One of the greatest challenges facing independent humanitarian action today is that of reaching civilians caught in war and armed conflicts. Nowhere is this more frustratingly illustrated than in Iraq, where MSF has struggled to gain a meaningful foothold since the US-led invasion of 2003. Various military and political actors have sought to use and abuse humanitarian action for political purposes and in doing so have made humanitarian organizations a target for violent attacks. This has undermined the ability of MSF, and other neutral humanitarian organizations to address critical needs of the civilian population.
MSF was forced to leave the violence-affected regions of Iraq in 2004 when attacks on humanitarian aid workers placed its teams at too great a risk. The recent moderation of violence levels in Iraq has presented MSF with new opportunities to re-engage inside Iraq with direct medical care. In 2008, MSF has cautiously started several new projects inside Iraq.
Four million people have been displaced by the war in Iraq, with 2 million of them trapped within the country itself, according to UN High Commissioner for Refugees and the Internal Displacement Monitoring Center of the Norwegian Refugee Council. There has been some improvement of security in Iraq in the past 18 months. Overall levels of violence have reduced and a changing political environment has emerged. Despite these changes, the situation in Iraq is uncertain and many people are still living under the threat of violence.
Bombings and sectarian violence continue, causing death and life-threatening injuries that require immediate and intensive medical attention. In addition to trauma, there are concerns regarding general health-care provision in Iraq. The Iraqi government has made recent efforts to develop health services, but there are still enormous gaps and thousands of Iraqis receive either no or insufficient medical care. This situation results from years of neglect of health services—particularly for primary health care—and the loss of medical staff who have fled Iraq out of fear of assassination or abduction.
MSF continues to run surgical programs in Amman, Jordan, for war-wounded patients referred by Iraqi medical colleagues, and in Iraqi Kurdistan for burn victims. It also conducts medical and mental health trainings for Iraqi professionals, supplies hospitals in selected cities throughout the country.
In particular, in Anbar province and Baghdad, MSF supports eight Ministry of Health hospitals by training medical staff, supporting mental health counseling, and providing medical materials.
In Basra, MSF is currently providing training on pre- and post-operative care with plans to carry out further assessments in order to get a clearer picture of other needs in the southern governorates. In the northern governorates of Tameen and Ninewa, MSF is supporting five hospitals by providing medical supplies on an ongoing basis as well as supporting emergency response and health education campaigns to raise awareness of communicable diseases. MSF is also assisting people who have been displaced to Dohuk governorate through the provision of psychological support.
Yet this effort reaches a tiny fraction of those who are in need. The complexity of the injuries treated and prevalence of multiple drug-resistant bacterial infections gives a window, albeit limited, to view the severity of the humanitarian crisis in the country.
“ The doctors told me I had several facial fractures, and I've already had one operation. They've taken bone from my hip to reconstruct my nose. I'm supposed to have a second operation in two weeks. I don't want to go back to Iraq. I've lost count of the number of friends who've died right before my eyes. ”
Said, 18 years old
an Iraqi patient in MSF’s
surgical program in Amman, Jordan