Months after Mosul was re-taken from the Islamic State group the healthcare system remains in a dire situation, accoridng to Médecins Sans Frontières (MSF).
According to the aid group most hospitals and clinics were bombed and there is still a severe lack of services, equipment, medical staff and medication.
MSF is working in Mosul to rebuild health facilities and improve access for the most vulnerable cases, often poor families who cannot afford to pay for private care.
MSF spent four months at Al Khansaa hospital - which sustained severe damaged during the conflict - rebuilding the emergency room, paediatric in-patient facilities, a nutrition unit and the intensive care unit. MSF handed over the Al Khansaa project to the Department of Health in November 2017.
Below is the written testimony of the family of 17 day old baby called Amran who was the first patient treated in the Al Khansaa hospital’s newly rehabilitated intensive care unit.
Amran was diagnosed with a severe congenital malformation. His trachea and oesophagus were joined, which meant when he was fed, liquid entered his respiratory system. He needed surgical treatment.
His father, Raad, told MSF his son’s story and it is published here for the first time.
Before [the arrival of the Islamic State], life was good. We had our first baby. I worked as a builder. When IS was here, we suffered a lot and had many difficulties. We didn’t work and we didn’t have money. Today, I have a debt of 3 million Iraqi Dinars (€2.175). Every day was worse than the next. We didn’t work, we just sat around the house all day. We couldn’t work because there were no jobs. The only jobs available involved working for them (IS).
There wasn’t any healthcare. Things were bad and the children got sick and there wasn’t any treatment. We were referred to private clinics but with no work, we couldn’t afford it. The hospitals were open but there were no drugs. When the children got sick with fevers we tried to cool them down with wet towels and mostly we stayed at home.
We had to buy diapers for 30,000 Iraqi Dinar (€21) and milk for 36,000 Iraqi Dinars (€26).
When the army came to our area, IS attacked them and re-took our area. Then the army came near our house and we ran. We used to live in the west side of Mosul and we lost our house. I feel sad about the house but the main thing is that my wife and the children are safe.
When we don’t work, life stops. For a single person it’s OK, but not for a married person.
The problem now is to find a place to live. We don’t have our own house so sometimes we stay with my family and sometimes with my wife’s family. It’s very difficult.
Besides not having a house we have to borrow money for [medical] treatment and for daily life. It’s hard to start from nothing but step by step we’ll get there.
We went to the hospital for tests and we didn’t know my wife was about to deliver. So, they took her in for surgery. [When the baby was born], we saw the doctors talking and they said they needed to keep the baby. Then they started giving the baby oxygen.
We were in another hospital and they didn’t have a ventilator. I checked all the hospitals, even the private ones, but they didn’t have any [ventilators].
At the beginning the doctors said you’ll just have to watch your baby die. But I kept asking when the intensive care unit (ICU) would open and I gave him oxygen by bag. He almost died six times a day.
But then the ICU opened - thanks to God and the MSF team. They inserted a tube into his lungs. They repaired the opening to his esophagus.
Nicholas Papachrysostomou is Head of Mission of Médecins Sans Frontières / Doctors Without Borders (MSF) in Iraq. He oversaw MSF’s project at Al Khansaa Paediatrics Teaching Hospital in East Mosul, which was recently handed over to Iraq´s Department of Health.
Could you describe the healthcare system in Mosul?
Mosul has gone through an excruciating and painful process to reach the point where it is today. There is a lack of access to healthcare and a lack of services.
This includes a lack of equipment, medical staff and medication. The number of returnees is increasing but very few hospitals are functioning. It’s a dire situation.
The east of the city is less affected and life is slowly returning to normal. However, the west of the city has been destroyed. For someone returning to Mosul it is very difficult to access healthcare.
Most of the hospitals are closed, most of the primary healthcare clinics are not up to standard – in terms of personnel and supplies – and patients have to pay a fee to enter the hospitals.
For us, a fee of 2,000 Iraqi Dinars (1.45 Euros) to enter a hospital is nothing but for a returnee, it is a lot of money. If they have children who need medical assistance, they probably wouldn’t be able to afford to treat them. Also, many people have to travel large distances on foot to reach medical facilities because they cannot afford to take a taxi or public transport. This means it’s hard for people to complete the trip in one day.
What kind of problems did MSF teams see?
The people who come to the Al Khansaa hospital are often suffering from diarrhoea and respiratory infections. Some people coming from the camps and West Mosul suffer from malnutrition.
They lack access to normal food. Mothers were diluting the milk for their children because under the Islamic State, the price for one can of infant formula was so high.
Because mothers were giving the children diluted milk, the children were losing weight. When a patient is severely or acutely malnourished, they can face several complications that can lead to death. Their immune systems are compromised so their bodies don’t react normally to infections. A small infection can cause death.
The people living in the west side of Mosul face the biggest challenges. MSF runs one of only two functional hospitals there, but access to healthcare is still a challenge as the number of people returning is well above the capacity of the health infrastructure in that part of the city.
Many can’t afford to pay for taxis or public transport to get to Al Khansaa in East Mosul if they need to, and we faced many problems following-up on patients who couldn’t afford much-needed trips to the hospital.
Many patients treated for severe acute malnutrition would improve in the hospital, but then they would go home and not return for the follow-up. The patients we would see after a prolonged absence were severely malnourished again.
.@MSF team in al-Khansa Hospital in east #Mosul have treated 2532 cases in the Emergency Room, 746 in the inpatient department and treated 159 malnourished children between July and October 2018. The hospital is handed over to the health authorities in #Ninawa #Iraq pic.twitter.com/BDxnlujtoo— MSF Iraq (@MSF_Iraq) November 23, 2017
What has MSF done at Al Khansaa hospital?
When we started working here, it was chaos. It was really shocking to see inside the hospital. It was utterly destroyed. Everything was very dirty and burnt objects could be seen in the corridors and in the patients’ rooms.
The project was focused on re-establishing essential services in the Al Khansaa Paediatrics Teaching hospital, one of the largest hospitals in Mosul. The aim was to rebuild a new emergency room (ER), which had been completely destroyed.
We restored an intensive care unit (ICU), also destroyed, and we rehabilitated some of the rooms in the paediatric ward. Our team established a nutrition program with spaces for an in-patient and out-patient feeding.
The programme provided treatment for children with severe acute malnutrition some of whom had been living in the camps or in west Mosul and had not been able to access adequate food.
When we opened the ER, this motivated the hospital staff to do further cleaning and repairs. It encouraged the staff and patients and gave them hope.
The intensive care unit is the only one of its kind in Mosul. It’s only a small unit with four beds, but it’s the only chance a severely unwell patient has to survive. If it didn’t exist, patients with severe health issues would die.
Our goal was to address the lack of basic healthcare and ensure the hospital improved in terms of access and services.
People had to pay to access services at the hospital, and we knew this was a barrier for many people. So we provided incentives to many of the staff so they could provide free services.
It was a complicated task, and not all the services were provided for free, but at least it was an improvement.
It is crucially important for this work to continue.
The rebuilding of essential medical services is of life-saving significance during this phase of Mosul´s post-war recovery.
Between July and October, MSF teams supported 2,532 admissions in the emergency room; 746 admissions in the inpatient department and treated 159 malnourished children through inpatient and ambulatory feeding programs in Al Khansaa hospital of East Mosul.
MSF handed over the project to the Department of Health in November 2017 after four months of work. MSF also runs another hospital in West Mosul.
The organization works across Iraq in the governorates of Dohuk, Erbil, Sulaymaniyah, Diyala, Ninawa, Kirkuk, Salaheddin, Anbar, Baghdad and Babylon. MSF provides basic healthcare, nutrition programmes, trauma care, emergency surgery, services for expectant and new mothers, treatment for chronic diseases, mental health support and health education activities.
MSF started working in Iraq in 1991 and provides medical care to vulnerable Iraqi communities, displaced families and Syrian refugees who find it difficult to access health services.