Iraq: the team reflect on providing medical services during conflict

Located at the west of Kirkuk Governorate, the Hawija district was part of Iraq’s one-third of territory that fell under the control of the Islamic State (IS) group in 2014. For three years, thousands of people fled their homes, leaving everything behind. Hundreds of thousands were displaced into camps in Kirkuk and other governorates. The district’s health infrastructure sustained significant damages; not only from the armed battles but also due to the depletion of resources and services during the area's isolation from the rest of the country for three years.

During this time, MSF set up two mobile clinics in Debes and Maktab Khalid where internally displaced people (IDPs) arrived after fleeing Hawija. MSF also established a primary healthcare facility at the Daquq camp where most of the displaced population eventually settled. Omar Ali was living in Hawija before fleeing his beloved home, seeking safety. Throughout his escape, he had many encounters with MSF as an IDP. 

When the fighting ended, almost all basic services were non-existent across Hawija. To assist those who stayed home, and anticipating a large wave of returnees, MSF arrived at Al-Abasi subdistrict. 

A JOURNEY OF RESILIENCE AND RECOVERY

Over the past eight years, the Hawija district saw a remarkable recovery that is visible in all aspects of life. During that time, MSF worked closely with healthcare authorities to help restore access to basic health services. In addition to medical care, MSF supported the Directorate of Health with infrastructure rehabilitation at Hawija General Hospital and provided essential training and coaching to healthcare providers.

After 8 years of being present in Hawija, MSF has now handed their medical services back to the Ministry of Health. 

Meet some of the team

The MSF team from Hawija talk about their experience of the conflict and the medical care over the last 8 years.

Huda Hussain, MSF mental health counsellor

Huda Hussain, is the MSF mental health counsellor in the Hawija district of Kirkuk. She has worked with MSF since 2021 until the handover of activities by the end of February 2024.

“During my work in the mental health department, I have met people who had a good understanding and acceptance of mental healthcare and some others who felt different levels of stigma around seeking this type of care. Once people start visiting us, they realise that mental health is a type of care that anyone would need, just like medical care, and there is no need to be ashamed of it. Most of the patients quickly develop positive feelings around these services and they become enthusiastic for their next session”.

Nermeen Abbas, Health Promotion Manager

I started working with MSF in 2017 in displacement camps, like Daquq and Laylan, and on the peripheries of the Hawija district. We worked on two fronts - our mobile clinic on the outskirts of Hawija received those who had just managed to escape and provided them with first aid and basic medical care, as many had not attended medical attention for weeks or months. Then at the camps where they eventually settled, we continued providing them the care they needed.

Our services included medical care for people with chronic diseases, maternity care, mental health care and health promotion. Today, there is a significant improvement in Hawija compared to the days we first came. The most prominent issue we faced when we first started responding was access. It was not easy for us to reach many locations as the security situation was still not good and many people were not able to reach our facilities easily, especially those in the camps who had no means of transportation.

As a woman, it hurt me to see how other women, among all, were exceptionally going through difficult times. They had to bear with the great responsibility of caring for their babies while not having the means. A lot of the women had resorted to unskilled birth attendants at home as no other option was available. They would not receive any medical attention during their whole pregnancy because nothing was available. They arrived at our facilities with a significant physical and psychological toll of what they’ve been through.

I feel that we made a significant impact, not only on people's physical health but also on their understanding of the importance of mental wellbeing. We worked here as one family, and the days we shared were immensely fulfilling. What I particularly appreciate about our project is the support it provided for women like me.

Aso Khalil, MSF Nurse Supervisor

My journey with the MSF began in 2016 at the Daquq camp in Kirkuk. The healthcare needs were very urgent back then as the people of Hawija were cut away from the rest of the country with little to no access to anything. We worked inside the camp and ran mobile clinics that went daily to the reception sites where people first arrived. We provided a range of medical services for both chronic and non-chronic illnesses in these areas. It was heartbreaking to witness the dire situations people found themselves in. I saw individuals who had lost limbs, others who suffered severe bodily injuries, and many grappling with profound mental suffering after losing everything and arriving at the camps exhausted.

From these activities, I continued working with MSF as we transitioned our work to the healthcare facilities inside Hawija following the end of the armed battles to take back Hawija from the Islamic State group and as people started returning to find no services available in their hometowns.

We first went to the Al-Abbasi subdistrict in the eastern part of Hawija. There, we established a primary healthcare clinic to provide medical care and treatment to people who had chronic diseases and mental health. We also rehabilitated the damaged local water plant and provided clean drinking water to the population. 

Ahmed Aqeed, MSF community mental health worker

I am from Salahaddin governorate, and I started my journey with MSF back in 2015, when I was displaced from my home to a camp in the Sulaymaniyah governorate. I started working with MSF as a community health worker in Arbat, Ashti, and Barika camps in Sulaymaniyah. Upon the conclusion of my contract there, I went to Kirkuk in June 2018 to join MSF again and then I started working in Laylan 1 and 2 camps before going to Hawija and Al-Abassi too.

Originally from Salahaddin, I made the transition to Kirkuk to resume my work with MSF. The decision stemmed from my passion to stay with MSF. I quickly found solace in the Kirkuk community, and my colleagues made me feel at home. In 2022 all our activities became focused on the Hawija district after the displacement camps I used to work in were closed. Without a thought, I moved to Hawija with MSF to continue my job here. I was always happy in my job and among my colleagues and I enjoyed the impact we were able to make on people’s lives.

Our journey in Hawija began with significant challenges, particularly in garnering societal acceptance for mental health services and combating the stigma around it. People were not used to seeking this kind of services and they felt awkward to attend them. However, with perseverance and dedication, acceptance gradually appeared, and today, people willingly seek psychological assistance, leading to a noticeable improvement in their psychological well-being.

Our work has seamlessly woven into our lives, creating bonds like family ties. Together with my colleagues, we gather almost every day after work. We enjoy each other’s company and often play board games or watch TV shows or football matches. These shared moments, filled with laughter, and tears have become cherished memories that we will carry with us wherever we go.