Medair response in Mosul

“You’ve given us dignity”

Amal and her family have lost everything. Having fled the conflict in Mosul with 25 people, they arrived in a sprawling suburb and settled on a spot of vacant land next to the home of a distant relative. Even in this open space, with no protection from the wind or relief from the harsh sun, Amal and her household feel fortunate,as more than 10,000 people pour into to an area newly retaken from armed groups. Amal’s first priority is setting up a kitchen by stretching a tattered tarp over some discarded pieces of iron to protect her cooking from the wind and dust.

When Amal counts the things she’s lost since the crisis began in 2014, she recalls saying goodbye to her village, to loved ones killed by stray bullets and airstrikes, and to a large extended family who hadalways lived nearby. More profoundly she talks about losing her dignity; living without proper sanitation and often having to rely on the kindness of neighbours even for access to water.

In Medair’s emergency response near Mosul, the team responsible for water, sanitation, and hygiene (WASH) found many families like Amal’s living in makeshift tents and unfinished buildings. During any emergency, such as in northern Iraq, water and sanitation are considered to be critical factors in matters of survival. Diarrhoea and waterborne diseases like cholera are common where there is contamination and a lack of facilities.

When the Medair assessment team first met Amal, she and her family had access to a tarped-off toilet area, perhaps just one square metre, which offered some privacy but had no pit or drainage for waste. Every few days, any available containers were loaded into the car and brought to a neighbour to be filled with water, but the jugs and barrels were not covered for storage or protected from contamination. With limited materials to create separate spaces for bathing, dishwashing, and cooking, Amal’s family was at risk of health problems.

In just a short time, Medair installed water storage tanks, handwashing stations, and latrines at 164 locations in this sprawling suburb. Where needed, showers were provided. Families were also given household items and shelter materials, and a mobile health team began operating a clinic shortly after people started arriving from areas of active conflict. Each day, Medair staff drive two hours to reach this community.

“This is a big thing for us,” says Amal during a visit by the Medair team just following the two-day construction project. “You have given us dignity. When we arrived here we had nothing, but step by step we are fixing everything. Only Medair has been here to help us, and we thank you.”

While the engineers inspect the new water tank and latrine, Amal’s children quickly turn on the tap to show us how well it works. Their faces light up as they splash water over themselves in the 48 C heat. There are still many things that Amal and her family are lacking, but for now they have dignity, and with proper water storage and effective hygiene training, they have increased protection from diseases. Amal has water for cooking in her small kitchen, and she and her daughters have invaluable privacy.

/ Prior to receiving a storage tank, Amal’s family was storing water in used barrels, water bottles, and small jugs collected from neighbours.
/ The Medair WASH team, led by project manager Andy Dow, visits Amal to inspect the recent installation of a water storage tank, handwashing station, latrine, and shower.
/ Amal’s children now have enough water to cool themselves when the temperature tops 48 C. The Medair team had the chance to see the family enjoy their new handwashing station.
/ Amal (back row, centre) and her family arrived in a suburb of Mosul and settled on an empty plot of land. With no latrine or access to safe water, this household was typical of many during the emergency in northern Iraq.
/ WASH Project Manager Andy Dow completes final inspection for the latrine installed for Amal’s family just outside of Mosul.

Starting a friendship

Waded, 53, is committed to caring for the needs of his village. Being the Mukhtar means he has been chosen to be the village leader, and even though many families who are here right now aren’t permanent residents, he is advocating for their needs as well. He carries a folder of ragged papers; copies of identification for all the families living under his care. He knows their stories and he is telling the Medair Emergency Response Team about their needs. He can see the smoke rising from Mosul from his front door, and he has opened his own home to three families who were able to find a way out of the embattled city.

“Our only hospital is in Mosul. Many times the road is closed so we cannot go by car. In an emergency we must walk across this field, which is not safe. And when it rains, we cannot go through the field,” explains Waded. Since August 2016, most routes have been blocked or have been the scene of fighting.

One of the families finding refuge in Waded’s home is Abdul, 24, his wife, and their infant. They fled Mosul by taking a boat across the Tigris River to a retaken section of the city. When stopped at a checkpoint, the young family was permitted to cross only when Abdul promised to return after taking his wife to her family. He hid for 15 days to avoid arrest before they were able to slip across the field to Waded’s village.

“My daughter is two months old, and she is ill. For two years I have been at home with no work,” says Abdul. “I had nothing for my daughter. Here, the Mukhtar and his family gave us the things we needed. Now we are safe, but I can’t sleep because I am worried about my family who is still in Mosul.”

In January 2017, after discussions with leaders like Waded confirmed a critical need for health care, Medair’s mobile medical clinic began visiting the Bashiqa sub-district each week. People arrive early on clinic days, even before the clinic opens. Many have not had access to care in many months, and babies under two years may be seeing a doctor for the first time. Staff are seeing people with chronic diseases like diabetes who are having complications because they’ve gone without treatment. They are seeing conditions such as respiratory problems caused by burning tyres used to conceal the location of armed groups. As soon as new areas become accessible, the community liaison team visits to determine how Medair can best help the population there.

“Even more important than the aid,” says Waded, holding his folder of papers, “is that you have come to start a friendship with us. No one else has come to see how we are doing.”

/ Medair Community Health Officer DrDilbreen speaks with Waded, a local leader, and Abdul, who has newly arrived from Mosul.
/ In newly retaken areas, Medair medical staff are seeing people who have been without health care for many months. Babies under two may never have been seen by a doctor.
/ People from nearby villages often arrive very early to see doctors at Medair mobile medical clinics. Truck come filled with people seeking access to health care.
/ Medair consults with village leaders to assess the needs in each community. Here, DrDilbreen, Community Health Officer, speaks with Waded about the area around his village on the outskirts of Mosul.

Treating Families Freshly Arrived from Mosul

Early on a rainy Monday morning, four medical teams pile into eight vehicles and leave Medair’s base in northern Iraq, all within minutes of one another. Two teams are part of the emergency response, visiting villages newly accessible as military action surrounding Mosul continues. The other teams will support communities where the healthcare centre is unable to meet the needs of the population. All are providing primary healthcare in a region of Iraq affected by years of conflict.

In a village just 12kilometres from Mosul, three Medair vehicles pull up to a building that has been standing empty, with no electricity or generator. The team of 10 makes short work of unloading the chairs, tables, medicines, and other supplies. By now, people are beginning to queue and the nurse begins triage – discussing ailments with each patient, taking temperatures, and screening each child for malnutrition.

Common colds, high blood pressure, aches, and pains – this health clinic is like any other. But these patients have gone many months living in fear for their lives, lacking food, and generally without access to health care.

“We see children who have never seen a doctor, never had a vaccination,” says DrIsmael, in between checking a throat for tonsillitis and telling one young man he should remember to wear his jacket since he has a cold. “Many people have hypertension, or some have mental health problems. We have been seeing a lot of tonsillitis here lately. It can spread quickly.” The rooms are quite dim because of the gloomy day. He pulls out his phone to use the flashlight for a better view of the rash on a young woman’s neck. It’s nothing serious and he advises her to wash the area well then keep it dry.

Nakhla has brought her five children. She arrived from Mosul 10 days ago, and they are staying with an uncle along with two other displaced families. She is worried about her youngest child, eight-month-old Nadja, who was born in a Mosul hospital by Caesarian section. Nakhla left the hospital immediately after she delivered, fearing she was in danger because her husband is a police officer. She recovered from her surgery at home, and Nadja has not been seen by a doctor since birth. The baby is wheezing – a deep cough coming from her small lungs. Nakhla says the baby has frequent diarrhea, and she does show signs of dehydration.

Dr Ismael examines Nadja, and all of Nakhla’s children in turn, then talks to Nakhla about her own health. He prescribes medication for respiratory conditions, and urges Nakhla to drink more clean water and to eat more healthy vegetables so that her breast milk will be of more benefit to her baby. He prescribes salbutamol and amoxicillin for the baby’s respiratory condition. He talks with the older boys individually. They are taking turns helping their mother with the young ones, and Dr Ismael shows them he cares. He knows their father is still in Mosul.

“We are here to fill in the gaps and work with the Directorate of Health to strengthen the health care that is available,” says Janet Luigjes, project manager for Medair’s Emergency Response. “We continuously do assessments of newly accessible areas to determine the needs. We focus on having good relationships with community leaders so they allow our teams to come. Our staff are well-trained doctors, nurses, and pharmacists – they are the backbone of our response.”

With her arms full of necessary medications and balancing Nadja on her hip, Nakhla climbs into her uncle’s crowded vehicle. He brought everyone to the clinic today for their first visit since arriving from Mosul. He says he has been able to give them clothing and food, but there is not enough. Most of the families in this village have taken in people from Mosul and are sharing what they have.

Three hours and 100 patients later, the Medair team packs up for the two-hour trip back to the base. They exchange glances when the ground shakes from a mortar landing several kilometres away. While not close enough to be any imminent danger, it is a reminder that the context mustn’t be taken for granted. The Mukhtar brings some biscuits and jugs of water. His wife and children come to say goodbye.

In one week the team will return, but until then many other people are waiting to see them. Tomorrow the team will be in a different location even closer to the areas of Mosul that are still the scene of armed conflict.

/ The triage nurse checks vital signs, screens for malnutrition, and talks to each patient. The most urgent cases are brought to the immediate attention of the Medair doctors.
/ Nakhla brings her youngest, Nadja, to see the doctor. This is the first time Nadja has ever been examined by a doctor since she was born in a Mosul hospital. Nadja is suffering from respiratory issues as well as diarrhoea and dehydration.
/ Nakhla is relieved that all of her children can see the doctor. Dr Ismael examines each one and talks to Nakhla about treatment.
/ After eight months in Mosul without access to health care, most of Nakhla’s children are in need of medical attention.
/ Nakhla and her sister, with their children, are staying with relatives. There are 17 in all, and they fled Mosul with nothing. Their uncle’s family is providing food and clothing, and brought them to the Medair clinic to see the doctors.

Neil Casey

Director – Medair UK

August 2017