Urgent need to rebuild health services one year after battle over Mosul, Iraq

Thousands have returned to their homes in Mosul’s old city, despite the danger of IEDs, unexploded ordinances, and booby traps. Much of the area remains inaccessible due to widespread destruction. Returnees face extremely difficult conditions, often living in damaged houses without food, electricity, or access to healthcare.
IRAQ 2018 © MSF/Sacha Myers
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JULY 9, 2018—One year since the battle between Iraqi forces and the Islamic State (IS) group officially ended in Mosul, the city's health system is still in ruins and struggling to cope as tens of thousands of people return to the city each month, Doctors Without Borders/Médecins Sans Frontières (MSF) said today.

During the conflict, nine out of 13 public hospitals were damaged in Mosul, and the process of rebuilding the health care system is very slow. Karel Hendriks, Doctors Without Borders/Médecins Sans Frontières head of mission, gives the following account:

This month marks the one-year anniversary of the end of the Mosul battle. In just the month of May alone, 46,000 people returned to a city that is still partially in ruins.

One of the big things affecting the local population in Mosul is that 70 percent of the health system, the health infrastructure, is still dysfunctional. People are still displaced, and medical professionals are still displaced. Whole medical complexes have been leveled and fully destroyed.

The improvements that are being made in the reconstruction of Mosul are very slow, particularly in the health sector. The needs in terms of primary health care, secondary health care and more specialized services, continue to be huge.

Health care in Mosul is affected by shortages. Equipment is lacking. Supplies of medication are lacking. At the moment, there are only five hospital beds available for every 10,000 people in the population, which is half of the internationally accepted minimum standard.

In spite of the large number of people returning, west Mosul is still actually a very dangerous place to live. Water, electricity and other basic services are barely available. Hygiene standards are very low and this increases the need for health care in that part of the city.

Anas - war wounded - Mosul
Anas, 12 years old, was hit in the spine with shrapnel during the conflict between Islamic State and Iraqi forces. He can no longer walk, and is currently receiving treatment for infected bed sores.
IRAQ 2018 © MSF/Sacha Myers

Even though the war is technically over, the aftermath continues to generate victims. If we look at the emergency room of MSF’s hospital in west Mosul, about 95 percent of all the trauma cases that we receive these days are related to unsafe living conditions.

People fall off of buildings, are injured by structures collapsing on them, or suffer other accidents relating to the level of destruction in west Mosul.

Much more needs to be done by the national authorities and the international community to rebuild Mosul city, and to ensure access to medication, quality health care, medical equipment and supplies for people returning.

In the operating theater, MSF surgeons care for war-wounded patients and also perform obstetric surgeries, such as emergency c-sections. MSF works closely with local health authorities to refer the most urgent patients for care.
IRAQ 2018 © MSF/Sacha Myers

Additional information:

Before the conflict, Mosul had 3,500 hospital beds. After the conflict, the number of hospital beds was reduced to less than 1,000 and has not increased significantly in the past year. Hospital bed capacity is used as a key indicator for health service delivery. Thus, Mosul's health care capacity is still reduced by 70 percent, one year after the conflict ended.

Based on figures from international and local authorities, MSF estimates Mosul's population to be 1.8 million people. The Sphere Standards—the internationally recognized minimum standards in a humanitarian response—state there should be more than 10 hospital beds per 10,000 people.

In May 2018, MSF received 3,557 cases in the emergency room of its west Mosul hospital. Of these cases, 790 were trauma-related, and of these trauma cases, 95 percent were caused by the unsafe living conditions, such as people falling off damaged buildings or walls or buildings collapsing.

MSF has been operating in Iraq since 1991 and works in the governorates of Anbar, Baghdad, Diyala, Erbil, Kirkuk and Ninewa. MSF currently runs a hospital in west Mosul, specializing in maternity, pediatrics and emergency room services, and a surgery and postoperative care facility for war-wounded patients in east Mosul. In July, MSF will start providing mental health services in primary health care clinics in the east and west side of the city.

MSF offers neutral and impartial medical assistance regardless of race, religion, gender or political affiliation. To ensure its independence, MSF does not accept funding from any government or international agency for its programs in Iraq, relying solely on private donations from the general public around the world to carry out its work.

Nablus Hospital in West Mosul is a referral center for complicated births, where patients are transferred from other clinics in the area that do not have surgical capacity. Today, Nablus is one of just two functioning and free medical centers in West Mosul. MSF staff assist an average of 400 deliveries each month.
IRAQ 2018 © MSF/Louise Annaud