report:
A rapid escalation in conflict in Iraq caused massive internal displacement in 2014. Nearly two million people have fled their homes in search of safety.
Continual fighting hampered the delivery of humanitarian assistance to displaced people in northern and central Iraq. Doctors Without Borders/Médecins Sans Frontières (MSF) launched emergency interventions and found that most of the health problems were related to poor sanitary conditions, particularly the lack of latrines and clean water. Staff routinely treated people with respiratory and urinary tract infections, gastrointestinal problems, and skin and chronic diseases.
Emergency Relief for Displaced People
The Islamic State (IS) group and allies launched major offensives in Samarra and Mosul in June, and around Sinjar, near the border with Syria, in August. During this period people fled for safety, mainly into Iraqi Kurdistan. MSF responded by launching emergency interventions to provide basic medical care and relief for displaced families in several locations.
In June, four mobile clinics started to operate across Dohuk governorate, providing basic medical care and distributing relief items to displaced people. Teams supplied over 1,000 wash kits (soap, shampoo) and undertook water and sanitation activities, including the construction of latrines and showers in Dabin to help maintain a basic standard of hygiene.
In Kirkuk city and the surrounding areas, two teams ran mobile clinics in five locations providing basic health care, focusing on chronic diseases, maternal, and pediatric care. More than 20,000 blankets and 2,200 wash kits were given to displaced families. Mobile clinics reached displaced people in several locations between Mosul and Erbil from June to August and MSF was the first health care provider to arrive and set up a basic health clinic at Bharka camp, where displaced people were gathering. The clinic was handed over to the International Medical Corps several weeks later.
In October, MSF began offering basic health care in a clinic in Diyala governorate, focusing on the needs of people displaced by the conflict in the region. Teams conducted more than 4,700 medical consultations. As winter was approaching, they distributed relief items, including blankets, tents, and shelter construction kits to more than 400 families living in makeshift camps and informal settlements in northern Diyala.
Between November 2014 and January 2015, MSF assisted displaced people coming from the north of the country and from Najaf, Karbala, Babil, Wassit, and Al-Qadisiyyah governorates, by running mobile clinics and health promotion activities, and by providing relief supplies. More than 14,000 kits containing blankets, cooking utensils, and hygiene items were distributed, and 1,387 consultations took place.
As fighting intensified in Anbar, Ninewa, Salah ad-Din, Diyala, and Kirkuk governorates towards the end of the year, people trying to leave unsafe areas were finding themselves trapped. MSF has repeatedly asserted that protection, access to humanitarian aid, and the right to reach safer areas must be guaranteed for all communities.
The Consequences of Conflict
In June, the day after MSF had completed its basic health care clinic in Tikrit, the structure was destroyed by an explosion, and international and Iraqi medical staff were evacuated from the area. The IS group took control of the city and MSF has not been able to return since.
Teams had been working in the general hospital of Hawijah, supporting the emergency services, since 2010. In August, MSF offices in the hospital compound were severely damaged during fighting and this prompted the closure of the project. Also in August, staff had to flee the Sinjar Hospital when IS forces seized the town; some staff members later joined the MSF teams in Dohuk and are still working to provide medical services to their communities.
In December, MSF withdrew from Heet Hospital after the IS group took the city. Most of the members of the medical team left, and thousands of people from Al-Anbar who had already fled their homes were forced to move on once again.
Iraq | Surge in Violence Triggers Large-Scale Displacement
Assisting Syrian Refugees in Iraqi Kurdistan
In addition to the newly displaced Iraqis needing assistance in the region, more than 200,000 Syrian refugees have been living in Iraqi Kurdistan, many in Erbil governorate, and have ongoing health care needs. MSF was the main provider of basic health care to Syrians in Darashakran and Kawargosk refugee camps, until activities could be handed over to the International Medical Corps in November and December, respectively. MSF had carried out more than 64,000 outpatient consultations. There is still a great need for psychological support among camp residents who have fled violence and are living with fear and uncertainty. MSF has continued to provide a program of mental health support in these camps and the team carried out more than 1,100 consultations during the year.
MSF remains the main health care provider in Domiz camp, Dohuk governorate, home to some 60,000 Syrian refugees. Services include sexual and reproductive health care, management of chronic diseases, and mental health support. MSF also ensures emergency services and referrals to Dohuk Hospital around the clock. In August, MSF opened a maternity unit and had assisted 571 deliveries by the end of the year.
Reconstructive Surgery in Jordan
Many victims of war are unable to access reconstructive surgery in Iraq because of the cost and the security situation, and post-operative care such as physiotherapy is lacking. MSF offers wounded Iraqis reconstructive surgery, psychosocial support, and physiotherapy through its project in Amman, Jordan. A network of eight medical liaison officers refers patients, and more than 150 Iraqi victims of violence needing these specialist services were referred in 2014.
In February, MSF ended its support of the neonatal unit in Kirkuk General Hospital. MSF also completed a program of training and support in Al-Zahra Hospital, Najaf governorate, in October.
At the end of 2014, MSF had 627 staff in Iraq. MSF first worked in the country in 2003.
Syrian refugee, Domeez camp
I arrived with two of my children, but had to leave my husband and my two other daughters behind. We walked for more than six hours to cross the border. We don’t have our own tent yet, so we must share with another family.
I have a kidney stone and it is very painful. Since we arrived here I have been lying down all the time because of the pain. I need surgery to remove the stone. Here, we Syrians suffer from sickness, but also from the difficult situation we have gone through.