MSF is con­cerned about con­tin­u­ing ac­cess to health care for ‘deeply trau­ma­tised’ dis­placed com­mu­ni­ties

The National - News - - NEWS - MINA ALDROUBI

The ban on in­ter­na­tional flights into Iraq’s Kur­dish re­gion could se­verely af­fect aid de­liv­er­ies if re­stric­tions con­tinue, ac­cord­ing to Médecins Sans Fron­tières (Doc­tors With­out Bor­ders or MSF).

An em­bargo on in­ter­na­tional flights to and from Iraq’s au­ton­o­mous Kur­dish re­gion went into ef­fect after Er­bil re­jected a call by Baghdad to sur­ren­der con­trol of its in­ter­na­tional air­ports to the fed­eral Iraqi gov­ern­ment.

It came amid grow­ing ten­sions be­tween Er­bil and Baghdad after Iraqi Kurds voted in favour of sepa­ra­tion from Iraq in the con­tro­ver­sial ref­er­en­dum of Septem­ber 25 – a vote Baghdad de­scribed as il­le­gal.

“Any mea­sures put in place must en­sure that peo­ple can con­tinue to ac­cess ba­sic ser­vices like health care, and that car­ers and hu­man­i­tar­ian work­ers can con­tinue to ac­cess pa­tients and com­mu­ni­ties in need of sup­port in Iraq,” MSF’s head of mis­sion ad­viser in Iraq, Wisam Al Nas­sar, said.

“As a non-po­lit­i­cal, in­de­pen­dent, neu­tral, med­i­cal hu­man­i­tar­ian or­gan­i­sa­tion, this is MSF’s pri­mary con­cern.”

At this point, MSF is able to con­tinue its op­er­a­tions in north­ern Iraq with min­i­mal dis­rup­tions.

“We are fac­ing slight dif­fi­cul­ties due to the re­stric­tions of the flight ban on the north­ern Kur­dish re­gion, but they have not yet reached an ex­tent that has blocked MSF’s op­er­a­tions,” Mr Al Nas­sar said. “We are able to work so far. How­ever, if those kinds of mea­sures and re­stric­tions con­tinue for an­other cou­ple of weeks then MSF will be con­cerned about its ca­pac­ity to re­spond.”

MSF pro­vides med­i­cal as­sis­tance across 10 prov­inces in Iraq, reach­ing more than 130,000 pa­tients. It em­ploys more than 1,750 Iraqi staff as well as 225 in­ter­na­tional staff.

Mr Al Nas­sar said op­er­a­tions are con­cen­trated mostly in Nin­eveh prov­ince, in Mo­sul and the sur­round­ing towns and also in the dis­puted city of Kirkuk.

The mis­sion chose Nin­eveh prov­ince, near the Kur­dish re­gion, as its base be­cause of the prox­im­ity of the air­ports in north­ern Iraq. But it op­er­ates all over the coun­try.

“Our main re­sponse is to fo­cus on the needs where no one else can cater to them, so as to not du­pli­cate the work that other NGOs are do­ing in an area,” Mr Al Nas­sar said. “We re­spond to the Kur­dish re­gion when we are needed.”

The work of MSF dif­fers de­pend­ing on lo­cal­ity. In Mo­sul, for ex­am­ple, MSF fo­cuses on long-term care and es­pe­cially men­tal health. The peo­ple in Mo­sul bear the deep­est men­tal scars, Mr Al Nas­sar said.

“Peo­ple have been trau­ma­tised from years of con­flict and wars. Men­tal health is­sues are not openly ex­pressed in the Mid­dle East due to the cul­tural stigma it holds. Peo­ple are usu­ally in de­nial of these kinds of is­sues.”

MSF doc­tors have to not only adapt to this as­pect of the lo­cal cul­ture but to ac­com­mo­date it in their work.

“We have to find ways to es­tab­lish great con­nec­tions and build trust with the pa­tient to give them the con­fi­dence they need to be able to ex­press them­selves so they can re­ceive the right med­i­cal sup­port. In Mo­sul, we turn our fo­cus to be­ing in­side hos­pi­tals be­cause of the high lev­els of dam­age done to med­i­cal fa­cil­i­ties, as well as the in­creas­ing num­ber of peo­ple re­turn­ing back to their homes.”

Dr Gre­gory Keane, MSF’s re­gional men­tal health ad­viser, said: “Any hu­man­i­tar­ian re­sponse should have a men­tal health com­po­nent in­te­grated into it. Most in­ter­na­tional NGOs work­ing in hu­man­i­tar­ian set­tings con­sider psy­choso­cial re­sponses as part of their in­ter­ven­tions.”

All NGOs are in­creas­ingly con­scious of the im­por­tance of tak­ing care of the men­tal health of own their team mem­bers, too, Dr Keane said, as they must also cope with the trauma of war. It starts with en­sur­ing team mem­bers are trained and feel com­pe­tent to carry out their jobs, then moves on to de­vel­op­ing cop­ing strate­gies, giv­ing sup­port and fi­nally pro­vid­ing in­di­vid­ual coun­selling for team mem­bers when ap­pro­pri­ate.

Since the start of the Haw­ija of­fen­sive, 14,000 peo­ple have been forcibly dis­placed to towns in neigh­bour­ing dis­tricts of Kirkuk gov­er­norate.

MSF is pro­vid­ing med­i­cal and trauma care to peo­ple ar­riv­ing from Haw­ija through mo­bile clin­ics at De­bis and Mak­tab Khalid en­try point.

“In most cases pa­tients need coun­selling and psy­cho­log­i­cal sup­port – we are pro­gress­ing on that although it is not easy,” Mr Al Nas­sar said.

A 37 year-old-man told MSF: “Flee­ing Haw­ija was so dan­ger­ous that peo­ple call it the road of death. We had to pass a nar­row road be­tween a moun­tain and a val­ley. Many peo­ple died on this road. Some of them fell in the val­ley. It took us 15 to 16 hours to es­cape the be­sieged town.”

Peo­ple liv­ing there have been un­der siege for al­most three years, with aid and ba­sic ser­vices un­able to reach them.

Ton Koene / MSF

Project teams around Er­bil have pro­vided tens of thou­sands of men­tal health and med­i­cal con­sul­ta­tions this year; Faten, five, left, and Mo­hamed, 11, cen­tre, at an MSF hos­pi­tal near Mo­sul; a Brazil­ian MSF worker, right, at Khanaqin camp

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