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In Iraq, even though overall levels of violence have decreased, highly volatile areas still remain. Bombings and assassinations continue in many regions, and dozens are killed or wounded every week. Although many health facilities function inside of Iraq, the quality of care has been undermined by a shortage of staff, and there has been no upgrading of skills since the early nineties. As in previous years, MSF could not give direct assistance to the most affected areas in 2009 due to security constraints. However MSF still worked to provide aid from more secure parts of the country or from the outside, especially Jordan.

According to the Iraqi Health Ministry, hundreds of medical employees have been killed in the course of the conflict and even greater numbers have fled the country. Iraq is critically short of nurses and of specialist doctors, including psychiatrists and psychologists. MSF has identified some of the main challenges to be the inability of hospitals in conflict zones to deal with mass casualty incidents due to deficiencies in skills and management, and a virtual absence of psychological care for patients with mental trauma.

MSF supports hospitals in different parts of the country such as Anbar, Baghdad, Ninewa and Kirkuk, by training medical staff, providing materials and supporting mental health counselling and conducting health education campaigns. MSF also established a programme in neighbouring Jordan in August 2006, from where it has been operating a reconstructive surgery project for the Iraqi war-wounded, focusing on orthopaedics, facial reconstruction and plastic surgery. In 2009, MSF remotely supported nine Iraqi hospitals from Amman that had been severely affected by the violence.

In 2009, some of the remote hospital support was closed as the security situation had largely improved in Iraq, permitting MSF to open a mental health counselling unit in Baghdad in September, followed by a similar unit in Fallujah in December. The units are located within Ministry of Health hospitals and seconded staff provide the counselling services. Over 175 patients were treated during the last quarter of 2009.   

For the first time since returning to Iraq in 2008, MSF was able to establish an international team in the southern part of the country. There, in Basra General Hospital, MSF provided technical support and training on anaesthesia, post operative care, hygiene and sterilisation throughout 2009. In addition, MSF is currently participating in the rehabilitation of the emergency operation theatre in this 600 bed hospital, as well as focusing on improving emergency response capacity and better management of emergency surgical cases.

MSF is directly supporting the emergency units of four hospitals in the Ninewa and Kirkuk governorates in northern Iraq through continuous medical supplies and training of medical and paramedical staff, such as the training to manage mass casualty situations.  MSF provides emergency response support to hospitals after violent incidents and is engaged in health education campaigns aimed at the prevention of communicable diseases. Campaigns promoted water treatment and personal hygiene, while others focused on awareness of leishmaniasis and on preventing swine flu (H1N1). In the Kurdish North of Iraq, MSF is also giving psychological support to persons displaced due to conflict

In Jordan, by the end of 2009, the reconstructive surgery programme lead by MSF in Amman treated nearly 900 wounded patients. The project has developed with the help of a small group of doctors in Iraq, who identified patients and organised their transfer to Amman, based on the specialist care we are able to provide (orthopedic, maxillo-facial and plastic). Treatment and follow-up are complex, requiring months of hospitalisation in a specialised environment. Beyond the complex surgery, MSF provide physiotherapy and psychological care to patients in need.

In the governorate of Kurdistan, MSF started a project in 2007 in the Sulaymaniyah teaching hospital, in order to respond more quickly to the wounded victims from the north of Iraq, and to improve the quality of care given to severely burnt patients.  After two years working to improve the quality of care in the burn unit, MSF handed over this project to the authorities by the end of 2009. Despite the difficulty of improving survival rates in such a medical context (due to the high number of severe burns), progress was made in pain management, infection control and palliative care.

MSF is continually assessing the possibility of providing further medical assistance to the Iraqi people and weighs this possibility against maintaining staff security.

MSF’s current intervention in Iraq started in 2006.

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