Iraq: Helping victims of war get back on their feet

A BMRC patient exercises with the support of an MSF physiotherapist.
IRAQ 2017 © Florian SERIEX/MSF
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A year ago, Doctors Without Borders/Médecins Sans Frontières (MSF) opened the Baghdad Medical Rehabilitation Center (BMRC) to support victims of war in Iraq. The center provides much needed post-surgical rehabilitation care, including physical and psychological support.

Mohammed Hussein, 27, can’t carry his newborn baby in his arms yet. Last year, fighters from the Islamic State group ambushed his car near the border between Iraq and Jordan. Both his legs were fractured and he suffered a severe nerve injury in one of them.

“I was lucky because I still have one good leg left,” he said. Four of his friends died in the attack. Mohammed managed to escape and hide. “They burned our car. I activated my phone’s GPS and recorded a voice message for my family. I thought I was going to die.”

For more than a year, Mohammed has been going in and out of hospitals across Iraq. Two major surgeries later, he is receiving post-surgical rehabilitation care at the BMRC.

The BMRC is the only health facility in Baghdad offering comprehensive rehabilitation care, including physical and psychological support, to victims of war injured by bomb blasts and gunshots. There is a scarcity of such services in the country, where health care facilities have been severely damaged after years of war. More than 150 patients have been treated at the BMRC over the last year by a team of 70 doctors, nurses, physiotherapists, and psychologists.

Patients like Mohammed come from different regions across Iraq and are referred to the BMRC by MSF medical liaison officers who regularly visit Baghdad’s public hospitals looking for patients in need of specialized care.

At the center, Mohammed has been receiving physiotherapy, pain management, and psychological support. After two months of treatment he is able to stand with a walker, but he might need another surgery to repair his damaged nerve.

Open war wounds

In December 2017, Iraq declared the end of the war against the Islamic State group. But the destruction of public infrastructure after decades of war has left many injured people without adequate post-surgical rehabilitation services.

War injuries often result in long-term impairments and disabilities. Insufficient nursing care, untreated pain, and lack of psychological support can lead to medical complications and more suffering.

“Early physiotherapy is the key to fully heal and recover after multiple surgeries,” explained Renata Beserra Xavier, MSF’s physiotherapy manager at the BMRC. “It has an impact on the early stages of rehabilitation, strengthens the patient’s weakened and wounded limbs, prevents possible contractures, and eventually restores mobility.”

BMRC - Baghdad medical rehabilitation center
"I was afraid when I started the sessions but not anymore. There are good people here, so I feel better."
IRAQ 2017 © Florian SERIEX/MSF

Healing bodies and minds

Psychological care goes hand in hand with physiotherapy; it is vital to help patients recover from the traumas they experienced during the conflict. Since activities started at the BMRC, 163 patients have joined individual or group therapy sessions, and MSF teams have conducted 1,617 follow-up sessions. They also run occupational and art therapy services.

“Mental health teams are supporting patients during their follow-up at the BMRC. They address issues related both to the traumatic events our patients have been through, and to their daily medical care and rehabilitation that can last for months,” described Saima Zai, a mental health manager at the BMRC. “I remember an 11-year-old girl coming in for physiotherapy and being terrified about a new surgery she was going to face. The mental health team helped her and her mom handle the situation and they were both relieved at the end of the first session.”

A psychologist from Pakistan, Saima previously worked for MSF in Mosul, Iraq, and in Amman, Jordan. “In the Middle East, it is difficult to access mental health support in public hospitals,” she said. “ There is still a lot of stigma about it.”

A unique project in Iraq

After decades of war, Iraq faces a high incidence of post-operative infections, particularly of war wounds treated in inadequate conditions because of a lack of functional health facilities. Most of these infections are multi-drug resistant due to inappropriate diagnosis and overprescription of antibiotics.

The BMRC’s high-quality infection control and its expertise in antibiotic treatment and antibiotic resistance make it a unique initiative in Iraq. Patients receive a specific diagnosis for antibiotics based on medical examinations including bone sampling and sensitivity testing to ensure they receive the best care possible.

For complex medical or surgical cases, like bone infections, BMRC patients can be referred to MSF’s Reconstructive Surgery Program in Amman where more than 11,000 surgeries have been performed over the past 10 years on patients from Syria, Libya, Yemen, and Palestine.