Iraq: Latest MSF Updates

Crisis Update: November 2017

Iraq has endured years of disastrous conflict. Since 2014, 5.3 million Iraqi children and adults have been forced to leave their homes and seek shelter from fighting. As the last remaining cities are retaken from the so-called Islamic State, Doctors Without Borders/Médecins Sans Frontières (MSF) teams have observed an increasing number of families leaving camps for displaced people. Many have now returned to their homes.

Though some aspects of life are beginning to return to normal in eastern Mosul and other retaken cities, unemployment remains high and most children have missed years of school. In western Mosul, Anbar, Kirkuk, and Salaheddin, homes, infrastructure, and services have been almost completely destroyed. And, in many regions, the state of health care services remains dire. In western Mosul, most hospitals and clinics were bombed and there is still a severe lack of services, equipment, medical staff, and medications.

Though populations are dropping, a significant number of displaced people still live in camps. Many, especially those from western Mosul, have nowhere to return to, and are entirely reliant on assistance they receive in the camps.

On September 25, the Kurdistan region held an independence referendum. Since then, the Iraqi government has moved to retake disputed territories, including Kirkuk and its surrounding oilfields, further complicating the humanitarian situation. Clashes between Iraqi and Peshmerga forces in several areas have caused displacement and road closures.

Additionally, a 7.3 magnitude earthquake struck several regions near the border with Iran on November 12, causing six reported fatalities and more than 500 injuries in Iraq. The Sulaymaniyah Emergency Hospital, where MSF supports the emergency room (ER) and intensive care unit (ICU), received 80 cases related to the earthquake. MSF also donated supplies to a primary health care clinic in Darbandikhan, which was used as a hospital in the quake’s aftermath.

MSF Operations

MSF works across Iraq in the governorates of Dohuk, Erbil, Sulaymaniyah, Diyala, Ninawa, Kirkuk, Salaheddin, Anbar, and Baghdad.

At Nablus hospital in western Mosul, war-related trauma cases have decreased. MSF is expanding maternity, newborn, and pediatric care activities, in addition to running the ER and a pediatric inpatient department with a newborn unit and providing services for complicated and non-complicated deliveries. MSF also introduced new activities including prenatal care, antenatal care, and family planning services. In October, 1,764 people were treated in the ER, 111 in the inpatient department (IPD), and 126 deliveries and 14 Caesarean sections were performed.

MSF has seen a significant increase in numbers of patients at its maternity clinic in the village of Tal Maraq, Zummar. Changes in the relationship between Iraqi and Peshmerga forces have led to an increase in returnees and people accessing the MSF maternity unit. The MSF team in Zummar is working around the clock to keep up with the demand for medical care, providing services for normal deliveries, pre- and antenatal consultations, basic emergency obstetrics, and running a small pediatric unit. Complicated cases are now transferred to western Mosul.

During the recent clashes between Iraqi and Peshmerga forces, MSF provided a hospital in Erbil with drugs and dressing kits. The hospital admitted 90 wounded patients. In Qayyarah, where MSF runs an emergency field hospital, 42 wounded patients were treated and items to support another 35 wounded patients were donated. In Zakho and Dohuk, MSF supported hospitals with medical supplies and trauma kits.

MSF continues to run primary health care, noncommunicable disease, and mental health services for internally displaced people in Anbar governorate, providing more than 10,000 consultations in October alone in response to the increase in displacement caused by military operations in the west.

New Projects

  • MSF constructed a post-operative care facility at the Al Salam/Al Shifa hospital in eastern Mosul and supports the hospital with waste management zones the ER. The team is preparing to start medical activities in collaboration with the Directorate of Health (DoH) and hopes to expand operations. 
  • In Hawija district, MSF has conducted several exploratory visits since the area was retaken from IS to assess health care needs. The first response will be in Abbassi sub-district, with an initial focus on providing primary health care, rehabilitating primary health care facilities, and water and sanitation activities. 
  • MSF recently opened the Baghdad Medical Rehabilitation Center (BMRC) to provide comprehensive care for post-operative patients, including physiotherapy, nursing care, pain management, and psychological support for civilian war victims. Improving the post-surgical recovery process will prevent short-term medical complications and long-term physical and psychological impairments. The BMRC includes a 20-bed IPD for the first weeks of treatment and an outpatient department (OPD) for patients’ follow-up after discharge. From August to October 2017, 37 patients were admitted to the IPD and the OPD.

Project Closures 

Al Khansaa Pediatric Teaching Hospital

MSF began supporting Al Khansaa Pediatric Teaching Hospital in eastern Mosul in July 2017. The hospital sustained extensive damage during the battle to retake the city, reducing capacity from 400 beds to just 120. In response, MSF constructed and equipped a 20-bed emergency room; re-established a four-bed ICU, the only one of its kind in Mosul; rehabilitated a 14-bed inpatient therapeutic feeding center and set up an ambulatory therapeutic feeding center; and partially rehabilitated the medical pediatric ward, establishing a minimum capacity of 32 beds. MSF also performed general rehabilitation in the engineering department of the hospital and renovated wash rooms and the plumbing system in the IPD.

From August to October, 2,532 patients were treated in the emergency room and 746 patients were admitted to the pediatric ward. MSF handed over this project to the Iraqi DoH on October 31 after a successful collaboration with the health authorities of Ninewa governorate.

Domiz Refugee Camp

After more than four years, MSF is finishing its sexual and reproductive health and maternity project in the Domiz camp for Syrian refugees near the city of Dohuk, which hosts some 30,000 people. In close coordination with the DoH, the project was launched in 2013 to offer pre- and antenatal care and family planning services. In 2014, the project was expanded to a full maternity unit with a 24-hour delivery room, triage, and gynecological consultations. MSF provided more than 27,400 gynecological consultations and delivered more than 3,400 babies. The project was handed over to the DoH on November 30.  

Sulaymaniyah Emergency Hospital and Asthi IDP Camp

MSF’s projects in Sulaymaniyah emergency hospital and Asthi IDP camp were started two years ago in response to a sharp increase in the number of IDPs in the area and the corresponding strain on health services. MSF renovated the ER and ICU at the hospital, implementing various medical protocols and management improvement processes and providing training for medical staff in support of and in collaboration with the DoH. In Ashti camp, and previously in Arbat camp, MSF conducted health promotion and mental health activities.

The project closed on November 30. The number of people in the camp is decreasing and local partners will take over activities. At the hospital, MSF enjoyed a positive partnership with the DoH, resulting in a large increase in the number of lives saved.

Qoratu IDP Camp, Diyala

The numbers of IDPs in Qoratu camp have decreased and the need for mental health services have eased. MSF’s activities in the camp closed at the end of November. Materials were donated to camp management.

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.

Crisis Update: September 2017
MSF Operations in North Iraq

MSF has increased its activities in Iraq, deploying teams across 11 governorates to provide medical care and essential relief items to displaced families, returnees, impoverished host communities, and Syrian refugees. In 2017, MSF expanded operations around Mosul to care for people affected by the battle for control of the city.

From January to June 2017, MSF teams in Iraq provided more than:

133,000  General medical consultations
57,000 Emergency room consultations
4,900 Surgical procedures
4,300 Inpatient consultations
38,000 Individual and group mental health consultations
28,000 Reproductive health consultations
19,000 Consultations for chronic diseases
2,500 Mothers with access to safe deliveries

West Mosul

On June 23, Doctors Without Borders/Médecins Sans Frontières (MSF) opened a hospital to provide lifesaving trauma assistance for war-wounded people escaping the final conflict areas of the Old City in West Mosul. Teams have adapted the services to the needs of the residents, and the hospital also focuses on providing maternal care to the returning population, in addition to surgical, short term post-operative, neonatal, pediatric, emergency, and inpatient care. Since opening, the hospital has provided care to more than 3,671 patients in the emergency room—including 362 patients with war-related trauma injuries. Teams have also performed 448 deliveries. Since opening the inpatient ward on July 20, 275 patients have been admitted for hospitalization.

East Mosul

Al-Khanssa: Pediatric Teaching Hospital

In July, MSF began supporting a public health facility in East Mosul, which has been heavily damaged during the conflict. The hospital, which had 400 beds, now only has 120. MSF rehabilitated and equipped a 20-bed temporary emergency room and enhanced the medical pediatric ward by rehabilitating two rooms and adding 14 beds. Teams also supported the opening of a 14-bed inpatient therapeutic feeding center and completed the construction of an expanded 20-bed emergency room outside of the main hospital structure. By mid-October, MSF will have completed the rehabilitation of an intensive care unit. Since the beginning of August, 1,642 patients have been treated in the emergency room. 554 patients were admitted to the pediatric ward.

Al-Taheel: Emergency and Post-operative Care

At the end of July, MSF closed its project in Al-Taheel, East Mosul. Since opening, 1,340 patients were treated in the emergency room and more than 500 surgical interventions were performed, the majority providing follow-up care and secondary surgery for war-wounded patients. MSF is currently in the process of handing over this facility to local health authorities, who plan to resume additional medical activities in this location.

Outskirts of Mosul City

Qayyarah

In December, MSF opened a hospital in Qayyarah, 37 miles south of Mosul. With an emergency room and an operating theater to provide surgical and emergency medical care, the 62-bed facility caters to the growing and diversifying needs of the community. The hospital also has an intermediate care unit, observational beds, and two resuscitation beds. The hospital also increased its capacities for pediatric care and for the treatment of the high numbers of infants suffering from malnutrition, many of whom are less than six months old. MSF provides a mental health clinic for patients admitted to the hospital or referred from the Qayyarah camps for displaced people. The mental health team consists of a psychiatrist, two psychologists, and two psychosocial counsellors. As of September 15, more than 9,000 patients have been treated in the emergency room, around 17 percent of whom were admitted to the inpatient department. A total of 1,400 surgical interventions have been performed, and more than 535 malnourished infants have been admitted to the therapeutic feeding program. Teams have also provided more than 1,300 mental health consultations in Qayyarah.

Qayyarah Camps

In late July, MSF opened an ambulatory feeding program in the Qayyarah camps, where an estimated 160,000 people displaced from Mosul reside. Two clinics have been opened in Jeddah 6 and Airstrip camps, and a third one is under construction in Jeddah 5. A cohort of 340 children—including follow-up patients referred by the Qayyarah inpatient therapeutic feeding center—are currently in the program. The program provides assistance to children under five, with a special focus on infants under six months of age who are at the highest levels of risk. The program also includes a baby-friendly space with a focus on promoting breastfeeding and providing support for mothers to resume breastfeeding. Mental health care for issues related to malnutrition is also available.

Al Hamdaniya: Post-operative and Rehabilitation Care

From March 15 to September 14, MSF provided post-operative care with rehabilitation and psychosocial support in Al Hamdaniya hospital in collaboration with Handicap International. Post-operative services will be shifted to Al Shifa hospital in East Mosul during the month of October. The hospital will initially have 30 beds, and capacity will expand to 80 beds after additional construction.

Camps for Internally Displaced Persons (IDPs) East of Mosul

Following the offensive launched into west Mosul mid-February, the total population of displaced persons increased in camps east of Mosul, areas controlled by the Kurdish Regional Government. Today, MSF mobile teams are providing treatment for chronic diseases—mainly diabetes, epilepsy, asthma, thyroid dysfunction, and hypertension. In addition, an MSF team of more than 20 psychiatrists, psychologists, mental health doctors, and counsellors is providing mental health care in nine camps to those suffering from moderate to severe mental health conditions. Activities include psychological and psychiatric consultations, group therapy, psychosocial counselling, and child therapy. So far in 2017, the team has carried out close to 23,000 medical consultations, including primary health care and non-communicable disease consultations, and more than 18,000 mental health consultations in the IDP camps.

Trauma care and primary health care, Hammam al-Alil

At the end of July, MSF closed its project in Hammam al-Alil. Over the course of the conflict in Mosul, Hammam al-Alil received major influxes of IDPs and war-wounded. In February, MSF opened a field trauma hospital with a 22-bed emergency room, two operating theaters, a seven-bed intensive care unit and recovery room, as well as a 32-bed inpatient ward. The hospital also provided mental health services. For more than a month after it opened, the MSF project was the closest surgical facility to West Mosul. By the end of June, the emergency room had received 3,852 patients, including more than 1,600 in critical or life-threatening condition. In the same period, the team performed 474 surgical procedures, most of which were emergency operations, and admitted over 750 patients for hospital care.

Since late February, MSF has supported a nearby primary health care center. Teams have also provided over 23,000 medical consultations and admitted 202 children suffering from acute malnutrition to MSF’s ambulatory therapeutic feeding program. In June and July, MSF provided inpatient therapeutic feeding for malnourished children. The project was closed due to reduced need for lifesaving trauma assistance and increased aid from other medical actors.  

Elsewhere in Iraq

Nineveh Governorate

In Zummar, MSF runs a maternity clinic in the village of Tal Maraq that assists approximately 200 deliveries per month. The clinic offers pre- and post-natal consultations, basic emergency obstetric and neonatal care, manages minor obstetric complications, and refers patients with more serious obstetric complications to hospitals in Zakho and Dohuk. The clinic also includes a small pediatric ward. MSF teams run mobile clinics in surrounding villages, offering general health care consultations, mental health consultation, and follow-up and treatment for patients with non-communicable diseases.

Kirkuk Governorate

MSF teams provide medical and mental health services to people displaced from Hawijah. MSF runs outpatient departments, a non-communicable diseases clinic, and provides mental health care support, including referrals for psychiatric care in Daquq IDP Camp, host to 10,600 displaced people. At Maktab Khalid entry point and at Debes screening site, MSF’s mobile clinics ensure that those fleeing Hawijah receive treatment in a timely manner. MSF also supports the emergency rooms of the two main Kirkuk hospitals with donations of crash carts and training for Directorate of Health doctors and nurses in ER-related topics, including mass casualties and trauma room reorganization.

Dohuk Governorate

In the Domiz refugee camp for Syrian refugees, MSF runs a maternity unit to provide maternity care and access to reproductive health care services. Teams assist an average of 100 patients per month.

Sulaymaniyah Governorate

MSF is working with health authorities in Sulaymaniyah emergency hospital, providing hands-on training to improve the quality of medical services in the intensive care unit and emergency trauma ward. MSF has rehabilitated the emergency room and intensive care unit wards, which are now fully functional, to improve the layout and patient flow. Since 2015, MSF has been working in IDP camps in the governorate. The teams conduct health promotion activities and provide psychological and psychosocial care. In July 2017 the ER performed 512 patient consultations and 150 mental health consultations.

Salah Al-Din Governorate

With the expansion of military operations in northwestern Iraq, thousands of Iraqis continue to flock to relatively safer areas. To respond to the growing needs, in June 2016 MSF started running mobile clinics in the city of Tikrit and the surrounding areas. The clinics offer outpatient and mental health consultations. In January 2017, MSF established a primary health care center in one of the camps.

Diyala Governorate 

MSF has been working in Diyala governorate since 2015, supporting displaced populations in three IDP camps in Khanaqin district and providing medical and mental health consultations in collaboration with the Directorate of Health. As of July 2017, MSF teams have completed more than 10,000 individual and group counselling sessions. MSF teams are also conducting health promotion activities in all camps. MSF supports primary health care clinics in Sadiya and Jalawla—which together host 100,000 IDPs—and focuses on chronic diseases, sexual and reproductive health, maternity, mental health, and health promotion services for IDPs, returnees, and the host community. As of July, in Sadiya and Jalawla, MSF has provided treatment for chronic diseases to nearly 1,200 new patients, performed almost 6,000 follow-up consultations, and provided 5,500 pre- and post-natal consultations.

Anbar Governorate 

In June 2016, MSF started running mobile clinics in Amariyat Fallujah, Habbaniyah, Khaldiya, and Ramadi, assisting populations fleeing the areas of Fallujah and Ramadi in 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. The facility offers primary health care consultations, emergency care, inpatient care, mental health, and stabilization and referral services. In total, MSF provided more than 10,000 medical consultations in the area in 2016.

Babylon Governorate

Since the spring of 2017, MSF has supported the 40-bed Ibn Saif Pediatric Hospital in Musayib, providing capacity-building assistance, training, and logistics support. An average of 280 patients per month are admitted to the hospital, including infants. MSF has created a psychosocial unit offering services for inpatients and the community. MSF has also negotiated with the Directorate of Health to eliminate the cost of recovery in this hospital.

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