August 10, 2017

Since ISIS took control of Mosul in June 2014, 3-year-old Mustafa had only known life under ISIS rule. Last week, he learned how to run for his life as he desperately ran to escape a sniper’s bullet.

Now, living a few miles outside of Mosul, Mustafa is fearful and easily alerted, running to his father at the sight of strangers, hiding his face behind his legs.

The day after we met Mustafa, we met a baby who was severely malnourished and had excoriated skin and sores all over her tiny body. She had been brought into a medical stabilization unit for further care. She escaped Mosul a day earlier with her extended family, all of whom were also in a terrible state with open and infected sores surrounding their mouths and other parts of their bodies. On their way out of Mosul on foot, the baby’s mother died, either from hunger or thirst. They were forced to leave her body where she collapsed. The family described how they had survived by eating sugar mixed with water for the last 9 months, as no food has been able to enter Mosul for nearly a year. Others mentioned eating grass, cats or hair gel – whatever they could find. These are the devastating choices that people in Mosul had to make in order to survive.

The trauma that these families have endured is not unique; thousands of civilians have fled Mosul in recent weeks. In addition to the trauma of their flight, civilians now contend with the devastating effects of psychological and physical trauma, malnutrition, chronic illness, and dehydration.

The conflict in Iraq has unfolded on people’s very doorsteps; civilians have not only been disproportionately affected, they have also been cruelly targeted. The international community needs to adapt and scale up their response to provide children like Mustafa with the assistance and rehabilitation they desperately need. However, because of the unique nature of the war in Iraq, as well as factors such limited resources, political unease inside Iraq, and the sheer numbers of IDPs in Northern Iraq, the humanitarian relief operation is facing new challenges.

Shouldering the Burden of Psychological and Physical Trauma

We recently visited Iraq to assess and evaluate the humanitarian response and offer support. There, we found multifaceted and acute medical needs that can only be addressed by a concerted collaborative effort from the international community. Many of the displaced people we met just arrived from Mosul by foot. People with disabilities have scarce resources to help them flee. Patients with chronic illnesses have not had access to their medications for weeks. There is a high incidence of dehydration, malnutrition and heat shock that requires hospital admissions for IV fluids and well planned stabilization to avoid complications. Many of the receiving medical stabilization points are reporting cases of acute malnutrition in children. The temperatures have reached up to 120F, and the lack of shade only adds to the horrid conditions.

The capacity of the local hospitals in the surrounding area has dropped by more than 50% in the last few months. Around Mosul, five emergency stabilization points were launched to shoulder the burden of increased trauma and emergencies. Most of them are underfunded, the patients are not ensured basic supplies, and medical equipment such as ventilators or Oxygen tanks are limited.

The devastating psychological toll of the crisis is omnipresent in our interactions with patients. We heard horrific stories about their lives under ISIS rule. Some families described how they refused to send their sons as fighters with ISIS and were forced to select one child for ISIS to sacrifice as a human shield. Many residents of Mosul, including children, have lost limbs. Some of the Mosul citizens we met and treated were completely in shock – unable to talk, communicate, or trust unfamiliar faces. Humanitarian workers and health care professionals require the ability and resources to treat psychological trauma and build trust.

The Need for a Humanitarian Operation 

With 800,000 internally displaced people from Iraq and 250,000 refugees from Syria, there are nowhere near enough NGOs or volunteers on the ground to handle this mass crisis. The plan for the military operation in Mosul has been in place for a few months now. A parallel humanitarian operation should have been firmly in place in anticipation of the sheer scale of need. With a better response plan, we could have saved lives.

The current response is lacking: guidelines and resources to respond to these non-traditional conditions need to be put in place. We face limited resources, both in the stabilization units, and in the referral hospitals. Financial resources must be directed to efficient emergency responders to enable them to respond effectively in these unique conditions. Local health actors and NGOs have limited professional and financial resources and are thus unable to adequately respond to these patients.

Finally, the security and support of the humanitarian workers is another challenge that needs to be better addressed. Humanitarian workers must be protected and granted secure access to operate.

Caught in the Crosshairs

In the meantime, small victories give us hope. Near Mosul today, we delivered a baby into this world of war and suffering. As the baby’s tiny head crowned, covered in dark curls, the joy of the moment was heavy with the knowledge that the world has abandoned innocent lives.
In Raqqa and Tal Afar, children, mothers and fathers are watching Mosul, and awaiting their fate. Between terror, incapable governments, and drained financial resources, the people are caught in the cross hairs of a conflict on their doorsteps.

We must act quickly to protect the people. We are entrusted because of the humanitarian values that we serve. We can do better; we must do better.

– Ahmad Tarakji, MD & Lindsey Smith, NP


Last month, Dr. Ahmad Tarakji, SAMS President, and Lindsey Smith, NP, President of the SAMS Minnesota Chapter, visited Mosul to provide emergency assistance and to assess the humanitarian response on the ground. This fall, SAMS will be embarking on its first medical mission to Iraq with a specialized team of OBGYNs, Pediatrics and General Practitioners, in order to provide care to refugees displaced by the conflict. 

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