THU 28 - 3 - 2024
 
Date: Oct 13, 2016
Source: The Daily Star
Humanitarian disaster threatens Mosul
Ned Whalley| The Daily Star
BEIRUT: In recent weeks humanitarian agencies have been gearing up for a massive exodus from Mosul. The U.N. expects up to a million people to flee the area when the Iraqi army moves on the city now held by Daesh (ISIS). But accurately predicting outflows is challenging and preparations face momentous challenges. Infrastructure is degraded, the security situation is dire and resources are scarce.

Caroline Abu Sada, head of Iraqi mission of Doctors Without Borders, known by its French initials MSF, said her organization is doing all it can to prepare for the unknown.

“What we are doing now is a bit tricky, because we are answering the current needs but preparing for the potential scenarios which are yet to come, with no clear idea exactly of when the Mosul battle is going to start, [or whether] the figures being provided at the moment are accurate or not,” Abu Sada said.

MSF operates mobile clinics throughout Iraq, in some of the country’s most dangerous and least accessible areas, including Tikrit. Situated in the Salahuddin province between Mosul and Bagdad, the area saw an influx of 65,000 internally displaced persons this summer according to the U.N., and could receive up to 350,000 more in the immediate aftermath of the Mosul operation. Iraqi officials have promised to liberate Mosul by the end of the year; Western officials have indicated the push could begin as early as this month.

“Nobody has any clue today how many people exactly are still ... in Mosul,” Abu Sada said. “In Fallujah we had so many figures going on. ... It changed three times per day during the Fallujah battle.”

Right now MSF is focusing treatment on individuals with noncommunicable diseases and infections, afflictions typical of displaced populations subsisting in poor living conditions. This could change quickly if the steady flow of people into the area turns into a flood of war victims.

“If we go [into] a different scenario with a massive arrival of people with a high percentage of war wounded, then this is where we would go as MSF,” Abu Sada said.

She explained that in such an event the organization will set up a field hospital and expand facilities to accommodate surgeries and inpatient care. The ability to react quickly and effectively in such circumstances is paramount.

UNPRECEDENTED SCALE“This is going to be the mother of all battles and the mother of all humanitarian crises. It has the potential to be the largest in the last 25 years, since the Rwanda genocide, where 2.5 million people came out,” said Bruno Geddo, the United Nations High Commissioner for Refugee’s representative in Iraq. “The sheer scale of the disaster will be overwhelming.”

Geddo said the U.N. is currently projecting that 700,000 people fleeing the city will require urgent humanitarian assistance.

Estimating the exact number of individuals in Iraq’s second-largest city has become challenging given the limiting information coming out of Mosul. Furthermore, many residents may choose not to leave, preferring to wait out the fighting.

“Many people fled, but with ongoing military operations, [sometimes the] only place for people to flee was to Mosul itself,” said Dr. Wael Hatahit, a technical officer with the World Health Organization in Iraq, which operates 65 mobile clinics in the country. Twenty have been earmarked for the response to the Mosul operation.

But however residents choose to weather the storm, the need will be acute. “Whether these civilians choose to stay or choose to leave, they all need to have access to medical care,” said Sarah al-Zawqari, spokesperson for the International Committee of the Red Cross in Iraq.

A SHORTAGE OF DOCTORS AND MEDICINEThe lack of existing health infrastructure compounds the challenges. Years of war and neglect have all but eliminated the country’s ability to provide basic services.

“[Tikrit] had hospitals, but most of them have been destroyed,” Abu Sada said. MSF supports the city’s sole functioning hospital, which struggles to cope with the number of patients. “These areas were already damaged by the takeover by Daesh and then the retakeover by the army. ... The Directorate of Health in Salahuddin is doing its best, but they just don’t have the capacity,” she said.

The issue is not limited to facilities – agencies also report a severe shortage of local, licensed medical staff.

“There’s not enough doctors,” Hatahit said. “And the doctors who are left behind, who did not flee, they have to be screened for security purposes. So at the outset of the crisis, we do not have enough doctors. ... The best estimate is 700,000 [IDPs in need of assistance] and we do not have enough doctors to treat all of them.”

The challenge has been compounded by the burden of government regulations. The federal government has made it difficult for organizations like MSF to bring in their own medical professionals, and NGOs have to coordinate with the army, the police, local officials and Shiite militias to gain unfettered access.

“At the central level in Iraq there are blockages,” Abu Sada said. “The Iraqi government is calling for a massive scale-up of the work of NGOs, and at the moment it takes up to four months to get a visa for an expatriate. ... It’s extremely difficult to run facilities if we don’t have enough human resources and if we don’t have people from abroad who have the knowledge and the skills from other MSF projects.”

The issue is not restricted to human capital. Importing medication requires a series of authorizations from the Iraqi Health Ministry, and several levels of bureaucracy and testing mean long lead times for vital drugs.

“This is a very lengthy process,” Abu Sada said.

“For the moment we are working with drugs that are produced locally and drugs that were already present, that we already brought before, but it’s definitely a challenge,” she said.

“If we scale up massively and quickly, this is probably going to be the most difficult part to handle. At some point if I don’t have people, and I don’t have human resources, and I don’t have supplies, there’s no way I’m going to be able to set up a field hospital.”

Hatahit said WHO is trying to negotiate on behalf of other NGOs to bring in more foreign staff and provision them with preapproved medicines. But the U.N.’s leverage in such matters is limited.

But it is not only Iraq’s lack of physical and legal infrastructure that is presenting problems. Importing doctors is expensive and many countries do not want their citizens working on the front lines, Hatahit said. It is particularly challenging to attract necessary resources when the duration of the crisis remains uncertain.

“It’s not a natural disaster where the expats stay in for three weeks ... it’s a long, protracted emergency,” he said.

“Fallujah started six months ago, and we are still providing services, and we are expected to provide services for the next six months at least.”

Acutely aware of the looming personnel challenge, the ICRC is providing training for anyone who might be able to help.

“A lot of hospitals around the north will [play] a central part when the Mosul operation happens – a lot of the wounded will be going there,” Zawqari said. “So we have rebuilt an operational-theater room, we have given training to ER doctors on emergency trauma, we give first-aid training to a lot of volunteers, to authorities, even to reporters ... everyone that might be in first-hand contact with internally displaced people on the front line.”

POOR SECURITY SITUATIONA fundamental precondition for success, however, is security. To date, Iraq’s perilous security situation has prevented aid organizations from expanding operations northward toward Mosul.

“We would like to go further north ... but you have bombing every single day or mortar attacks,” said Abu Sada, recounting an MSF assessment north of Beiji. “It’s far too dangerous ... the day afterward there were five mortars that arrived exactly where we were, so there’s no way I’m sending teams now. We know that there are needs, that there are populations stuck there, but we just can’t access them.”

The volatile situation means aid missions are often forced to turn back. “The problem again is that it is very unpredictable ... the day before [a mission] would be cleared security-wise, and the day after [Daesh] would start shelling the area, so we’d have to retrack. This is the kind of environment we are operating in, and this is what we expect in Mosul,” Hatahit said.

The situation also affects the setup of camps, where tens of thousands of IDPs will be housed and receive aid.

“If the location of the camp is too close to the front line there is a risk of shells and mortars falling on civilians and killing them, so we tend to be at a reasonable distance,” Geddo said. “But the problem is that for us to start building them, we have to deal with the front line we have,” he explained. “There has been improvement, the line is moving, slowly, but moving.”

And the shadow of sectarian violence creates additional logistical problems. “The Yazidis for example have declared openly, adamantly, they would never want again to be close to Sunni neighbors. Whenever we decide where to establish a camp, we also have to keep in mind the possibility, the risk that bringing in populations of certain religious or ethnic backgrounds could cause problems that of course we don’t want to cause.”

A DESPERATE POPULATIONThe need is clear, and much support will be needed to ensure sufficient aid can be provided to the beleaguered population of Mosul. The city has been occupied by Daesh since June 2014, and the current condition of the civilian population is a major concern.

“For people in Mosul, for the past two years many of them did not have health care, including vaccinations. So this is one thing that we are definitely worried about, what will be the health status of those who are trying to flee?” said Hatahit.

Zawqari painted a bleak picture, citing the experience of other cities retaken from Daesh.

“When these things happen, there is a lot of weapon contamination that takes place; we’ve seen that as well in Ramadi and Fallujah and with many of the IDPs that we met in the field,” Zawqari said. “Many of them have lost limbs or were severely wounded because of unexploded devices on the road or near where they were staying.”

“People who were trapped in Fallujah for a while, after we met them, a lot of them had been eating grass for a very long time,” she recounted. “There was no food, there was no water, it was very tough conditions for them. So there was a lot of malnutrition, a lot of trauma cases, a lot of fear, family separation.”

Abu Sada said that mental health care is already an important component of the medical need.

“All of them will need mental health support because of the trauma they’ve gone through in the past couple of years – trauma that they had to go through when they left and because of the living conditions that they are actually in now.”

The U.N. and ICRC have issued urgent appeals for funding. Geddo said the U.N. is hoping to secure financing not just for the immediate fallout, but also for winter assistance to those who will join Iraq’s 3.3 million displaced people.

“The international community should resist the temptation of succumbing to fatigue. This might be a situation that gets worse before it gets better, but we may see light at the end of the tunnel if [Daesh] is booted out of Iraq after Mosul is taken,” Geddo said. “2016-17 maybe the turning point for Iraq. Iraq needs every bit of support and attention to go from here to there.”

A version of this article appeared in the print edition of The Daily Star on October 12, 2016, on page 9.


 
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