Why are we there?
- Armed conflict
- Health care exclusion
Iraq: Latest MSF Updates
- MSF Opens Newly Renovated ICU in Sulaymaniyah
- As Fighting Intensifies, MSF Bolsters Response Around Mosul
- The Constant Flight for Hameed and His Family
- Baroj's Story: Forced to Flee in Iraq
- MSF's Activities in Iraq, June 2016
- Iraq: Few Humanitarian Actors in Baghdad Area
- Refugees in Greece: "We Did Not Expect to Live This Life in Europe"
March 2017 Update: Crisis in Mosul
Ninewa and Erbil Governorates
Since the start of the Mosul offensive, MSF has worked to bolster its response in Ninewa Governorate where possible by providing lifesaving stabilization and emergency care, including mother and child health care. MSF medical teams are working in eastern Mosul and in advanced medical posts around the city. They also provide health and mental health care in newly established camps for internally displaced people (IDPs) fleeing Mosul.
Since June 2014, MSF has been increasing its response to the displacement crisis by deploying mobile medical teams, supporting local health structures, and opening field hospitals. This flexible approach has allowed MSF to provide assistance according to people’s needs, with a focus on internally displaced populations and impoverished host communities.
To the south of Mosul city, MSF runs a trauma field hospital with an emergency room (ER), two operating theaters (OTs), an intensive care unit (ICU) and recovery room, and an inpatient department. Since the opening of the project there have been a large number of patients, the majority being war-wounded civilians (of the 900+ patients received from February 19 to March 16, 2017, 763 were war-wounded) and several mass casualty incidents.
A rapid malnutrition screening of 486 children conducted early March in the Hammam Al-Alil Camp showed 1.2 percent suffered from severe acute malnutrition (SAM) and 2.2 percent from moderate acute malnutrition (MAM). A similar screening revealed revealed a SAM rate of 1.2 percent with a 2.2 percent MAM rate in Qayyarah Camp (Jeddah 4). However, rapid screening fails to capture the rate of malnutrition in children under six months old, who are particularly vulnerable to food shortages and lack of specialized appropriate food sources.
MSF set up a 32-bed hospital 60 kilometers [about 37 miles] south of Mosul with an ER and an OT to provide surgical and medical emergency care. Referrals are also organized to Erbil hospitals when needed. Over 1,500 patients were received in the ER in January 2017 (compared to 990 in December 2016). Thirty percent of them were children under five years old. A total of 250 surgeries were performed in January 2017.
Children recently displaced from West Mosul started to be admitted with severe malnutrition in early March. They are treated in the pediatric ward pending the setup of an intensive therapeutic feeding center inside the hospital that will serve as a referral point for newly arriving IDPs sheltered in Hammam al-Alil and Qayyarah camps.
In recent months MSF teams have expanded their reach to those most recently displaced in Ninewa Governorate. In response to the influx of people fleeing the fighting in Mosul, mobile teams are providing primary health care, treatment for chronic diseases, and psychological and psychiatric care in Hasansham, Khazer, and Chamakor IDP camps west of Erbil. They also provide health services in camps like Debaga, which hosts displaced people who fled their homes in 2014 or later.
In January and February 2017 over 4,800 medical consultations and 4,341 mental health consultations with a psychiatrist, psychologist, or psychosocial counselor were provided. Overall, mobile teams have been providing mental health services in 15 sites.
In the village of Tal Maraq, MSF runs a maternity clinic that has assisted more than 500 safe deliveries since the project was opened in November 2016. Access to secondary health care is limited in the area due to the ongoing conflict around the cities of Tal Afar and Mosul. The maternity clinic offers pre- and postnatal consultations and basic emergency obstetric and neonatal care, manages minor obstetric complications, and refers patients with more serious obstetric complications to hospitals in Zakho and Dohuk. Since February 2017, the clinic also includes a small pediatric ward. In parallel, MSF teams run mobile clinics in surrounding villages offering general and mental health consultations and followup and treatment for patients suffering from noncommunicable diseases.
In the Domiz refugee 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.
The surge in violence since January 2014 has resulted in the displacement of over 50,000 people to Kirkuk Governorate, of which approximately 150,000 originate from the IS group-held region of Hawija.
In October 2016, MSF started new medical activities in Kirkuk Governorate to respond to the continuous influx of IDPs and patients wounded as a result of the Hawija offensive. The intervention includes support to the emergency rooms in Kirkuk General Hospital and Azadi Hospital and provision of primary health care and mental health care in the Daquq camp for displaced people. MSF teams also conduct mobile clinics in locations where people arrive after escaping Hawija, which include primary health care, first-aid, and emergency referrals to hospitals in Kirkuk.
MSF works with the health authorities in Sulaymaniyah Emergency Hospital and provides hands-on training to improve the quality of medical services in the intensive care unit and the emergency trauma ward. Since the project was opened more than 38,000 patients were seen in the emergency room.
Since 2015, MSF has been working in IDP camps in the governorate. 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. To respond to the growing needs, MSF began mobile clinics in the city of Tikrit and the surrounding areas in June 2106. The clinics offer outpatient and mental health consultations. In January 2017, MSF also 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 Directorate of Health (DoH). 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, over 100,000 IDPs have returned to the towns of Sadiya and Jalawla, which were retaken from the IS group. MSF supports the MoH primary health care clinics in both towns, focusing on chronic diseases, sexual and reproductive health, maternity, mental health, and health promotion services for IDPs, returnees, and the host community. In Sadiya and Jalawla, 913 ante- and postnatal consultations were provided in 2016.
In June 2016, MSF began mobile clinics in Amariyat Fallujah, Habbaniyah, Khaldiya, and Ramadi (Kilo 18) to assist populations who were forced to flee the areas of Fallujah and Ramadi in Al-Anbar Governorate. Later that 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, mental health care, and stabilization and referral services. In total, 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 the 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. The team is currently assessing the needs of thousands of returnees who were displaced and are now returning to their homes in villages in northern Abu Ghraib and Karma District in Anbar.
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."