A spiral of violence
After having been blocked from
entering Iraq between 1992 and
the very end of 2002, MSF was
given permission by the former
government to start providing
care to civilians in Baghdad
shortly before the war began in
March 2003.
Weeks later after the most active combat
between Iraqi forces and the US-led coalition
had ended, MSF visited more than 70
health facilities in 25 cities, assessing the
most urgent medical needs and donating
medical equipment and drugs as necessary.
In some hospitals that were facing
staff shortages, MSF also offered the help
of its own medical volunteers. While many
civilians could not get care amid the chaos
that followed the conflict, the country's
civilians did not suffer from disease epidemics
or huge refugee movements as had
been predicted by some.
MSF staff quickly concluded that the most
pressing medical problem facing Iraq in
the days following the fighting was a lack
of leadership within the country's centralized
health care system. MSF called on the
members of the US-led coalition, as occupying
powers, to assume their responsibility
as stipulated under the Geneva
Conventions and provide basic services,
including health care, to the Iraqi people.
Humanitarian aid workers targeted
Although heavy fighting ended in April
2003, the country's security situation deteriorated
sharply in mid-2003, and humanitarian
aid workers began to be viewed by
some as a component of the Western military
effort. On 19 August, a bomb attack on
the UN compound in Baghdad killed many
international and Iraqi humanitarian workers,
including UN Special Representative
for Iraq Sergio Vieira de Mello. Later, in
October, an explosives-packed ambulance
slammed into the Baghdad headquarters
of the International Committee of the Red
Cross, killing 12 Iraqi staff members and
injuring 15 others. MSF condemned both
of these violent actions as heinous assaults on innocent civilians and on the principle
of independent humanitarian aid work. In
a statement, MSF emphasized that recent
actions and statements made by Western
officials attempting to incorporate aid into
their political plans were contributing to
humanitarian groups' vulnerability to
attacks.
Providing care for those trapped
by violence
While MSF had withdrawn many of its
international volunteers by September
2003 due to both unacceptable risks and
reduced emergency health needs, teams
continued to provide assistance in a
number of ways. MSF began helping civilians
in Sadr City, one of Baghdad's poorest
areas, where the slum's two million residents
had little ability to access clean
drinking water, sanitation facilities or basic
health care. By mid-2004, MSF teams were
providing basic and prenatal care as well as
treatment for malnourished children in
three of the area's health clinics, each of
which includes a first-aid post. More than
3,000 medical consultations were provided
each week in these clinics. MSF staff
trained medical and paramedical personnel,
supervised nurses and rehabilitated
the pediatric unit in the hospital in Sadr
City's Al Thawra district. When Sadr City
underwent a siege in mid-2004, the team
treated 40 to 50 people wounded during
the stand off. In August, MSF began an
ambulance service, in cooperation with other NGOs, to transport the injured to
local hospitals.
In August 2004, MSF distributed 1.5 tons of
medicine and material to Najaf Hospital
and nearby clinics during heavy fighting
between US forces and Shia militants
around the city's holy shrine. Although the
area had an adequate drug supply, MSF
found that civilians had trouble entering
local hospitals and clinics that were guarded
by military forces.
In September 2003, MSF ended the distribution
of medicines to treat people with
the deadly disease, kala azar (visceral leishmaniasis)
which is endemic in the southern
part of the country. The project was started
because supply deliveries had been interrupted
by the war. The materials were distributed
among pediatric hospitals and
other facilities in Ramadi, Karbala, Falluja,
Hindiyah, Najaf, Diwaniyah, Afaq,
Samawah, Baghdad (Sheikh-Zaid Hospital)
and Nasiriyah. Another organization will
now supply the drugs. MSF also donated
equipment, reagents and material to help
diagnostic-testing facilities resume operations
in the public health laboratories of
Baghdad and nine other governates in the
upper southern region of Iraq.
MSF worked in Iraq from 2002 until 2004.
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