Iraq Field Report: 2016

Published on April 18, 2016
A bi-national coalition of surgeons and physicians are teaming with a local organization to bring surgical and trauma care training to local doctors in northern Iraq.

Sunset at Sharya Camp, one of four refugee and 17 internally-displaced person (IDP) camps in Duhok Province. With its proximity to several regions that are controlled by the Islamic State, Duhok Province, in Kurdistan, northern Iraq, has received over 850,000 displaced persons and refugees.

There are more refugees and displaced persons in the world today than ever previously recorded. Thirty-eight million people were forcibly displaced within their own countries in 2014, an increase from 33.3 million in 2013, according to the Norwegian Refugee Council’s Internal Displacement Monitoring Centre. To put these figures into perspective, 30,000 people a day are newly uprooted from their homes because of violence or fear of violence.

Currently, there are 60 million refugees and internally displaced persons (IDPs) worldwide, half of whom are children, according to the UNHCR. If this were the population of a country, it would be the world’s 24th largest country by population.

The majority of IDP’s (63%) are displaced within five countries: Syria, Colombia, the Democratic Republic of the Congo, Nigeria, and Sudan. In Syria alone, 7.6 million people are displaced internally and an additional 3.88 million people live as refugees in the surrounding region, many in the northern provinces of Iraq, and a United Nations commission estimates that over half of the estimated needs of Syrian refugees are unmet. While disaster relief organizations have traditionally met the medical needs of war-torn countries, this is becoming increasingly difficult in Syria and northern Iraq, and some organizations, including Médecins Sans Frontières (MSF), have been forced to scale back or abandon some medical aid missions owing to unacceptable security risks.

In June 2015, health care teams were withdrawn from Tikrit, Iraq, about 140 kilometers northwest of Baghdad. Health care teams in Iraqi cities were subsequently withdrawn from Hawijah, in July; Sinjar, in August; Heet, in October; and from Duhok, in Kurdistan, in November, leaving the Duhok Directorate of Health responsible for the care of 2.2 million individuals living in Duhok Province and the liberated areas of the Mosul Governorate.

The host community in Duhok consists of 1.4 million people. An additional population of 854,000 people, composed of 745,000 IDPs and 109,000 refugees, are living in and around four refugee and 17 IDP camps, with another camp currently under construction. The population growth in the area is staggering, with 62,761 births over the past year, many of them in the camps, and only 5,007 deaths. Yet the area remains resource poor. There are only 1,820 hospital beds, and 4.4 physicians per 10,000 people, as compared to 24.5 in the US.

Emergency Medicine as a specialty does not exist in Iraq. Surgeons with limited experience in medical, pediatric, and obstetrical emergencies staff the surgery hospital emergency departments, and internists with limited experience in trauma, pediatric and obstetrical emergencies staff the medical hospital emergency departments. Patients are left to determine whether they have a medical or a surgical problem, and they self-triage to the appropriate facility. The military forces do not commission physicians, and the doctors most often sent to the front lines are recent medical school graduates who, without the benefit of internship or residency training, are serving their country in some of the most dangerous conditions that can be found in the world today.

I have been making trips to the northern provinces of Iraq for the past several years as part of a team of doctors supported by the Americas Hepato-Pancreato-Biliary Association, Operation Hope, and the Kurdistan Regional Government Prime Minister Foundation. The focus of our work is on training young physicians in the management of trauma and critical care, training experienced physicians in transplant surgery and advanced laparoscopy, and teaching medical students the skills they will need to serve in rural clinics and on the battlefield after graduation. The next edition of Emergency Physicians International will feature an in-depth discussion of this work in the Kurdistan provinces of northern Iraq.

Dr. Lisa Moreno-Walton is a professor of emergency medicine at Louisiana State University Health Sciences Center-New Orleans, and secretary-treasurer of the Board of Directors of the American Academy of Emergency Medicine.

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