A Doctors Without Borders doctor provides technical advice about the examination of a COVID-19 patient to an Iraqi doctor working with the Directorate of Health in Baghdad at the respiratory care unit of Al-Kindi Hospital. Iraq, February 2021. © Ghada Safaan/MSF
Fatima, 19 years old, is receiving medical care at the intensive care unit of the Doctors Without Borders-run ward of Al-Shifaa 13 COVID-19 centre. Fatima developed bilateral kidney failure as a complication of COVID and has to undergo dialysis on regular bases while admitted at the ICU. Her infection was initially mild and she resorted to home care and medication following the advice of her doctor. Eventually Fatima’s condition deteriorated and she was referred to Al-Kindi Hospital in Baghdad for hospitalization and intensive care. Iraq, February 2021. © Hassan Kamal Al-Deen/MSF
Doctors Without Borders' doctors, nurses and physiotherapist exchange patient updates and discuss patient conditions and treatment plans during the daily morning meeting at Doctors Without Borders-run ward of the COVID-19 centre at Al-Kindi Hospital, Baghdad. Iraq, February 2021. © Hassan Kamal Al-Deen/MSF
From September 2020 until October 2021, we worked there in close collaboration with the hospital’s management and healthcare providers to provide lifesaving care, physiotherapy, and mental healthcare to severely and critically ill COVID-19 patients. We started with a ward of 24 beds that was later expanded to 36 and then to 52 beds, as the numbers kept increasing with each wave. In total, our teams cared for 934 critically ill COVID-19 patients at Al-Kindi Hospital and reduced the average mortality for severe cases by 40 per cent.
“During the peaks, we often saw how some patients who were in dire need of intensive care were unable to access it, because intensive care beds were full everywhere,” says Dr Uche.
“Healthcare providers had to put in extra work to care for the large influxes of sick people and they were exhausted.”
To increase bed capacity, healthcare authorities were sometimes left with no option but to switch other healthcare facilities into COVID-19 treatment centres.
“As a result of that, regular healthcare services had to be disrupted in many facilities across the city, which in turn impacted other patients with other health conditions,” Dr Uche adds.
The country has experienced three waves of the disease, each bigger than the last. Some of the challenges have remained constant, however.
One of the big problems we often faced was that most of the patients admitted to the intensive care unit came to us at a very late stage and already in a critical condition. They tried everything they could at home and only came when they couldn’t avoid it anymore. So, most of the time we were treating the complications of late arrival on top of the COVID-19 infection itself.Dr Daniel Uche, Emerg. Medical Team Lead
The numbers of COVID-19 infections in Iraq have started to increase recently, and with just around 15 per cent of the population fully vaccinated and poor compliance with infection prevention measures, in addition to the recent arrival of the rapidly spreading Omicron variant of the virus, Iraq is not safe from the effects of another wave.
Iraq also has high numbers of people with chronic diseases that are considered risk factors for a severe COVID-19 illness, such as hypertension, diabetes, and lung disease. All these factors mean that the preparedness of the health system is key to responding effectively to any increase of hospitalization rates and that’s what Doctors Without Borders has been supporting Baghdad Medical City’s Al-Shifaa Hospital with.
From Al-Kindi to the Medical City
When the last wave of COVID-19 was declared over in Iraq, Al-Kindi Hospital, one of the major medical and surgical training facilities in the capital, went back to its regular services. Our COVID-19 team moved their activities to the Baghdad Medical City to continue the support and preparedness for any future increase in infections.
“At Medical City, we are currently simultaneously caring for severe or critical COVID-19 patients in the intensive care unit and raising the levels of preparedness of healthcare workers by providing training and on the job coaching,” said Dr Uche. “We hope that we don’t see a surge in the number of cases, but at the same time we are doing our best to be ready if that happens.”
“We have also recognised the limitations people face when trying to access information from credible sources amid widespread rumours and misinformation,” continues Dr Uche.
To tackle this, our teams are incorporating a health promotion and community awareness component in their current COVID-19 activities in the Al-Shifaa Hospital. These activities support the Iraqi Ministry of Health in delivering fact-based information and guidance to people in Baghdad.
Elsewhere in Iraq, our teams also run a six-bed patient isolation and treatment unit for mild to moderate COVID-19 patients at the Sinuni General Hospital in Sinjar. We support the Tel After General Hospital with essential infection prevention and control training, and preparedness to care for severe and critical COVID-19 patients if numbers start increasing.
Doctors Without Borders also supported healthcare facilities in responding to the pandemic in Ninewa, Erbil, Kirkuk, and Duhok governorates, mainly through providing essential training and supplies to strengthen infection prevention and control measures in hospitals. Between March and December 2020, we temporarily transformed our 62-bed surgical hospital in East Mosul to become an isolation and treatment centre for suspected and mild to moderate COVID-19 patients. Between November 2020 and April 2021, we ran a COVID-19 intensive care unit at Al-Salam Hospital in East Mosul.