Photo: Khalil Sayyad Despite the ongoing conflict that has made it difficult for humanitarian organizations to be present in Iraq, Médecins Sans Frontières (MSF) is striving to provide medical care to the Iraqi people. Since 2006, MSF programs have been implemented in Anbar, Tameen, Ninewa, Sulemaniya, Baghdad and Basra. MSF also runs a project in Jordan for Iraqi war wounded.* Khalil Sayyad recently returned from Basra, southern Iraq, where he worked as a field coordinator for nine months. He was part of the first MSF international team to establish a presence in Iraq since 2004, when high insecurity forced MSF to leave country. Here Sayyad talks about how MSF is working together with Iraqi medical staff to provide critical surgical care to hundreds of wounded Iraqis.

What brought MSF to Basra in 2008?

In March 2008, when the Iraqi government forces launched a military operation against armed militia in Basra, we provided supplies to the general hospital in Basra in Nasiriyah. In the months following this battle, the security situation gradually improved. As a result, we were able to do some assessments in the area and consider starting a project with the presence of international and Iraqi staff. For the population, seeing foreigners returning to Basra is a sign of stability and improved security. It also brings some hope that severe medical cases that so far had no treatment in Iraq could now be solved, as we are training medical staff and providing an update on latest medical developments, techniques and equipment.

What did you find in the assessment?

Photo: Khalil Sayyad Our assessment was focused on the hospital because although the security situation had improved, it was still volatile. There we found doctors and surgeons who were very qualified and experienced, but in urgent need of medical updates. Also, during the conflicts they went through in the last decades, when they would receive several patients into the operating room at the same time, all the basic standards would be forgotten, so they could cope with the emergency situation. But this “emergency mode” had become their standard way of working. Therefore, we found operating rooms that were far from meeting the minimum requirements. For example, they didn’t have a recovery room, patients were not monitored, the material used was not properly sterilized, hygiene procedures were not there. All this increased the risks of post-operative infections. Another great deficiency was in the anesthesia. There is a big focus on surgery, but anesthesia and bedside care, for example, were not given enough importance. And finally, they had a lot of equipment that had been donated in previous years, but which they were unable to install, use, maintain or repair.

What kind of work did MSF decide to do?

We identified huge gaps and needs in the emergency department and considered the possibility of working there, but the staff in the hospital thought — and we agreed — that it was too early to start these activities. We were just coming back to the country and security was still an issue in Basra. We decided then to work on improving the services in the general surgery operating room and ensuring patients had adequate care before, during and after operation. We believed we could have a real impact there and at the same time work in a relatively safe environment. Also, for us it was an opportunity to be present and restart activities while the objective remained to start working in an emergency capacity when the circumstances allowed.

Did you have the impact you expected in the operating room?

In nine months, things have really changed. First of all, hygiene has improved immensely. For example, after each surgery the room has to be cleaned before the next patient comes in, which did not happen before. We also changed the protocols of how our colleagues perform surgeries, introducing universal precautions such as one syringe per patient. There are now universal standards of hygiene and sterilization. We set up a full recovery room and now patients are properly monitored while they recover from surgery. We bought some biomedical equipment and repaired others that were not working; now they have functioning sterilizers, monitors, ventilators, anesthesia trolleys and suckers. We also repaired the operating room sewage system, which was not functioning properly. So we managed to increase the quality of care given to the patient and, most importantly, reduce the risk of post-operation infection and minimize the suffering for the patient. This is recognized by all surgeons in the hospital, as well as by the hospital director and the director of the Basra Health Directorate. To me, this was a big achievement. Our work is appreciated by our colleagues and now the doors are open for us to have a stronger presence in Basra.

What are the next steps for MSF in Basra?

Emergency. Basra General Hospital is the main reference for emergencies in Basra, most of the ambulances in the city go there. But there are big gaps in the services offered. We plan to start working in the emergency room in the next few weeks. We can make a real difference in the management of the patients. From arrival to triage to the care provided in the very first hours, reducing loss of time and increasing the possibilities to save the lives of the patients with huge traumas or other acute emergencies.

*In Anbar province and Baghdad, MSF supports eight hospitals by training medical staff, supporting mental health counselling and providing medical materials. In the northern governorates of Tameen and Ninewa, MSF supports five hospitals by providing medical supplies and training staff, as well as supporting emergency response and health education campaigns. MSF also assists people who have been displaced to Dohuk governorate through the provision of psychological support. In Sulemaniya, in the north, MSF provides services at a hospital specializing in burns. Each month, the hospital admits an average of 100 patients with severe burns and 1,600 patients are treated in the outpatient department.

To continue providing valuable services despite the difficulties of operating inside some of the worst conflict-ridden areas, MSF has also established a program in Jordan. Since 2006, MSF has been offering reconstructive surgery for Iraqi war wounded in Amman. More than 660 patients have been benefited by surgery through this project.

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