As the war fell from the headlines, the BMRC expanded their admission criteria and began to receive the survivors of non-violent trauma, such as those involved in traffic accidents and industrial accidents well as those who continued to be injured in ongoing violence in Baghdad.
When mass protests over deteriorating living conditions, unemployment and the lack of basic services broke out in Baghdad on October 1st, health facilities in the capital were inundated with those wounded in the violence accompanying the protests.
From the beginning, MSF kept a close eye on the situation in the capital and reached out to several health facilities to identify their needs, providing donations of emergency medical supplies and support.
At the same time, the BMRC, which initially had a 20 bed capacity, was expanded to be able to care for up to 30 patients from October until December. The centre treats those in need of early physiotherapy and post-operative care, including mental health support to ease and treat accompanying mental health issues.
War wounds in peace time
At around 9:30 AM on October 27, Yasser Falah’s* wife told him that she was pregnant. Two hours later, he was hit by a tear gas canister and rushed by a tuk-tuk to a nearby hospital. He was then referred to another hospital where he underwent two surgeries before being transferred to the BMRC to start his rehabilitation.
Yasser has troubles falling asleep at night. His mind travels to the country’s north where he had to dig his mother’s body out of the wreckage of their house following an airstrike during the war to retake Iraqi cities from IS. Despite taking sleeping pills he gets no more than a couple of hours of rest at night. He has lost his appetite and only takes a bite from the food stacked next to his bed every now and then.
“I graduated from the Institute of Fine Arts, but after the injury, I lost my craving to draw. I always think of my family and my work, I am the only source of livelihood for them but because of my injury I haven’t been working for the past three weeks,” he says.
With the metal spikes of an external fixator sticking out of his left leg, Yasser uses crutches to move around and go see other patients at the BMRC. He loiters on a rooftop to enjoy a few hours of sunshine and some cigarettes along with other patients. They befriend each other up there where they can share their hopes and worries, vent their emotions and dream of a speedy recovery to resume their lives.
Early medical rehabilitation plays a role in reducing short-term medical ramifications and long-term physical and psychological consequences of injuries.
Dr. Aws Khalaf, BMRC’s Medical Activity Manager
Yasser’s concerns are echoed by other patients at the BMRC who were injured during the protests. Whilst their wounds are not that shocking to the experienced Iraqi medical staff employed by MSF, the injuries of many patients are comparable with the war wounded received in 2017 in terms of severity.
Lost lives and limbs
It took hours to extinguish and then remove the tear gas canister that was lodged in Saif Salman’s right leg. After several surgeries in different health facilities in Baghdad, the decision was taken to amputate it. Any further interventions seemed pointless. It had to be done.
“I was standing on al-Jumhouriyah Bridge when a tear gas canister hit my leg. It embedded in my leg and kept on fuming gas. I opened my eyes to tuk-tuk drivers and other people swarming over me. They carried me to a hospital,” he says, adding that he was shot from close range.
“It’s true, they amputated my leg but I have two hands and another leg. Three more limbs that I can work with. I didn’t lose anything. In fact, I feel lighter now,” 24-year-old Salman says with a grin on his face.
His sense of humour will certainly boost his recovery process and those of his fellow patients but his trauma and anguish is hidden just below the surface. Salman breaks into tears when he remembers his classmate and friend who was killed during the protests.
“I cannot bear seeing his picture and get sad when I remember him. He didn’t deserve to die - I wish if I it was me who died not him,” he says, sobbing.
Early rehabilitation means better reintegration
Inside the BMRC, a multidisciplinary team of specialised doctors, nurses, physiotherapists, psychologists and non-medical support staff work not only to treat the patients in the in-patient department but also care as outpatients for those who are well enough to go home.
The work begins almost as soon as a patient’s anaesthetic wears off and the patient is referred to the BMRC by a network of doctors in Baghdad’s hospitals or by the MSF team touring hospitals in the city in search of patients in need of intensive post-surgery care and rehabilitation.
“Early medical rehabilitation plays a role in reducing short-term medical ramifications and long-term physical and psychological consequences of injuries,” explains the BMRC’s Medical Activity Manager Dr. Aws Khalaf.
Dr. Khalaf says that the consequences of not receiving early post-operative care can include blood clots and infection. By reducing the impacts of the injuries and accelerating the patients’ recovery process, the medical staff at the BMRC “help them to reintegrate in their communities as active individuals, not a burden on other people.”
In addition to the physical rehabilitation, medical staff at the BMRC see mental support as a key ingredient of rehabilitation.
In frequent mental health sessions, psychologists and counsellors seek to address depression and anxiety amongst patients, deal with their often traumatic memories and help them adjust to their new realities.
To date, 75 percent of the patients treated by MSF in the BMRC have been discharged with an improved mental health status.
The lasting social impact of violence
Like many of those injured during recent violence in Iraq, 16 year old tuk-tuk driver Kadhim Dhaygham and his brother were the breadwinners for their family. Like many others, they began to work from an early age due to the same dire economic conditions that pushed them to protest.
On the afternoon of Sunday October 27, after parking his tuk-tuk near al-Jumhouriyah Bridge and trying to cross the street, a tear gas canister slammed into Kadhim’s leg.
“It was so powerful that after hitting the person in front of me, it hit my leg and then the guy behind me. I tried to get up on my feet and started crawling then one guy carried me to a tuk-tuk. The driver drove me out to the Neurosurgery Teaching Hospital where they referred me to al-Kindy,” Kadhim recalls.
After undergoing emergency surgery and having an external fixator applied to support his broken bones in another hospital, Kadhim’s surgeon referred him to the BMRC, where Kadhim says medical staff “brought life back” to his leg with immediate physiotherapy.
Despite the improvement in his condition, Khadim has begun to feel that he is “deprived of everything.” He feels bitter for not being able to see his friends more often or leave his house. He longs for normal life, enjoying outdoor dinners with friends and tuk-tuk rides in the city.
Kadhim, who hails from a poor neighbourhood in the eastern part of the Iraqi capital, cannot wait to get back to work and help his older brother provide for his family.
“The two of us are responsible for supporting our family. We are like a pair of legs, if one of us falls, the other suffers too,” Kadhim ends.
* Name has been changed.
Mass protests against the Iraqi government's failure to provide basic services, create jobs and stamp out corruption broke out in Baghdad on October 1st, before spreading to cities in the south of the country.
The authorities’ violent response has included the use of live ammunition, tear gas and stun grenades. As a result, hospitals across Baghdad were filled with wounded and injured protesters.
MSF teams visited hospitals and provided donations of emergency medical supplies where needed and expanded the capacity of the Baghdad Medical Rehabilitation Centre (BMRC) in order to be able to offer early rehabilitation and post-operative care to a larger number of patients in need.
Among those referred to the BMRC in recent weeks is 20-year-old Ali Salim, a tuk-tuk driver who spent his days ferrying wounded people to hospitals before he ended up in a hospital bed himself.
“From October 1, they started firing at people and as a tuk-tuk driver, or the ambulance of the nation as people call us, I started evacuating wounded people. I have seen some injuries that really damaged me, I couldn’t just go back home, put my head on a pillow and fall asleep. Some get hit by “smokers” [Iraqi slang for tear gas canisters] in the head, others in the leg – my convictions didn’t allow me to leave,” he says.
Ali was hit in the leg by a stun grenade and was taken to hospital for surgery. He was told he needed to stay for two weeks to properly recover but he was unable to rest as he saw the influx of wounded arriving to the hospital alongside him.
“I thought I would be able to gather my strength, stand up and drive my tuk-tuk to save more people,” he says.
He discharged himself against medical advice after just two days. Ali was soon back at Tahrir ferrying wounded people from al-Jumhouriyah Bridge, which runs over the Tigris river linking the main square to the Green Zone where government buildings and foreign embassies are located.
“When we drive onto the bridge we turn off our headlights, but they aim towards us and fire. When they shoot, I move my head sideways as the tear gas and stun grenades or bullets penetrate the windshield – it was as if you’re watching a Bollywood film,” Ali says, adding that he never thought he would still be alive by now.
From October 1, they started firing at people and as a tuk-tuk driver, or the ambulance of the nation as people call us, I started evacuating wounded people.
Ali Salim, MSF patient
The worst was yet to come for Ali. On November 7, while posing for journalists with his heavily damaged tuk tuk, a medical volunteer asked Salim to take him to al-Shuhada Bridge where there were reports of the use of live ammunition.
Once on the scene, Ali and the medic found three injured people. The medic asked for permission from security forces to aid those injured, raising his hands over his head. They refused.
“He looked at me, smiled and told me: son, wait here,” Ali says, poignantly describing the last words uttered by the medic. He was shot in the chest almost immediately as he ran to assist the wounded.
Appalled by what he had just witnessed, Ali rushed to collect the medic and the other wounded people. But just as he was about to drive out to safety, his eyes caught sight of another injured man.
“He was an old man, I was truly devastated,” he remembers. As he approached the man, a security member shouted for Ali to go back. But he refused and was shot from point-blank range in the thigh.
Ali was taken to hospital for surgery and his tuk-tuk was never seen again.