Why are we there?
- Armed conflict
- Health care exclusion
Iraq: Latest MSF Updates
- Iraq: Families Escaping Western Mosul Describe Life Under Siege
- Medical Care in Mosul: “There are No Heroes in This Story, Only Victims”
- Stabilizing Patients by the Front Line in Mosul
- Iraq: Shoring Up a Ruined Health System in Mosul
May 2017 Update: Crisis in Mosul
The battle for Mosul is taking a staggering toll on the people of Iraq’s second largest city, especially those still trapped inside western Mosul where ongoing fighting continues to result in high numbers of civilian casualties. The patients who make it to Doctors Without Borders/Médecins Sans Frontières (MSF) facilities report that water and food are running low, that the few supplies available are extremely expensive, and that access to health care is almost impossible.
Maternal Health, Karama
MSF opened a 15-bed, 24-hour maternity hospital in Karama, eastern Mosul, on March 19, 2017. Since then, the MSF team, comprising both international and Iraqi midwives and obstetricians, has assisted 200 women during safe births.
Emergency and Post Operative Care, Al-Taheel
MSF opened a 24-hour emergency room in Al-Taheel Hospital on March 26. The team also set up a surgical unit (currently one operating theater, with a second opening soon) and a 32-bed post-operative ward to provide medium-term care to patients suffering from violent trauma injuries in and around Mosul. Cold cases, surgical follow-up, and other surgical issues are also treated in this facility. Since the opening, about 336 patients have been received in the emergency room and 30 surgical interventions have been carried out.
Hospital, Northeastern Mosul
In northeastern Mosul, MSF works in a hospital set up inside a former retirement home. The emergency room opened in February 2017 and has been running 24 hours a day since March 1, providing emergency, surgery, and maternity services (including Caesarean sections), in addition to a 50-bed inpatient department.
From its opening to early May, the hospital’s MSF team treated 4,376 patients, over half of whom (2,286) were urgent cases. Ninety-three Caesarean sections were performed in the maternity unit. As the level of access to health care improves in eastern Mosul, the hospital has seen a drop in activities in recent weeks, especially in terms of lifesaving medical care. As a result, MSF is reevaluating the project strategy.
Outside Mosul City
Trauma Care and Primary Health Care, Hammam al-Alil
Hammam al-Alil (known as HAA) is the closest internally displaced persons (IDPs) camp to the south of Mosul, located about 30 kilometers [about 19 miles] south of the conflict’s current front line. The town has received a large influx of IDPs from western Mosul since the start of the military offensive, with more people arriving every day.
Here, MSF opened a field trauma hospital with an emergency room, two operating theaters, an intensive care unit/recovery room and IPD on February 16, 2017. For more than one month this hospital was the closest surgical facility to western Mosul. The emergency room received 2,689 patients from February 19 to May 19, 55 percent of whom were women and children and 67 percent were war-wounded. So far the team has performed 245 major surgical procedures and 56 minor procedures.
Since April 15, 2017, MSF has supported the local health department’s primary health care center (PHCC) in Hammam Al-Alil town and as of May 19 had already carried out 12,232 consultations both the host population and the IDPs hosted in the community. In the PHCC, MSF also provides dressings for wounded patients, including those still being followed up after discharge from the MSF trauma center. MSF also runs an ambulatory therapeutic feeding center for children suffering from malnutrition, with a rapidly growing cohort made up primarily of children under six months old.
Post-Op, Al Hamdaniya
MSF provides long-term post-operative care with rehabilitation and psychosocial support in Al Hamdaniya Hospital in collaboration with Handicap International. Activities began on March 15, 2017, and to date MSF has admitted 189 patients, around 44 percent of whom were women and children. The facility now has 40 beds to respond to the huge need for post-operative care and is almost constantly full.
In December 2016 MSF opened a 32-bed hospital in Quayyarah, 60 kilometers [about 37 miles] south of Mosul, with an emergency room and operating theater to provide surgical and medical emergency care. The facility has now been extended to address growing and diversifying needs.
The team has treated 6,000 patients in the emergency room as of May 1, around 10 percent of whom were admitted to the 50-bed IPD. In total, 1,130 surgical interventions were performed from December 2016 to May 1. 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 the Shirkat Region, as well as those from IDP camps in Hammam al-Alil and Quayyarah. The majority of the patients in the feeding center are less than six months old. The center is regularly over capacity and last week there were 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 Quayyarah camps. The mental health team consists of a psychiatrist, two psychologists, and two psychosocial counselors.
Since the beginning of 2017, MSF teams have carried out more than 15,000 medical and 9,000 mental health consultations in the IDP camps near Mosul.
Following the offensive launched into western Mosul in mid-February, the total population of the four camps west of Erbil currently hosting IDPs from Mosul sharply increased to 80,000 people by the end of March. Soon after, displaced people started leaving the camps to move in with relatives or rent houses in retaken areas of eastern Mosul, and the overall population decreased to approximately 70,000.
Today, MSF mobile teams provide primary health care, treatment for chronic diseases (mainly diabetes and hypertension), as well as psychological and psychiatric care in two of these camps, Chamakor and M2. Currently, activities in M2 are more focused on care for non-communicable diseases, with MSF planning to hand over primary health care activities by the end of May. MSF has already handed over the treatment of non-communicable diseases in Debaga Camp, given the number of IDPs leaving the camp to return to their homes or move in with relatives in eastern Mosul.
An MSF team comprising a psychiatrist, psychologists, and counselors 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. MSF teams currently provide mental health care in 14 sites, and are always extremely busy. Since the beginning of 2017, MSF teams have carried out more than 15,000 medical and 9,000 mental health consultations in the IDP camps near Mosul.
Hawija District, one of the four districts of Kirkuk Governorate, is the second-largest territory in Iraq controlled by the Islamic State. A large proportion of the district’s 288,000 residents (as of June 2014) have reportedly fled, leaving some 70,000 others living under siege. Since November 2016, MSF has been operating two mobile clinics at Maktab Khalid checkpoint and at Debes screening site to respond to the immediate needs of people fleeing Hawija. Primary health care, first aid, psychological trauma care, and referrals to Kirkuk Hospital’s emergency room for severe cases are provided. MSF renovated water and sanitation facilities at the two sites and also distributes water.
In Daquq IDP Camp, MSF runs a non-communicable diseases clinic and mental health activities. MSF also supports the emergency rooms of the two main Kirkuk hospitals, and has conducted emergency response workshops including specific training on treating injuries to the abdomen and chest, as well as on advanced trauma responses in preparation for mass casualties that could result from any future Hawija offensive.
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 2015 International Activity Report:
The conflict in Iraq continues to cause massive displacement and hardship, yet funding shortfalls resulted in a reduced international response, which was largely concentrated in the more secure areas of Iraqi Kurdistan.
Over 3.2 million Iraqis are now displaced within the country, putting an immense strain on host communities. In 2015, MSF expanded its activities to provide basic healthcare and relief to displaced families, returnees, impoverished host communities and Syrian refugees in locations across 11 governorates: Dohuk, Erbil, Sulaymaniyah, Ninewa, Kirkuk, Salaheddin, Diyala, Baghdad, Najaf, Karbala and Babil.
Throughout these governorates, MSF deployed mobile clinics to deliver medical care to those unable to reach health facilities due to movement restrictions and security risks. The teams visited a number of locations regularly, basing themselves in clinics, tents and even buses. In highly militarized areas, doctors provided referral documents to ensure safe passage for patients requiring treatment at secondary care facilities. MSF teams also monitored possible disease outbreaks.
Most of the health problems seen by MSF staff were related to people’s poor living conditions, and included respiratory and urinary tract infections, gastrointestinal problems, arthritis and skin diseases. MSF also focused on chronic diseases, particularly hypertension and diabetes, and mother and child health. Female medical staff were present to encourage women to attend clinics.
Mental Health Activities
MSF efforts this year were also directed at increasing psychological first aid for the growing number of people who have been traumatized by the recurrent violence and their precarious living conditions. In Karbala, Najaf and Babil governorates, MSF continued its regular mental health programs assisting internally displaced people. Over 1,500 individual counselling sessions were completed and 9,220 people participated in group psychosocial education The team trained health ministry staff, as well as teachers working with children, in mental healthcare. In Erbil governorate, a team of MSF psychologists and psychiatrists provided support to Syrian refugees in Kawargosk, Gawilan and Darashakran camps.
Mobile Medical Care
During most of 2015, MSF medical teams provided healthcare (21,775 consultations) to displaced people sheltering in unfinished buildings in Dohuk governorate. As people were gradually moved into formal camps offering medical services, MSF shifted its activities to Tel Afar district in Ninewa governorate, where medical infrastructure had been destroyed during the conflict and needs were very high. Teams ran clinics close to the frontline, where people were afraid to move and could not afford to travel long distances to reach medical facilities. Mobile teams conducted 19,505 outpatient consultations for chronic diseases, sexual and reproductive health and mental health for IDPs and the local community. MSF teams also ran mobile clinics in several other locations between Mosul and Erbil, and an emergency field surgical unit was established in the district to provide care for people directly affected by armed conflict.
Two mobile teams provided basic healthcare and mental health services in a number of locations in and around Kirkuk, and a third supported the Directorate of Health in Laylan camp with chronic disease management and sexual and reproductive health services. A total of 48,895 consultations were provided. Towards the end of the year, as other medical organisations moved into Kirkuk, MSF handed over most of activities in Kirkuk to other NGOs and redirected its efforts to outlying areas, for example deploying a mobile clinic to displaced people living in small settlements along the road to Baghdad, near Tuz Kurmato, who were afraid to travel across the militarised area to seek medical treatment.
Activities in Baghdad started in March in Abu Ghraib district, with one mobile clinic serving the local community and the displaced people living in Abu Ghraib and Al Salam camps. In response to the massive needs, a second team started working in September to bring medical care to several other locations in this impoverished district.
MSF also assisted displaced people and host communities in north Garmian district and neighboring Diyala governorate with activities ranging from basic healthcare in health ministry facilities to mobile clinics. Teams provided mental health services in three camps in Khannaqin, Diyala.
In September, MSF responded to a cholera outbreak that spread across central Iraq and affected Dohuk, Kirkuk, Erbil, Baghdad, Diyala, Najaf, Diwaniya and Babil governorates. Water and sanitation assessments were carried out in all locations affected and MSF teams supported the Ministry of Health with training, health promotion, and hygiene and infection control activities in all the hospitals dealing with the outbreak.
Since May 2012, MSF has been the main humanitarian organisation providing medical services, in collaboration with the Dohuk Directorate of Health, to Syrian refugees in Domiz camp, the largest refugee camp in Iraq and home to 40,000 people.
In October, the general medical services were handed over to the Directorate of Health, but MSF continues to run chronic disease, sexual and reproductive health and mental health services, as well as regular health promotion activities. The team assisted 1,155 deliveries in the maternity unit this year.
MSF also worked in Sulaymaniyah and Arabat camps, undertaking water and sanitation and health promotion activities. In December, MSF started supporting Kalar maternity hospital with staff training and donations.
MSF continued to run basic healthcare and mental health services in a clinic in Diyala governorate, focusing on the needs of displaced people.
Reconstructive Surgery in Jordan
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 team is specialized in complex surgery requiring multiple stages of treatment, in particular maxillofacial (dealing with the head, neck, face, jaw and sinuses), orthopedic and reconstructive burn surgery. Patients also receive physiotherapy and psychosocial support.
Additional Support to the Ministry of Health
Periodically MSF organizes medical training programs for Iraqi doctors in collaboration with the Ministry of Health. In early 2015, 12 Iraqi physiotherapists attended a 10-week physiotherapy training course.
MSF has also supported the Baghdad-based Poisoning Control Center for many years by providing antidotes that are difficult for the Ministry of Health to obtain.
Iraq | Surge in Violence Triggers Large-Scale Displacement
At the end of 2015, MSF had 547 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."