The conflict in Iraq continues to cause massive displacement and hardship, yet funding shortfalls resulted in a reduced international response, which was largely concentrated in the more secure areas of Iraqi Kurdistan.
Over 3.2 million Iraqis are now displaced within the country, putting an immense strain on host communities. In 2015, MSF expanded its activities to provide basic healthcare and relief to displaced families, returnees, impoverished host communities and Syrian refugees in locations across 11 governorates: Dohuk, Erbil, Sulaymaniyah, Ninewa, Kirkuk, Salaheddin, Diyala, Baghdad, Najaf, Karbala and Babil.
Throughout these governorates, MSF deployed mobile clinics to deliver medical care to those unable to reach health facilities due to movement restrictions and security risks. The teams visited a number of locations regularly, basing themselves in clinics, tents and even buses. In highly militarised areas, doctors provided referral documents to ensure safe passage for patients requiring treatment at secondary care facilities. MSF teams also monitored possible disease outbreaks.
Most of the health problems seen by MSF staff were related to people’s poor living conditions, and included respiratory and urinary tract infections, gastrointestinal problems, arthritis and skin diseases. MSF also focused on chronic diseases, particularly hypertension and diabetes, and mother and child health. Female medical staff were present to encourage women to attend clinics.
Mental health activities
MSF efforts this year were also directed at increasing psychological first aid for the growing number of people who have been traumatised by the recurrent violence and their precarious living conditions. In Karbala, Najaf and Babil governorates, MSF continued its regular mental health programmes assisting internally displaced people. Over 1,500 individual counselling sessions were completed and 9,220 people participated in group psychosocial education The team trained health ministry staff, as well as teachers working with children, in mental healthcare. In Erbil governorate, a team of MSF psychologists and psychiatrists provided support to Syrian refugees in Kawargosk, Gawilan and Darashakran camps.
Mobile medical care
During most of 2015, MSF medical teams provided healthcare (21,775 consultations) to displaced people sheltering in unfinished buildings in Dohuk governorate. As people were gradually moved into formal camps offering medical services, MSF shifted its activities to Tel Afar district in Ninewa governorate, where medical infrastructure had been destroyed during the conflict and needs were very high. Teams ran clinics close to the frontline, where people were afraid to move and could not afford to travel long distances to reach medical facilities. Mobile teams conducted 19,505 outpatient consultations for chronic diseases, sexual and reproductive health and mental health for IDPs and the local community. MSF teams also ran mobile clinics in several other locations between Mosul and Erbil, and an emergency field surgical unit was established in the district to provide care for people directly affected by armed conflict.
Two mobile teams provided basic healthcare and mental health services in a number of locations in and around Kirkuk, and a third supported the Directorate of Health in Laylan camp with chronic disease management and sexual and reproductive health services. A total of 48,895 consultations were provided. Towards the end of the year, as other medical organisations moved into Kirkuk, MSF handed over most of activities in Kirkuk to other NGOs and redirected its efforts to outlying areas, for example deploying a mobile clinic to displaced people living in small settlements along the road to Baghdad, near Tuz Kurmato, who were afraid to travel across the militarised area to seek medical treatment.
Activities in Baghdad started in March in Abu Ghraib district, with one mobile clinic serving the local community and the displaced people living in Abu Ghraib and Al Salam camps. In response to the massive needs, a second team started working in September to bring medical care to several other locations in this impoverished district.
MSF also assisted displaced people and host communities in north Garmian district and neighbouring Diyala governorate with activities ranging from basic healthcare in health ministry facilities to mobile clinics. Teams provided mental health services in three camps in Khannaqin, Diyala.
In September, MSF responded to a cholera outbreak that spread across central Iraq and affected Dohuk, Kirkuk, Erbil, Baghdad, Diyala, Najaf, Diwaniya and Babil governorates. Water and sanitation assessments were carried out in all locations affected and MSF teams supported the Ministry of Health with training, health promotion, and hygiene and infection control activities in all the hospitals dealing with the outbreak.
Since May 2012, MSF has been the main humanitarian organisation providing medical services, in collaboration with the Dohuk Directorate of Health, to Syrian refugees in Domiz camp, the largest refugee camp in Iraq and home to 40,000 people.
In October, the general medical services were handed over to the Directorate of Health, but MSF continues to run chronic disease, sexual and reproductive health and mental health services, as well as regular health promotion activities. The team assisted 1,155 deliveries in the maternity unit this year.
MSF also worked in Sulaymaniyah and Arabat camps, undertaking water and sanitation and health promotion activities. In December, MSF started supporting Kalar maternity hospital with staff training and donations.
MSF continued to run basic healthcare and mental health services in a clinic in Diyala governorate, focusing on the needs of displaced people.
Reconstructive surgery in Jordan
Since August 2006, a network of Iraqi doctors has been referring victims of violence from all over Iraq to MSF’s reconstructive surgery hospital in Amman, Jordan. The team is specialised in complex surgery requiring multiple stages of treatment, in particular maxillofacial (dealing with the head, neck, face, jaw and sinuses), orthopaedic and reconstructive burn surgery. Patients also receive physiotherapy and psychosocial support.
Additional support to the Ministry of Health
Periodically MSF organises medical training programmes for Iraqi doctors in collaboration with the Ministry of Health. In early 2015, 12 Iraqi physiotherapists attended a 10-week physiotherapy training course.
MSF has also supported the Baghdad-based Poisoning Control Centre for many years by providing antidotes that are difficult for the Ministry of Health to obtain.