Iraq: Providing Dialysis Support in Kirkuk

Iraq 2010 (c) Patrick Ruedin

A patient receives dialysis treatment at the hospital in Kirkuk. MSF is providing support to the facility, including the training of staff to provide specialized dialysis care.

Some 20 patients with end-stage kidney disease are currently receiving dialysis at Kirkuk hospital, in northern Iraq. This number represents just a fraction of those in need.

It is still very difficult to work in Iraq. The security situation has improved somewhat over the past two years, but it remains unstable. Within this troubled environment, Doctors Without Borders/Médecins Sans Frontières (MSF) is trying to provide assistance to Iraqis by supporting the hospital in Kirkuk, among other activities. Kirkuk is an oil industry center in northern Iraq and is in dispute between the Kurd and Arab communities.

Iraqis have faced two wars, several years of embargoes, and seven years of instability and violence, which has led to the disruption of the country's health system. The health structures in Iraq suffer from shortages of staff, and highly overstretched emergency rooms and operating theatres. Like other countries in the region, diseases such as diabetes and kidney disease, heart disease and high blood pressure are on the rise. Responding to these challenges is doubly difficult for a war-affected country. 

In Kirkuk, MSF trains Iraqi staff for specialist care, namely the treatment of renal failure with dialysis. To do the job a diseased kidney cannot, an artificial replacement—a dialysis machine—cleans toxins from the patient’s blood. This treatment is complex and medical staff in Iraq have undergone training to develop the necessary highly specialized skills. The country previously had an advanced health care system, before the 1991 Gulf War and years of embargo.

Now, MSF’s objectives include plans to increase the capacity of the dialysis unit in Kirkuk to treat 80 patients three times a week. Patrick Ruedin, an MSF doctor from Switzerland, visited Kirkuk in October to assess the level of care being provided there. A nephrologist for more than 25 years, he took part in a number of humanitarian missions in the Middle East and Chad in the 1980s. Here Dr. Ruedin shares more about MSF’s project in Iraq.

How long did you stay in Iraq?

A week, including two days in Kirkuk. I already visited back in October 2009 for a first assessment. At the time, the building where the patients were being treated with dialysis was being refurbished. The service was not operational. Some 20 patients have been benefiting from this lifesaving treatment since January 2010. The population in the Kirkuk region is around one million people. In Switzerland, for the same population sample we would have 600 patients on dialysis. So much remains to be done.

Is it the role of a humanitarian organization like MSF to enter such a complicated domain?

The number of patients concerned is indeed very limited. However, they would die if they couldn’t get the treatment. One could look at dialysis as an elitist treatment while there are more glaring needs, but Iraq has the means of reintroducing this speciality; they just need a bit of a boost.MSF has asked me as a nephrologist to assist as they don’t have the expertise in-house, so it is a very interesting partnership. We have just sent 10 dialysis machines to Kirkuk. This equipment was used in Swiss hospitals before. MSF has conducted much-needed training in hygiene and nursing procedures for patient care and is coordinating the technical follow-up of the water supply and dialysis equipment. 

What are the next steps of the collaboration with Kirkuk hospital?

Now the Iraqi personnel must be trained to provide the best possible care in this advanced domain. As a nephrology specialist and president of the humanitarian commission of the Swiss Society of Nephrology, I will continue acting as the guarantor of the quality of care provided in Kirkuk. I can also act as the link between the Iraqi and Swiss hospitals, in particular with the nephrology service of Geneva’s university hospitals where I am a consultant and professor at the faculty of medicine. We are considering boosting contacts, thanks to the Internet in particular. We need this collaboration. To clean a patient’s blood, very clean and pure water is required. A dialysis machine uses 30 liters of this water per hour. Yet the most accurate water analysis cannot be done in Iraq and even in Switzerland. Specialized labs are needed.

What were the security conditions during your visit to Kirkuk?

The trip to the hospital, in the city center, takes about 15 minutes. MSF doesn’t use armed security there as they don’t want to be confused as being part of any side of the conflict. There are a lot of different forces present, but on the other hand, it appears calm. In the hospital, the different communities work side by side without obvious problems. It is important to support this hospital because it brings together people from different communities and goes beyond Iraq’s recent divisions.

Despite the ongoing conflict in Iraq, which has made it difficult for humanitarian organizations to be present in the country, MSF is striving to provide medical care to the Iraqi people. Since 2006, MSF has implemented programs all over Iraq and also in neighboring countries such as Jordan and Syria.

As an international medical emergency organization, MSF strives to provide free medical assistance to communities affected by natural disasters, armed conflicts, disease outbreaks, and suffering from a lack of access to health care.  MSF offers neutral and impartial assistance regardless of race, religion, gender or political affiliation. MSF is an independent, non-profit organization founded in 1971. Today MSF teams of medical and non-medical staff work in close to 65 countries.

In order to ensure its independence, MSF does not accept funding from any government, religious committees or international agencies for its programs in Iraq. The organization relies solely on private donations from the general public around the world to carry out its work.