© Ton Koene

Iraq

The conflict in Iraq continues to cause massive displacement and hardship

Years of armed conflict have disrupted health services in Iraq. 

The conflict in Iraq continues to take its toll by killing, injuring and displacing thousands of civilians. Many health facilities were destroyed, leaving the sick and wounded with no access to care. Millions of people continue to be affected by fighting and are in need of medical assistance. 

Since 2014, over 3.3 million people have been displaced across the country, and while many have found their way to camps, others are living in schools,  mosques and unfinished buildings. 

The heartland of the Islamic Empire in the middle ages, Iraq gained independence from Britain in 1932.   

A US-led invasion in 2003 has lead to instability, with insurgents, including al-Qaeda, fighting for control. Médecins Sans Frontières/Doctors Without Borders (MSF) first worked in Iraq in 2003. Our work in the country has provided a response to armed conflict and healthcare exclusion.

With more than 1,500 staff, MSF in Iraq delivers primary and secondary healthcare, services for expectant and new mothers, treatment for chronic diseases, surgery and rehabilitation for war-wounded, mental health support and health education activities. MSF currently works in the governorates of Erbil, Diyala, Ninewa, Kirkuk, Anbar and Baghdad.

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MSF’s work in Iraq: 2018

With almost two million people* still displaced and many health facilities damaged or destroyed, medical needs remain extremely high in Iraq. 

Although the conflict subsided in late 2017 and increasing numbers of displaced people returned to their areas of origin in 2018, significant barriers to returning remain. Many displaced families lack the necessary documentation, properties and livelihoods have been damaged if not destroyed, and security concerns persist in some areas. The context remains complex and unpredictable, due to ongoing political disputes, tribal conflicts and attacks by armed groups. 

In 2018, Médecins Sans Frontières (MSF) continued to offer services ranging from basic healthcare and treatment for noncommunicable diseases (NCDs), to maternity, paediatric and emergency care, surgery and mental health support for displaced people, returnees and communities most affected by violence. We also rehabilitated and equipped hospitals and clinics in some of the most waraffected regions to help get the Iraqi health system back on its feet. 

Anbar governorate 

We continued to provide primary healthcare, treatment for NCDs and mental health services, including psychiatric care, in two camps for internally displaced people (IDPs), handing over activities in the second half of the year as the camp populations gradually decreased and other organisations started providing medical services. 

In April, we opened an outpatient clinic at Ramadi teaching hospital to treat patients with moderate and severe mental health disorders. 

Baghdad governorate 

Our teams in Baghdad Medical Rehabilitation Centre provided post-operative rehabilitation to 261 severely injured patients in 2018, including physiotherapy, pain management and mental healthcare. 

We also completed the rehabilitation of Imam Ali hospital’s emergency department, in Sadr city, with the installation of highquality medical equipment and a new triage system, supplied 60,000 tablets of first-line medication to Iraq’s national tuberculosis (TB) programme, and donated a GeneXpert machine to Rusafa chest and respiratory clinic to improve the detection of drug-resistant TB.

DIYALA GOVERNORATE 

MSF teams offered treatment for NCDs, mental health support and sexual and reproductive healthcare in Jalawla and Sadiya primary health centres for families returning to the area, and in camps for displaced people in Khanaqin. We also ran health education sessions on chronic and endemic diseases, sexual and reproductive health, and psychological first aid. 

ERBIL GOVERNORATE 

We provide psychological, psychiatric and psychosocial care in four different camps around Erbil, and to displaced people and host communities in Kalak. We reduced our activities in October as the camp populations declined, concentrating on moderate to severe mental health cases and treatment for NCDs. 

KIRKUK GOVERNORATE 

As displaced people continued returning to Hawija, one of the areas most affected by conflict, our teams conducted some 14,500 outpatient consultations, as well as treatment for NCDs and health education sessions in Al-Abassi and Hawija city. We also provided mental healthcare in Al-Abassi, and rehabilitated the water stations in Al-Shazera and Al-Abassi to ensure clean drinking water and to prevent outbreaks of water-borne diseases. 

We continued to run basic medical and mental healthcare in Daquq camp until it closed in September, and offered technical support and training at Hawija hospital in the emergency room, laboratory and maternity department and in infection prevention and control. 

Ninewa governorate 

Several neighbourhoods in Mosul still lie under piles of rubble, and thousands of people struggle to access basic services such as healthcare, water and electricity. In 2018, we scaled up our medical activities in both east and west Mosul in response. 

In Nablus, west Mosul, we ran a comprehensive maternity unit with surgical capacity for caesarean sections, paediatric healthcare (including for newborns), stabilisation and referrals for emergencies and mental health services. Our teams assisted more than 5,300 normal deliveries, performed 1,120 caesarean sections and treated 34,500 patients in the emergency room. 

In April, we opened a comprehensive postoperative care facility in east Mosul for patients with violent or accidental trauma injuries. The facility has a mobile operating theatre, a 20-bed inpatient ward, 11 recovery rooms, a mental health department and a rehabilitation unit. 

In July, we launched a programme specifically aimed at increasing access to mental healthcare and psychosocial aid. Working in three health centres, our teams provide counselling, psychosocial first aid, psychosocial support and referrals for psychiatric care. 

At the end of the year, we also completed the rehabilitation of Al-Salam hospital’s 24-hour emergency department, which now has two wards, a trauma room, a pharmacy, two consultation rooms and a triage area. 

South of Mosul, we provide emergency consultations, intensive care, treatment for burns and mental healthcare for the resident and displaced population of Qayyarah subdistrict and the surrounding area. Our 62-bed hospital has an inpatient department, a paediatric ward and an inpatient therapeutic feeding centre. As the healthcare needs of displaced people and those returning to the area continued to grow in 2018, we expanded our burns and neonatal activities and set up a second operating theatre. Our teams performed more than 18,000 emergency room consultations and almost 2,500 surgical interventions during the year. 

We also started providing primary healthcare in Qayyarah Airstrip camp at the beginning of 2018, including outpatient treatment for malnutrition, mental healthcare, sexual and reproductive health services, and referrals. In July, we added a 24-hour emergency room.

In August, we completed the rehabilitation of Sinuni hospital, in Sinjar district, where medical activities were significantly limited during the conflict. It reopened with a fully equipped emergency room, maternity unit, inpatient paediatric ward and mental health services. 

We also continued to provide emergency maternity and neonatal care, basic paediatrics, emergency stabilisation services and mental health support in Tal Maraq health facility, Zummar sub-district. 

Salahedin governorate 

For the first six months of the year, we conducted outpatient and mental health consultations for returnees and displaced people through our mobile clinics in Tikrit and managed a primary healthcare centre in Al-Allam camp. Following a reduction in the number of displaced people and an increase in activities by other organisations, we handed over these activities to the Iraqi Department of Health in June. 

Emergency response activities 

After several cases of Crimean-Congo haemorrhagic fever were reported in different regions of Iraq, we rapidly deployed a team of experts to support hospitals. In July, 228 Iraqi doctors, nurses and cleaners were trained in five public hospitals in Diwaniyah, Najaf, Babel and Baghdad governorates. 

We also supported the Department of Health to vaccinate more than 111,000 children aged six months to 15 years old in response to a measles outbreak in Ninewa governorate in July. 

*IOM Iraq Displacement Tracking Matrix

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