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    Iraq: Bringing vital medical care closer to the people of Hawija District

    MSF nurse is examining and recording the vital signs of a patient suffering from a chronic disease

    Doctors Without Borders nurse is examining and recording the vital signs of a patient suffering from a chronic disease at the Doctors Without Borders-run clinic for chronic diseases in the Hawija primary healthcare centre, before referring him to the doctor’s room for his regular consultation. Iraq, 2022. Ⓒ Hassan Kamal Al-Deen/MSF 

    Like every morning, Dr. Ramah Essa arrives at the Doctors Without Borders clinic in the Al-Abbasi subdistrict in Kirkuk governorate, northern Iraq, to follow up on patients with chronic diseases. It’s around 8:00 am, and several patients are already waiting for him to arrive. He starts his day with an older woman who suffers from diabetes and hypertension. She regularly comes for routine check-ups. “And now, we are going test your blood sugar level, so we can see if your diabetes is controlled, and if it is not, we will adjust the treatment,” explains Dr. Ramah to the woman.

    In this Doctors Without Borders facility, Dr. Ramah and his colleague Dr. Saif receive patients seeking medical attention for Non-Communicable Diseases (NCDs) like diabetes, hypertension, asthma, epilepsy, and psychiatric disorders. Such conditions require long-term or lifelong medical treatment and close follow-up to avoid developing complications that may lead to critical situations. “We have between 3,000 to 3,500 patients on treatment who visit us regularly in Al-Abbasi clinic”, Dr. Ramah says. “Together with Dr. Saif, we see around 50-60 patients on average every day”.

    Since 2016, Doctors Without Borders has been providing free access to healthcare services to those who fled Hawija during the control of the Islamic State group and the ensuing battles to retake the area, the returnees, and those who did not leave. We first ran mobile clinics at the reception sites for people fleeing Hawija. Then we worked at the displacement camps, where those who fled were settling.

    A patient with a chronic disease checks in at the registration department of the MSF-run non-communicable diseases (chronic diseases) clinic in the Abbasi subdistrict of Hawija

    A patient with a chronic disease checks in at the registration department of the Doctors Without Borders-run non-communicable diseases (chronic diseases) clinic in the Abbasi subdistrict of Hawija, west Kirkuk. Iraq, 2022. Ⓒ Hassan Kamal Al-Deen/MSF 

    But since 2020, these camps have been closed following a decision by the federal government, forcing families to return to their areas of origin and sometimes leading them to face secondary displacement to other regions. Many healthcare facilities were either partially or entirely destroyed during the battles to retake Hawija from the control of the IS group, leaving the returning population with reduced access to much-needed healthcare services. As the needs of the people and the existing gaps in healthcare provision grew, Doctors Without Borders shifted the activities to focus on NCDs, mental healthcare, and sexual and reproductive healthcare.

    Before the battles, the healthcare system had already suffered from shortages in supplies and healthcare workers in this region. But now, with several damaged facilities still not restored or non-functional, along with the additional pressure placed on the system to cater to the healthcare needs of the returnees, meeting the tremendous needs in the area is impossible. People often must travel long distances to attend a medical consultation. Because the facilities close to them are out of service, face shortages, or because they never existed at all.

    Today, we work in both Al-Abbasi clinic and the Hawija primary healthcare centre, which is in the main town of Hawija. Our teams provide care to 7,000 patients suffering from NCDs in both locations combined, and Doctors Without Borders’s capacity to respond is reaching its peak. While we acknowledge the big needs among the community, we cannot enrol all the patients that need treatment. We are trying to maintain a good quality of care for the patients, and there will be limitations to this if the cohort keeps growing. Limited space at the facilities, supply challenges, and staff availability are among the challenges we could face.
    Tetyana Pylypenko, Medical Coordinator

    In collaboration with local healthcare authorities, Doctors Without Borders has developed specific criteria for treatment initiation in our facility. Our teams focus on caring for the most vulnerable patients who need urgent treatment. At the same time, we refer more stable patients to the nearby public primary healthcare centre. In this manner, we can split the load with the public clinic and provide better-targeted care to the patients. Still in the Hawija primary healthcare centre, Doctors Without Borders gives women antenatal, postnatal, and family planning consultation but in a separate section from the NCD clinic.

    In both Hawija and Al-Abbasi, our teams don’t only receive patients from the big towns but the surrounding villages and even neighbouring governorates as well. People come to the Doctors Without Borders clinics to benefit from free and quality medical care.

    MSF mental health promotion team member conducting a health promotion session with a group of women and their children

    Doctors Without Borders mental health promotion team member conducting a health promotion session with a group of women and their children in the Abbasi subdistrict of Hawija, in western Kirkuk. Iraq, 2022. Ⓒ Hassan Kamal Al-Deen/MSF 

    Amira and her colleagues, who work with us as community mental heal workers, conduct daily visits to the houses throughout Al-Abbasi to educate people about mental health and sensitize them about Doctors Without Borderss services. They often meet individuals who exhibit signs of anxiety or stress that suggest they require psychosocial support. They advise people to visit our mental health counsellors at the clinic. There, Fatin, our mental health counsellor, and her colleagues give patients key information to better understand their condition and provide them with some techniques and adaptation mechanisms to help them overcome and develop sound coping mechanisms.

    The care we provide has to address the difficulties and constraints that patients go through in their life and the trauma and psychological state they are in. That’s why we keep mental healthcare as an essential part of the services we provide, especially knowing that in recent years, the population here has lived through several traumatic experiences that would require years to heal completely.
    Dr. Annie Marie, Medical Team Leader

    In the Hawija General Hospital, Wafaa, an Doctors Without Borders midwife developer, spends her day at the Doctors Without Borders-supported maternity department helping midwives who sometimes assist up to 300 women deliver their babies every month. Here, Doctors Without Borders supports the midwives by building their capacities in the delivery room on a daily basis.