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MSF in Iraq, 2010
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The seventh year of violence and political tension since the war itself saw continuing pressure on the emergency capacity of the health system in Iraq. The needs are not only for trauma care following explosions but for a whole range of specialist services.
MSF has been attempting to fill some of the gaps that have been identified in obstetric care, mental health and other specialised services. It has also sustained its training and support for general surgery and its reconstructive programme for severely wounded people who are brought to neighbouring Jordan for treatment.
Activities are still considerably restricted by the remaining threats to staff but the response to pressing needs in the country developed in new directions in 2010. The ability to travel and work in some of the more stable parts of the country has increased MSF’s capacity to support these more complex areas of medicine and to raise standards of care.
In the areas most affected by violence, bombings and assassinations continue and dozens of people are killed or wounded every month. Fear of violence has driven people from their homes, while others are trapped inside them with significant consequences for their physical and mental health. Direct access to victims of the violence in the most densely populated areas remains limited for international and independent humanitarian organisations.
Although many health facilities are functioning, the quality of care has been affected by a shortage of specialised staff and lack of training. According to the Iraqi health ministry, hundreds of medical employees have been killed in the course of the conflict and great numbers have fled the country. Iraq is short of nurses and of specialist doctors, including psychiatrists and psychologists. There has been no upgrading of skills since the early 1990s. Iraq’s doctors once provided some of the highest quality and best resourced services in the region, but now the quality of some medical services is seriously impaired.
Maternal and child health
Just one of the consequences is that maternal and infant mortality has been rising in the country. In October 2010, MSF started a project to improve the quality of obstetric and perinatal care in Al Zahra district hospital, the main specialist referral centre in Najaf Governate. Staff worked in the neonatal unit, and also focused on supporting emergency facilities, infection control, drug supply and staff training. That form of support has also been the pattern for MSF’s work in the setting of the general hospital in the major southern city of Basra, where MSF has worked since 2006. Staff treat as many as 20,000 people a month for the whole range of injuries and illnesses. In the northern city of Hawijah, an MSF surgical team of Iraqi doctors in the general hospital performs around 300 operations a month.
In the city of Kirkuk, MSF supports the dialysis unit of the public hospital and started a renal treatment programme in June 2010 for patients with severe kidney failure. The target is to treat around 80 people who need the complex dialysis procedure. A visiting Swiss specialist, Dr Patrick Ruedin, was advising the team. “The number of patients concerned is indeed very limited. However, they would all die if they couldn’t get the treatment. One could look at dialysis as an elite treatment while there are more glaring needs, but Iraq has the means of reintroducing the specialty; they just need a bit of a boost.”
The reconstructive surgery programme in the Jordanian capital of Amman, which was started in 2006, continued to receive Iraqi patients. In 2010, more than 300 people benefited from the orthopaedic, maxillofacial and plastic specialties. Treatment and follow-up are complex, requiring months of hospitalisation. As an illustration, 19,000 individual physiotherapy sessions were carried out over the year.
Mental health services
A more recent development has been in the neglected area of mental healthcare. Hospital staff from the Ministry of Health were trained as counsellors by MSF and are now working in units in two hospitals in Baghdad and one in Fallujah. In 2010, over 5,000 sessions took place to reduce the mental trauma patients were experiencing from their exposure to violence and insecurity. The counsellors are supported by video-conferencing systems, which allow international staff to work with them from outside the country.
The pattern of remote support for Iraqi staff and for Ministry of Health facilities still prevails, with MSF providing triage training to doctors from three hospitals in Kirkuk, and in Ninewa.
MSF first worked in Iraq in 2003.