ERBIL, Kurdistan Region—Those returning home to the highly militarized Tel Afar area in northern Nineveh province face tough conditions, including insecurity, poverty, and lack of medical care. The medical aid agency Médecins sans Frontières, (MSF, or Doctors Without Borders in English), has recently begun running mobile clinics in three villages in the area to meet the healthcare needs of this population trying to rebuild their lives.
Khalas, 40, is a father of three. He and his extended family of 80 people have returned to the Jussa area where they had heard there were abandoned houses they could live in.
“But when we got there all the houses had been already occupied so we ended up in a school. We have all been living in a big room with just one toilet for a year. There are no showers. Can you imagine living, cooking and washing in the same space?”
Khalas said that his family owns land and have the documentation to prove it, “But now someone else is farming the land. We survive on dry food distributions. Some NGOs donate foodstuff but it is never enough. We are a big family. Believe me in our home a frozen chicken is a big feast.”
“We have no money, no opportunity to work.”
Khalas, with his ailing mother, is a patient at one of MSF’s clinics.
MSF has opened mobile clinics in three villages to serve the area. They began operating in Jussa in October 2015, in Abu Wajnam in January 2015 and, most recently, in Hutheima at the end of April, where they are supporting the Kurdistan Region’s Department of Health’s Primary Health Care Centre, including providing training of the local medical professionals.
For the 170 families, less than one third of the village, that have returned to the Hutheima area since it was retaken by the Peshmerga, life is slowly returning to normal. Farmers are in their fields, the sheep market is busy, and an oil company has resumed operations in the area, providing some employment.
But the sounds of mortars from the frontlines just six kilometres away means the war is never far from people’s thoughts.
“Things are slowly improving; security is stable, people are starting to work again, electricity and
water are back,” said Khalaf, the Mukhtar of Hutheima. “[B]ut when mortars and bombing hit villages on the frontline, people flee and move to Hutheima for a few days. Once the fighting is over they return to their homes.”
Unexploded devices also pose a serious hazard, for the locals and the mobile MSF teams. "Once, as we were driving to carry out an assessment, it was pouring with rain and suddenly we saw an IED on the road and called the security forces and eventually had to wait for them to dispose of it before we could continue," said Baroj, who is responsible for the security of the MSF teams.
"In this context we need to follow very strict security rules and part of my job is to maintain a network of sources, authorities, community leaders, and other actors in order to exchange information in a timely manner."
MSF teams do not work with any security teams. They do not hire private security guards and they operate completely independent of local, national, and international, civil and military authorities. Instead, they rely on building up a network within the communities they are there to serve. They depend on being known and accepted by the local population and communicating closely with them.
Their mobile team in Nineveh includes two doctors, three nurses, a psychologist, and a psychosocial counselor, offering general medical care with a focus on sexual and reproductive health as well as chronic diseases and mental health.
Before MSF began operating their mobile clinic on April 27, health services in Hutheima were minimal with a shortage of medication and no doctors at all.
KRG Department of Health staff did their best, offering a few medical services out of the house of the Sheikh, but it was not enough.
“Of the 4500 people who live in this area we could only cater for 2% of those in need of medication,” said Abdul Khader, a Department of Health lab technician in Hutheima. “We had to turn down people and that was really hard. One boy was suffering from epilepsy but we had no drugs to give him.”
“People know we don’t have medication so most of the time they don’t even bother to come,” he added.
Before MSF began working in the area, people in Hutheima had a 40 minute drive through highly militarized areas to reach a health professional. And the closest hospitals were in Duhok and Zakho, two hours away.
MSF noted that the community is poor and people are unable to drive to access health care, nor can they afford to pay for private services.
If a patient needs specialized care beyond what the mobile team can deliver, MSF provides referrals – necessary documentation to cross through the many checkpoints.
Since the beginning of the year, the MSF mobile clinic team in Nineveh has provided 3,454 out-patient department consultations, 1,180 non-communicable disease consultations, 271 sexual and reproductive health, including mother and child care, consultations, and 206 mental health consultations.
This article has been modified from the original to correct a date. MSF's clinic in Abu Wajnam was opened in January 2015, not January 2016 as originally stated.