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Iraq: Supporting Iraqi hospitals to face a pandemic

21 Jan 22

Baghdad, 21 January 2022- “When the COVID-19 pandemic reached Iraq in March 2020, it was quickly clear that it would be a huge challenge to the health system,” says Dr Daniel Uche, the emergency medical team leader in Baghdad for Médecins Sans Frontières (MSF). “Numbers started increasing rapidly and healthcare workers were soon overwhelmed.” 

An MSF doctor provides technical advice about the examination of a COVID-19 patient to an Iraqi doctor working with the Directorate of Health in Baghdad at the respiratory care unit of Al-Knidi Hospital. (October, 2021).

Struggling healthcare system

MSF, already present in the country to provide support to a healthcare system struggling to meet the needs of Iraqis after decades of war and instability, sprang into action.

An MSF doctor examines a COVID-19 patient at the respiratory care unit of Al-Kindi Hospital, Baghdad. (October, 2021).

Our support continues and is developing, nearly two years after the beginning of the pandemic, with Al-Shifaa Hospital at Baghdad Medical City being the latest in a line of hospitals that we have collaborated with.  

Overwhelmed hospitals

Baghdad has been the city hardest hit by the coronavirus, and so it is here that our teams have focused their efforts.

Admissions in the intensive care units increasing

This started at Ibn Al-Khateeb Hospital in April 2020, then we moved to Al-Kindi Hospital in June of the same year, two of the main COVID-19 treatment centres in Baghdad.

A patient receiving oxygen therapy at the MSF run inpatient ward of the Al-Shifaa 13 COVID-19 ward in Al-Kindi Hospital, Baghdad. (February, 2021).

We provided essential training on infection prevention and control measures, and on triage management, as well as mental health support to help COVID-19 patients and caretakers cope with the impact of the disease.

Critically ill COVID-19 patients

With admissions in the intensive care units increasing at a fast pace, hospitals were overwhelmed by the number of severe cases. 

Infection prevention and control in MSF COVID-19 facility. (July, 2020).

Our teams extended their support to include directly caring for patients in the intensive care unit of Al-Kindi Hospital.  

Lifesaving care

From September 2020 until October 2021, we worked there in close collaboration with the hospital’s management and healthcare providers to provide lifesaving care, physiotherapy, and mental healthcare to severely and critically ill COVID-19 patients.

A patient,19 years old, is receiving medical care at the intensive care unit of the MSF-run ward of Al-Shifaa 13 COVID-19 centre. (Febraury, 2021).

We started with a ward of 24 beds that was later expanded to 36 and then to 52 beds, as the numbers kept increasing with each wave.

In dire need

In total, our teams cared for 934 critically ill COVID-19 patients at Al-Kindi Hospital and reduced the average mortality for severe cases by 40 per cent. 

“Healthcare providers had to put in extra work to care for the large influxes of sick people and they were exhausted.”

[Dr uche]

“During the peaks, we often saw how some patients who were in dire need of intensive care were unable to access it, because intensive care beds were full everywhere,” says Dr Uche. 

Large influxes of sick people

“Healthcare providers had to put in extra work to care for the large influxes of sick people and they were exhausted.”  

An MSF doctor examines a COVID-19 patient at the respiratory care unit of Al-Kindi Hospital, Baghdad. (October, 2020).

To increase bed capacity, healthcare authorities were sometimes left with no option but to switch other healthcare facilities into COVID-19 treatment centres.  

Disrupted services

“As a result of that, regular healthcare services had to be disrupted in many facilities across the city, which in turn impacted other patients with other health conditions,” Dr Uche adds. 

An MSF Nurse, checks up on the condition of a COVID-19 patient at the MSF-run ward of the COVID-19 centre at Al-Kindi Hospital, Baghdad. (February, 2021).

The country has experienced three waves of the disease, each bigger than the last. Some of the challenges have remained constant, however. 

“They tried everything they could at home and only came when they couldn’t avoid it anymore."

[Dr uche]

“One of the big problems we often faced was that most of the patients admitted to the intensive care unit came to us at a very late stage and already in a critical condition,” says Dr Uche. 

MSF nurses wearing personal protective equipment and touring on patients at the MSF run inpatient ward of the Al-Shifaa 13 COVID-19 ward in Al-Kindi Hospital, Baghdad. (February, 2021).

“They tried everything they could at home and only came when they couldn’t avoid it anymore."

"So, most of the time we were treating the complications of late arrival on top of the COVID-19 infection itself.”  

Poor compliance

The numbers of COVID-19 infections in Iraq have started to increase recently, and with just around 15 per cent of the population fully vaccinated and poor compliance with infection prevention measures.

Healthcare workers at the Al-shifa COVID-19 Centre at the Baghdad Medical City during a MSF-run bedside training on the treatment of severely and critically ill COVID-19 patients. (January, 2022).

In addition to the recent arrival of the rapidly spreading Omicron variant of the virus, Iraq is not safe from the effects of another wave.

Risk factors

Iraq also has high numbers of people with chronic diseases that are considered risk factors for a severe COVID-19 illness, such as hypertension, diabetes, and lung disease. 

MSF Nurse, Mahmood Mohammed, checking up on the condition of a COVID-19 patient who is admitted to the MSF-run ward of the Al-Shifaa 13 COVID-19 centre at Al-Kindi Hospital, Baghdad. (February, 2021).

All these factors mean that the preparedness of the health system is key to responding effectively to any increase of hospitalization rates and that’s what MSF has been supporting Baghdad Medical City’s Al-Shifaa Hospital with. 

From Al-Kindi to the Medical City 

When the last wave of COVID-19 was declared over in Iraq, Al-Kindi Hospital, one of the major medical and surgical training facilities in the capital, went back to its regular services. 

“We hope that we don’t see a surge in the number of cases, but at the same time we are doing our best to be ready if that happens.”

[Dr Uche]

Our COVID-19 team moved their activities to the Baghdad Medical City to continue the support and preparedness for any future increase in infections. 

Preparation

“At Medical City, we are currently simultaneously caring for severe or critical COVID-19 patients in the intensive care unit and raising the levels of preparedness of healthcare workers by providing training and on the job coaching,” said Dr Uche. 

Al-Kindy hospital, in Baghdad, is receiving large numbers of severe and critical COVID-19 patients. (September, 2020).

“We hope that we don’t see a surge in the number of cases, but at the same time we are doing our best to be ready if that happens.”  

Fatal consequences

“We have also recognised the limitations people face when trying to access information from credible sources amid widespread rumours and misinformation,” continues Dr Uche. 

MSF doctors examining a COVID-19 patient at the respiratory care unit of Al-Kindi Hospital in Baghdad. (October, 2020).

“We have seen some of the fatal consequences that misinformation can have, such as people avoiding hospitals and using unapproved treatment methods at home, as well as creating a lot of vaccine hesitancy.”  

Community awareness

To tackle this, our teams are incorporating a health promotion and community awareness component in their current COVID-19 activities in the Al-Shifaa Hospital. 

Outdoor hallway of COVID-19 male inpatient ward in MSF COVID-19 facility. (July, 2020).

These activities support the Iraqi Ministry of Health in delivering fact-based information and guidance to people in Baghdad. 

Elsewhere in Iraq, our teams also run a six-bed patient isolation and treatment unit for mild to moderate COVID-19 patients at the Sinuni General Hospital in Sinjar. We support the Tel After General Hospital with essential infection prevention and control training, and preparedness to care for severe and critical COVID-19 patients if numbers start increasing.

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