by Diane Hanna
Seventeen year old Hala* was pale, and she was quickly bleeding out. Her mother was screaming and crying while her grandmother prayed silently from a wheelchair.
They had all been brought into our trauma hospital in Adhba by our field ambulance after their last minute decision to flee their ISIS captors resulted in a horrifying gunshot wound to Hala’s stomach. She was 9 months pregnant.
This was during the final battle for Mosul in 2017, the offensive to retake control of the city and push the terror group out from their final stronghold.
As a psychologist and former Australian Army medic, I was on my first deployment to Mosul. 15 km from the frontline, my organisation had turned a broken down cement factory into a trauma and maternity hospital to provide medical services for those fleeing ISIS captivity in Mosul.
Hala was immediately taken into the operating room. Her mother and I walked around the small compound while her grandmother rested. Hala’s mother cried and pulled out a small Christian card from her pocket, kissed it and handed it to me, curling my fingers around it. We prayed together and walked some more.
The situation was critical. Hala’s mother was sobbing inconsolably, and I began to wonder if she or her baby would survive. I was careful not to create any false hope, as her condition did not appear hopeful.
After many hours, surgeons finally managed to save both Hala and her baby, who had only suffered a bullet graze to her tiny wrist. The trauma team emerged from the operating theatre smiling triumphantly after working tirelessly to save both of them.
As surgeons presented Hala’s baby to her proud grandmother, she smiled but motioned with her hands to give the child to me first. After I held Hala’s baby in my arms, her grandmother handed me back the Christian card as a parting gift. To me, Hala’s baby became known as ‘The Miracle Baby of Mosul.’
Unfortunately, the reality is that even the most dedicated medical staff are ordinary human beings, not miracle workers, and things don’t always work out so well. Two years after the liberation of Mosul, the medical personnel who treated the wounded still carry the weight of the countless lives lost and the memory of the many atrocities we witnessed.
We saw many casualties, and the sight of blood flowing out of the ambulance doors never got any easier. At times there were up to five victims of violence that had been shot, blown up, or cut up all in one ambulance. No matter how severe the wounds, they had to wait at the front gate with precious seconds ticking away while a security check was done.
Trained medical professionals learn early about boundaries and the emotional cost of over-identifying with patients, but the context of war changes that. War injuries are vastly different from car accidents and regular admissions that are often seen, and the staff at our field hospital outside Mosul was constantly exposed to blast and chemical injuries, burns, and other severe injuries for 12-18 hours a day, seven days a week.
One afternoon, staff gathered around the bed of a dying man. The man had eventually passed away after sustaining blast injuries. Staff members were struggling to contain and conceal their emotions, avoiding each other’s gaze.
Alex, our security officer, took me to the front gate to inform the family. It was the hardest thing I had ever done. His brother fell to his knees onto the sharp stones and sobbed hysterically. Alex and I watched him drive away, holding his dead brother in the back of a stranger’s utility.
The people we treated reminded us of our own family and friends, and the difficulty of coping with such emotionally intense working conditions could often be seen in the form of silent tears, confusion, and social withdrawal. Alex has since left Iraq, but three years later he continues to express his sadness, saying, “The things that hurt me the most, was not being able to save everyone - all those children…”
We ate dinner that night under the stars, mopping up rice and tomatoes with stale bread. Flat expressions all around, shuffling back to the kitchen to make tea before heading off to try and sleep and then rising to do it all again the following day. A joyous win for Hala and the devastating loss of somebody’s brother, and more patients to care for after either scenario; this is the harsh daily reality of such deployments and missions.
In the months that followed, the toll taken on medical staff ranged from confusion and anxiety to alcoholism and trauma. The importance of pre and post deployment screening, as well as follow up interviews and regular counseling and debriefing for all personnel deployed in hostile environments, cannot be understated.
While I served our mission as a staff psychologist employed for the sole purpose of providing psychological intervention to staff members, this type of support is not typical for medical and humanitarian missions in Iraq. In most cases, staff are usually given nothing more than a phone number for a mental health contact that is often based in a completely different country.
In May of this year an exasperated senior level security advisor to 3 major NGOs operating in Iraq said, “the mental health care chain is non-existent, and there is no psycho-social support for NGO staff, just a phone number.” Another medical officer who served in Iraq and has since returned to her home country referred to this mental health phone contact as “useless.” One nurse who I know personally refused to go on any further missions due to “the lack of support there and when you get back home.”
As the humanitarian effort continues in Iraq with no end in sight, it is my professional opinion that all humanitarian organizations working here need to undertake a review of the deployment, debriefing, and follow up processes to ensure the integrity of the working contract, insurer commitments, and duty of care to all personnel. As a professional who works in the field of psychological care and as an individual who has personally experienced the inadequate debriefing process, it is clear to me that more needs to be done.
Medical personnel put their lives on the line and are frequently subjected to vicarious traumatization, which may not present itself for years. If we can summon the funds and manpower to execute such humanitarian missions, then our efforts should also focus on protecting and supporting those who come to Iraq to offer humanitarian aid.
*Names have been changed to protect identities.
Diane Hanna is a senior consultant, psychologist and artist from Sydney, Australia. She has been deployed on 3 separate missions to Iraq in 2017 and 2019, and currently lives and works in Erbil.
The views expressed in this article are those of the author and do not necessarily reflect the position of Rudaw.
