Mosul still lacks 70% of healthcare capacity, one year since the battle ended

The reconstruction of health facilities has been extremely slow and there are still less than 1,000 hospital beds for a population of 1.8 million people

Monday, July 9, 2018 — Mosul, Iraq

One year since the battle between the Islamic State (IS) group and the Iraqi forces officially ended in Mosul, the health system is still in ruins and struggling to cope as thousands of people continue to return to the city, Doctors Without Borders (MSF) said today.

During the conflict, nine out of 13 public hospitals were damaged in Mosul, slashing healthcare capacity and the number of hospital beds by 70 percent. The reconstruction of health facilities has been extremely slow and there are still less than 1,000 hospital beds for a population of 1.8 million people, which is half of the internationally recognised minimum standards for health service delivery in a humanitarian context.

“Accessing healthcare services is a daily challenge for thousands of children and adults in Mosul,” said Heman Nagarathnam, MSF’s Head of Mission in Iraq. “The city’s population is increasing by the day. In May 2018 alone, almost 46,000 people returned to Mosul. But the public health system is not recovering and there is a huge gap between the available services and the needs of the growing population.”

“Emergency room services and surgical, oncology and burns facilities are urgently required, as well as medical equipment and a steady and affordable supply of medication.”

“Other needs include mental health services for people coping with the trauma of violence and losing loved ones, and follow-up surgery, pain management and physiotherapy for war-wounded patients who have been suffering for months because they have not been able to access the healthcare they need to recover from their injuries.”

Forty-two-year-old Nashwan* was shot in the leg and back by a sniper in Mosul in March 2017 when he was buying food. Since then, he has lived in agony with his injury and has been unable to access adequate healthcare.

“When I was at home…the pain started to grow in my leg and hip, and eventually it was unbearable,” Nashwan said. “So I went to the general hospital in October 2017 in west Mosul. They did x-rays and tests and they said I needed a huge operation and they didn't have the capacity to do the operation.”

“Life has been really hard. My injury has impacted negatively on my life - my family, the way I interact with my kids. I can’t play with them. I can't work and we haven’t had an income. I've been really depressed.”

The dangerous living conditions in Mosul – poor hygiene due to a lack of water and electricity, damaged buildings and the presence of improvised explosive devices and booby traps – also pose a risk to people’s health and increase the need for healthcare facilities.

At MSF’s hospital in west Mosul, the team saw in the past 12 months a shift from war-related wounds, to mine injuries, and more recently, injuries and medical issues related to poor living conditions as more people return to the city. For example in May this year, 95 percent of trauma cases received in the emergency room (ER) were related to the unsafe living conditions – such as falling rubble, buildings collapsing or people falling from unstable structures.

“It’s been one year since the conflict officially ended in Mosul, and much more needs to be done in the coming year to improve access to healthcare,” Mr Nagarathnam said. “MSF is calling on national authorities and the international community to urgently rebuild public health infrastructure, provide patients with access to affordable medication and ensure medial facilities are supplied with the necessary equipment.”

Notes to editors:

  • Before the conflict, Mosul had 3,500 hospital beds. After the conflict, the number of hospital beds was reduced to less than 1,000 and has not increased significantly in the past year. Hospital bed capacity is used as a key indicator for health service delivery. Thus, Mosul’s healthcare capacity is still reduced by 70 percent, one year after the conflict ended.
  • Based on figures from IOM and local authorities, MSF estimates Mosul’s population to be 1.8 million people.
  • The Sphere Standards – the internationally recognised minimum standards in a humanitarian response – state there should be more than 10 hospital beds per 10,000 people: http://www.spherehandbook.org/en/health-systems-standard-1-health-service-delivery/ One thousand hospitals beds for 1.8 million people = five beds per 10,000 people.
  • As of 31 May 2018, IOM says 846,072 people have returned to Mosul. In the month of May, 45,618 returned to Mosul: http://iraqdtm.iom.int/ReturneeML.aspx (accessed on 24 June 2018).
  • *Nashwan is now receiving treatment in MSF’s surgical and post-operative care facility in east Mosul.
  • In May 2018, MSF received 3,557 cases in the ER of its west Mosul hospital. Of these cases, 790 were trauma-related, and of these trauma cases, 95 percent were caused by the unsafe living conditions, such as people falling off damaged buildings or walls or buildings collapsing on people.
  • MSF has been operating in Iraq since 1991 and works in the governorates of Anbar, Baghdad, Diyala, Erbil, Kirkuk and Ninewa. MSF currently runs a hospital in west Mosul, specialising in maternity, paediatrics and ER services, and a surgery and post-operative care facility for war-wounded patients in east Mosul. In July, MSF will start providing mental health services in primary healthcare clinics in the east and west side of the city.
  • MSF offers neutral and impartial medical assistance regardless of race, religion, gender or political affiliation. To ensure its independence, MSF does not accept funding from any government or international agency for its programs in Iraq, relying solely on private donations from the general public around the world to carry out its work.
“Nashwan, 42, is prepared for surgery at the Médecins Sans Frontières / Doctors Without Borders (MSF) post-operative care facility in east Mosul. Nashwan is one of the many war-wounded patients still trying to recover a year after the conflict in Mosul officially ended.  “On 11 March 2017, our neighbourhood was retaken [from the Islamic State group],” Nashwan recalls. “Two days later, we went out to buy food and we were happy. But fighting was continuing in the neighbourhoods around ours. There was a tall building nearby and there was a sniper on top. He started hunting us down. My neighbour was shot in the head and killed. My brother was shot in the leg. The sniper shot me in the back and in the leg.” Nashwan went to several hospitals outside Mosul for treatment. He then returned to his home in west Mosul where the conflict was still raging. “I waited in my home for several months for the bombs to stop,” he says. “When I was at home during these seven months the pain started to grow in my leg and hip, and eventually it became unbearable. So in October 2017 I went to the general hospital in west Mosul. They did x-rays and tests and they said I needed a huge operation and they didn't have the capacity to do the operation.”  Nashwan’s neighbours helped him pay for a private doctor to do the operation, but it was unsuccessful and Nashwan was soon in agonising pain again. He was forced to go back to the general hospital, which then referred him to MSF’s surgery and post-operative care facility in east Mosul.<br/><br/>“Life has been really hard. My injury has had a negative impact on my life - my family, the way I interact with my kids. I can’t play with them. I can't work and we haven’t had an income. I've been really depressed and I cannot talk to people. Even to go to the bathroom I need someone to come with me. And I need the crutches to go everywhere. It's been really hard for me. But thankfully the hardest part has passed now that I am here.”  The MSF facility provides free surgeries, post-operative care, rehabilitation and mental healthcare, especially for war-wounded patients. MSF works closely with local health authorities to refer the most urgent patients for care. The facility is run by a team of 30 highly qualified international and Iraqi medical experts and has a 33-bed capacity.”<br/>Photographer: Sacha Myers/MSF
“Omar Khaivadin Khalid manages the operating theatre at the Médecins Sans Frontières / Doctors Without Borders (MSF) post-operative care facility in east Mosul, northern Iraq. The facility provides free surgeries, post-operative care, rehabilitation and mental healthcare, especially for war-wounded patients. MSF works closely with local health authorities to refer the most urgent patients for care. <br/>The facility is run by a team of 30 highly qualified international and Iraqi medical experts and has a 33-bed capacity.  “I manage the operating theatre including the schedule for the surgeons and the anaesthetist, equipment, supplies, the sterilisation and the recovery room,” Omar says.  “We mainly treat victims of trauma injuries – people who have badly broken limbs and amputees. We treat a lot of infected wounds and bed sores. We take samples from the wounds and determine what antibiotic they need, as many patients have multi-drug resistant bacterial infections.  “During the conflict, most of the hospitals were destroyed. MSF is the only one who provides this type of care for war-wounded in all of Mosul.”<br/>Photographer: Sacha Myers/MSF
The scars on 18-year-old Anoud’s face show only a fraction of the pain she has endured over the past year. During Ramadan in 2017, her family’s house in Hawija, central Iraq, was hit by a bomb. The loss and damage was unimaginable. For the past year, her family has been separated as they desperately try to seek medical care to heal their injuries. Anoud is currently looking after her eight-year-old sister, Bushra, who is receiving treatment in a Médecins Sans Frontières / Doctors Without Borders (MSF) surgery and post-operative care unit in east Mosul. “It was the fifth day of Ramadan last year when the attack happened. We were in our home in Hawija. We had fasted for five days by then. We were sitting in the garden. A rocket hit our neighbour’s house. We ran to see if our neighbours were OK and we brought them all to my father’s house. And that was the moment when our house was bombed,” Anoud says.  “We lost a sister and a brother in the attack. The rest of us were all injured. My mother lost her leg. I got shrapnel in my left eye, and in my hand and my leg. I also broke my leg. My youngest sister’s eye was severely damaged and her hands were ruined.  “Shrapnel hit Bushra’s knee and her knee cap was badly damaged. Now her knee cap is gone. She also has shrapnel in her head. It's still there and the doctors don't want to move it because they say any movement will be fatal. She also has shrapnel in her chest and hand, and two pieces of shrapnel in her eye. She can't fully see.”<br/><br/>“Another NGO referred us to this MSF facility. It's been eight days since we've been here. The services here have been really good. Bushra has had two operations on her knee.  “My leg still really hurts to walk on. Yesterday morning they took x-rays of my leg, and x-rays of all the shrapnel in my hands to see what they can do.  “I just want my family to be together again and I don't want anything else to happen.” <br/><br/>The MSF facility provides free surgeries, post-operative care, rehabilitation and mental healthcare, especially for war-wounded patients. MSF works closely with local health authorities to refer the most urgent patients for care. The facility is run by a team of 30 highly qualified international and Iraqi medical experts and has a 33-bed capacity.  Following the return of people to the Hawija area, MSF opened a clinic in Al-Abassi for the treatment of non-communicable diseases (NCD) and mental health care. MSF also opened a primary health care clinic in Hawija city, which will soon offer NCD treatment, mental health services and sexual reproductive healthcare. As more people return to Hawija city, MSF will provide emergency room services in Hawija hospital.”<br/>Photographer: Sacha Myers/MSF
“Twelve-year-old Anas is currently receiving treatment for infected bed sores at the Médecins Sans Frontières / Doctors Without Borders (MSF) post-operative care facility in east Mosul, northern Iraq.During the conflict between the Islamic State (IS) group and the Iraqi forces, Anas was hit in the spine with shrapnel and can no longer walk.  “We were sitting outside, then out of nowhere, a mortar shell hit the middle of the street,” Anas explains. “People died and people were injured. I fell behind something like a table. I crawled on the street until the ambulance came.” “After my injury, I was really frustrated and bored, especially in the beginning when I would watch my friends play. But then I learnt not to feel frustrated.”  The MSF facility provides free surgeries, post-operative care, rehabilitation and mental healthcare, especially for war-wounded patients. MSF works closely with local health authorities to refer the most urgent patients for care. The facility is run by a team of 30 highly qualified international and Iraqi medical experts and has a 33-bed capacity.” Photographer: Sacha Myers/MSF