INSIDE MOSUL CITY
MSF just began activities inside of medical structure in West Mosul to provide life-saving trauma assistance for war-wounded in the final conflict area of the Old City, where an estimated 60,000 residents remain. The project includes surgery for war-wounded and emergency C-sections, short-term post-operative care and, maternity, an emergency room and a mass casualty intake room for triage in case of an influx of wounded patients.
Emergency and Post Operative Care, Al-Taheel
MSF opened an24/7 emergency room in Al Taheel hospital on 26 March. The team has also set up a surgical unit (currently one operating theatre but a second will soon be online) and a 32-bed post-operative ward in order to provide medium term care to those suffering from violent trauma injuries in and around Mosul. Cold cases, surgical follow-up and other types of surgical issues are also treated in this facility. Since the opening, over 1000 patients have been received in the emergency room and more than 175 surgical interventions have been carried out.
Al-Khansaa Teaching Hospital, East Mosul
MSF has just started supporting this MoH facility, located in the Al-Sukkar neighbourhood, which has been heavily damaged during the conflict. The hospital currently has a 120-bed capacity (down from an original 500) to respond to the massive needs in Mosul. Discussions are on-going with the local authorities to rehabilitate the emergency room. Mental health support for all patients will also be provided.
Maternal Health, Karama
MSF opened a 15-bed, 24/7 free-of-charge Maternity hospital in Karama, East-Mosul on the 19th of March. Since then, the MSF team made up of both expat and Iraqi midwives and obstetricians has assisted 376 women to give birth safely.
OUTSKIRTS OF MOSUL CITY
Trauma care and primary healthcare, Hammam al-Alil
Hammam al-Alil (known as HAA) is the closest IDP camp to the south of Mosul and is located some 30km away. The town has received a big influx of IDPs, with more people arriving daily to be settled in different camps and with many transiting through to return to East Mosul. MSF opened a field trauma hospital with a 22 beds emergency room, 2 OTs, a 7 bed ICU/recovery room and a 32 beds IPD on 16 February and for more than one month was the closest surgical facility to West Mosul. The emergency room received 3144 patients from 19 February to 10 June, 56% of them were women and children. So far the team has performed 305 major surgical procedures and 67 minor procedures. The majority of cases are emergency surgeries.
Since April 15, MSF has also been supporting the local department of health’s primary healthcare centre (PHCC) in Hamman Al Alil town and by June 10th has already carried out over 18,000 consultations for both the host population and IDPs. MSF also runs an ambulatory therapeutic feeding centre for children suffering from acute malnutrition with a rapidly increasing cohort of 142 patients on June 10th of which the vast majority comes from the 2 nearby IDP camps. Psychosocial support is offered to the patients in the trauma center and the primary health care center.
Post-operative and rehabilitation care, Al Hamdaniya
MSF is providing post-operative care with rehabilitation and psychosocial support in Al Hamdaniya hospital in collaboration with Handicap International. Activities started on 15 March and to date, MSF has admitted 255 patients, around 46% of whom were women and children. The facility now has 43 beds in order to respond to the huge need for post-operative care and is almost constantly full, receiving new patients who need post-operative follow-up as soon as those who complete their follow up are discharged. An advanced dressing room, with the possibility to perform debridement under sedation and other minor surgical procedures should be opened in the next days.
In December, MSF opened a 32-bed hospital in Quayyarah, 60 km south of Mosul, with an ER and an operating theatre to provide surgical and medical emergency care. The facility has now been extended up to 46 beds to cater for the growing and diversifying needs. The team has treated 7100 patients in the ER as of June 1st. Around 10% of whom were admitted to the inpatient department (IPD) which currently has a 46-bed capacity. A total of 1,350 surgical interventions have been performed since December 2016 until June 1st. A 4-bed intermediate care unit was opened mid-April to provide care to patients in critical conditions and 7 observational beds and 2 resuscitation beds are also now available. In March, MSF set-up a 12-bed intensive therapeutic feeding centre to provide care to children recently displaced from west Mosul or Shirkat Region as well as those from IDP camps in Hammam al-Alil and Quayyarah. For the month of May, there were 178 admissions, including 91 for infants under six months old. The centre works regularly over capacity with as many as three babies per bed. Since February, MSF has been running a mental health clinic for patients admitted in the hospital as well as for patients referred from Quayyarah camps. The team consisting of a psychiatrist, two psychologists and two psychosocial counsellors.
Following the offensive launched into west Mosul mid-February, the total population of the four camps west of Erbil currently hosting IDPs from Mosul sharply increased to 80,000 people by the end of March. Soon after, the displaced started leaving the camps to move in with relatives, or rent houses in retaken areas of East Mosul and the overall population decreased to approximately 70,000. Today, MSF mobile teams are providing treatment for chronic diseases (mainly diabetes and hypertension) in Chamakor and M2 and psychological and psychiatric care in these two camps as well as M1 and U3. An MSF team of a psychiatrist, psychologists and counsellors is also providing health care to those suffering from moderate to severe mental health conditions. Activities include psychological and psychiatric consultations, group therapy, psychosocial counselling and child therapy. MSF teams currently provide mental health care in 13 sites are always extremely busy. So far in 2017, the team has carried out some more than 19,400 medical consultations and 12,200 mental health consultations in the IDP camps near Mosul.
ELSEWHERE IN IRAQ
MSF teams are providing medical and mental health services to people displaced from Hawija. MSF runs a non-communicable diseases clinic and mental health activities including referrals for psychiatric care in Daquq IDP Camp (8,328 individuals). At Maktab Khalid entry point and at Debes screening site, MSF’s medical and humanitarian presence through the provision of mobile clinics ensure the sickest IDP population fleeing Hawija receive treatment in a timely manner. MSF also supports the emergency rooms of the two main Kirkuk hospitals with training for DoH doctors and nurses in ER related topics, including mass casualty, donation of Crash cart, and Trauma room reorganization.
MSF runs a maternity clinic in the village of Tal Maraq that assisted more than 500 safe deliveries since the start of the project in November 2016. Access to secondary healthcare is limited in the area due to the ongoing conflict around the cities of Tal Afar and Mosul. The maternity offers pre and post-natal consultations, basic emergency obstetric and neonatal care, manages minor obstetric complications, and refers patients with more serious obstetric complications to hospitals in Zakho and Dohuk. Since this February, the clinic also includes a small pediatric ward. In parallel, MSF teams run mobile clinics in surrounding villages offering general health care consultations, mental health consultation, as well as follow up and treatment for NCDs patients.
In the Domiz refugee camp for Syrian refugees, MSF is running a maternity unit where women can deliver their babies safely and access reproductive healthcare. Since January 2016, MSF teams assisted more than 1000 deliveries in the Domiz maternity.
MSF is working with the health authorities in Sulaymaniyah emergency hospital and is providing hands-on training to improve the quality of medical services in the Intensive Care Unit and the emergency trauma ward. The project has completed the rehabilitation of the ER and ICU wards which are now fully functional with an improved layout and patient flow to benefit the quality of care to patients. Since the start of the project more than 200,000 patients were seen in the emergency room and over 500 in the ICU. Since 2015 MSF has been working in internally displaced people (IDP) camps in the governorate. The teams conduct health promotion activities and provide psychological and psychosocial care.
Salah Al-Din governorate
With the military operations expanding in northwestern Iraq, thousands of Iraqis continue to flock to relatively safer areas. To respond to the growing needs, MSF started running mobile clinics in the city of Tikrit and the surrounding areas in June 2106. The clinics offer outpatient and mental health consultations. In January 2017 MSF established a primary healthcare center in one of the camps.
MSF has been working in Diyala governorate since 2015, and supports displaced populations in three IDP camps in Khanaqin district, providing medical and mental health consultations in collaboration with the Directorate of Health (DoH). In 2016 more than 20,000 individual and group counselling sessions were provided. MSF teams are also conducting health promotion activities in all camps.
Since May 2016, approximately 100,000 IDPs have returned to the towns of Sadiya and Jalawla that were retaken from the IS group. MSF supports the primary healthcare clinics in Sadiya and Jalawla, focusing on chronic diseases, sexual and reproductive health, maternity, mental health and health promotion services for IDPs, returnees and the host community. In Sadiya and Jalawla, MSF provided treatment for chronic diseases to nearly 800 new patients and almost 1,200 follow-up consultations. In addition, 913 ante and post-natal consultations were provided in 2016.
In June 2016, MSF started running mobile clinics in the Amariyat Fallujah, Habbaniyah, Khaldiya and Ramadi (Kilo 18), to assist populations who were forced to flee the areas of Fallujah and Ramadi in Al-Anbar governorate. Later the same year, a healthcare center was established in the camp in Amariyat. The camp currently has a population of around 60,000 people and the facility offers primary healthcare consultations, emergency care, inpatient care, mental health and stabilization and referral services. In total, more than 10,000 medical consultations were provided by MSF in the area in 2016.
In Abu Ghraib MSF teams provide medical and mental health services to people displaced from central Iraq, mainly Al-Anbar, Salah Al-Din and Diyala. A mobile medical team operates in impoverished neighborhoods in the Abu Ghraib district, where many displaced people have settled in the past two years. A second medical team is based in a primary healthcare clinic in the Al Shuhada II area. Lately the team is assessing the needs of thousands of returnees who were displaced and are now returning to their homes in villages in northern Abu Ghraib and Karma district in Anbar. MSF has provided over 12,700 consultations in 2017, more than 2,300 consultations for NCDs and over 450 mental health consultations.
Since the spring of 2017, MSF has started fully supporting the Ibn Saif Paediatric Hospital located in Musayib. The team will concentrate on supporting this 60-bed hospital through capacity-building and trainings as well as logistics support. Support for psycho-social services will not only be rendered in the hospital but as well within the community. MSF has negotiated with the MoH to eliminate the cost recovery in this hospital.