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Iraq

The conflict in Iraq continues to cause massive displacement and hardship

In 2020, the arrival of COVID-19 in Iraq presented new challenges to a country still reeling from the effects of years of conflict and instability. 

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: 2020

Médecins Sans Frontières (MSF) responded to multiple health emergencies across Iraq in 2020, providing care to thousands of people displaced by the war against the Islamic State group, protesters injured in violent clashes with security forces, and patients with COVID-19.

We also supported the national health system, which is still in the early stages of reconstruction, by filling gaps in essential healthcare.

Supporting emergency preparedness 

The mass demonstrations that started at the end of 2019 continued into 2020, prompting MSF to launch an emergency intervention in Najaf, Dhi Qar and Basra governorates to respond to an increase in the number of patients with violence-related injuries. In Najaf, we ran training in mass casualty planning at three local hospitals to help staff deal with a sudden influx of patients.

In Nasiriyah, our teams supported the emergency room of Al-Hussein hospital with training on trauma care, focusing on critical injuries and resuscitation. Teams in Basra provided training on emergency preparedness at city level, as well as trauma training for paramedics, in collaboration with the Department of Health. 

COVID-19 response

As many health facilities damaged in recent years have yet to be rebuilt or rehabilitated and returned to full capacity, and there is a shortage of specialised healthcare staff and drugs, it was immediately clear that the health system would struggle to cope with the increased needs and challenges generated by the pandemic. We therefore decided to maintain our lifesaving medical activities while strengthening infection prevention and control measures, and putting in place triage and referral procedures to protect our patients and staff.

An MSF nurse adjusts the oxygen supply of a patient with COVID-19 at the COVID-19 treatment centre in Al-Kindy hospital, Baghdad. Iraq, September 2020.

In Baghdad, the city hit hardest by the virus, we supported Ibn Al-Khateeb hospital, a facility run by the Ministry of Health. When it was identified as one of the three main hospitals for COVID-19 care in the early stages of the pandemic, we sent a team to train medical staff on patient triage and infection prevention and control. We also supported the capital’s Al-Kindi hospital by treating patients with severe cases. At the beginning of the outbreak, our staff worked in the hospital’s respiratory care unit (which included beds for patients in intensive care). Later in the year, we opened our own 24-bed ward, and then gradually moved to a 36-bed ward in a purpose-built wing.

We also supported the response to the outbreak in Mosul, in Ninewa governorate, temporarily transforming our 64-bed post-operative care facility in the east of the city into a COVID-19 treatment centre for suspected and confirmed cases. In mid-November, we opened an additional 15-bed intensive care unit at Al-Salam hospital to offer advanced care for patients with critical and severe forms of the virus.

At other facilities in Ninewa, as well as in Erbil, Diyala, Kirkuk and Dohuk governorates, we provided training sessions, with a focus on infection control. In addition, we set up a 20- bed isolation unit and treatment facility at Laylan displacement camp in Kirkuk, in preparation for a potential spike in COVID-19 cases.

Essential healthcare for vulnerable communities

In the rest of the country, we continued to run general and specialist health services at our ongoing projects for displaced people, returnees and vulnerable communities. In all locations, including our COVID-19 centres, we maintained our emergency room and mental health services.

As a result of the pandemic and the closure of private clinics, our maternity and paediatric teams in west Mosul and Sinuni saw a sharp increase in demand for care and admissions.

An observer looks on as an MSF nurse examines a patient during a training simulation exercise at Al-Hakim General Hospital in Najaf. Iraq, February 2020.

In Ninewa, we provided emergency and intensive care, burns treatment, physiotherapy and mental healthcare at our hospital in Qayyarah, until October, when we handed over all our activities to local government hospitals. As part of the process, we trained staff and donated medical supplies and other equipment. Until October, at the Qayyarah displacement camp, MSF also offered general healthcare, maternity services, and treatment and follow-up for non-communicable diseases, until we handed over our activities to another organisation.

We also had teams working in general healthcare centres in the towns of Hawija and Al-Abasi in Kirkuk governorate, and in Sinsil Al-Muqdadiya in Diyala governorate, where we supported maternity services, sexual and reproductive healthcare, treatment for non-communicable diseases, health promotion and mental healthcare. Our general healthcare services were also available in Laylan camp (Kirkuk), until its closure in November, and in Alwand and Sinsil camps (Diyala), until August, when MSF handed over these activities to the Department of Health and other organisations.

In Baghdad, MSF continued to collaborate with the national tuberculosis (TB) programme, with the introduction of a new, more effective oral treatment for drug-resistant TB.

Due to the COVID-19 outbreak, we were forced to temporarily suspend our activities at the Baghdad medical rehabilitation centre, where people injured in violent incidents or accidents receive comprehensive care, including mental health support. However, we were able to maintain our support to patients through online physiotherapy and mental health consultations, for example using Skype, and restarted activities later in the year. 


MSF’s work in Iraq: 2019

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

Although displaced people continued to return to their homes in 2019, more than a million still face significant barriers that prevent them from doing so. Some have been living in camps for years, with little access to basic services. At the end of the year, the violent crackdown on protests in various cities across the country put additional pressure on the health system. 

Many healthcare facilities have been destroyed and there is an overall shortage of healthcare specialists and services, vitally needed to address primary and secondary healthcare needs and trauma resulting from ongoing violence. Our teams have observed an increase in mental health needs generated by prolonged suffering among both internally displaced people and the rest of the Iraqi population, including trauma related to domestic violence, psychosomatic disorders, post-traumatic stress disorder, depression and anxiety

In 2019, we maintained our range of basic and secondary health services, such as maternity and neonatal care, emergency rehabilitation, treatment for non-communicable diseases, surgery and post-operative care, and mental health support for displaced people, returnees and vulnerable communities. From October, when the demonstrations started, our teams also provided medical supplies and technical support to various hospitals across the country. Throughout the year, our teams operated hospitals and clinics in some of the most war-affected regions to help restore some of the most indispensable healthcare services for the Iraqi people. 

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 

The focus of activities at Baghdad Medical Rehabilitation Centre is rehabilitative care, including pain management, physiotherapy and mental health support for people injured in violent incidents or accidents. After the mass protests broke out in October, we increased capacity from 20 to 30 beds.

In addition, we gave mass casualty triage training to 80 doctors and nurses working in the emergency department at Imam Ali hospital in Sadr city, to enable them to cope with approximately 20,000 patients every month. We also opened a project aimed at providing shorter and injection-free treatment for drug-resistant tuberculosis patients and supported local diagnostic capacities for the disease. 

DIYALA GOVERNORATE 

In Diyala, MSF teams addressed the needs of displaced people, returnees and host communities by offering basic healthcare, mental health support, sexual and reproductive healthcare services, treatment for non-communicable diseases and health promotion in Khanaqin and Alwand camp, and through facilities in Sinsil, Sadiya, Al-Muqdadiyah and Jalawla. 

MSF staff near Alwand 2 camp in the Khanaqin district of Diyala governorate. Many people displaced from different regions have been living in the camp for years. Iraq, August 2019.

dhi qar GOVERNORATE 

When protests started in southern governorates at the end of 2019, MSF launched an emergency response in Nasiriyah, which included training staff to deal with mass casualties, and supporting the emergency preparation of first-aid posts. 

KIRKUK GOVERNORATE 

In this conflict-affected area, MSF teams helped to restore healthcare facilities in Hawija, and provided health services in Al-Abbasi town and Laylan camp. Our teams provided basic healthcare, maternity and sexual and reproductive health services, treatment for non-communicable diseases, mental health support and health promotion activities.

In addition, we supported the emergency room, laboratory and infection prevention department in Hawija general hospital.

Ninewa governorate 

The war against the Islamic State group had a devastating impact on Ninewa, resulting in severe physical and mental trauma among its inhabitants, the destruction of health facilities and the displacement of large numbers of people.

Mental healthcare was a main component of all MSF services in Ninewa, and our teams of psychologists conducted a total of 14,000 individual mental health consultations there in 2019.

To address the shortage of skilled surgery and post-surgical care, MSF opened a comprehensive centre for patients with violent or accidental trauma injuries in east Mosul in 2018.

The hospital has a mobile operating theatre, a 33-bed inpatient ward, recovery rooms and rehabilitation units. During 2019, MSF teams conducted nearly 580 surgical interventions. We also donated to the Department of Health a newly built facility dedicated to the treatment of infectious diseases in east Mosul.

In west Mosul, we run a comprehensive maternity unit in Nablus hospital with surgical capacity for caesarean sections. Our team there provides emergency obstetric and neonatal care, inpatient paediatric services, as well as emergency treatment and stabilisation of patients before referral to other hospitals. 

During 2019, they conducted 43,100 emergency room consultations and assisted 9,300 births. As displaced families returned to west Mosul, we set up maternity services in AlRafedein basic healthcare centre to respond to the increased demand for sexual and reproductive healthcare. 

We also extended our outreach activities for Yazidis and other communities in Sinjar district, offering sexual and reproductive health services, including births, and paediatric care through our hospital and in the displacement camps. We treated a total of 14,581 patients in the emergency room in 2019. 

In Qayyarah subdistrict, we continued to run an emergency room and offer paediatric and maternity services, nutritional support, surgery and rehabilitative care, as well as treatment for burns. These services benefit host communities as well as internally displaced people. 

During 2019, our teams conducted 2,670 surgeries, and were also able to boost the capacities of local healthcare providers through training and donations, and hand over our neonatal and paediatric activities. 

DOHUK governorate 

From the beginning of the clashes in northeast Syria in October until the end of 2019, more than 17,000 people crossed the border into Iraq.

In October, we conducted mobile clinic activities in Bardarash camp and at the Sahela border reception site to provide refugees and internally displaced people with general healthcare services and mental health consultations.

Jamilla, a 58-year-old Syrian Kurdish refugee, at a clinic run by MSF inside Bardarash refugee camp. Jamilla came to the clinic with back and leg pain. Iraq, November 2019.

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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