Two days earlier, Ahmed and his family were caught in crossfire while fleeing their home. Ahmed himself was hit several times, his wife and parents were seriously injured, and his youngest son died in his arms. “As we were running, I turned back and found my son gasping,” he says. “I saw he had multiple gunshot wounds to his back and chest. As a nurse, I knew that my son was dying.There was nothing I could do to save him.”
Ahmed’s two older sons were also in the hospital, physically safe but visibly traumatised; both staring silently into empty space.
Surgeons imprisoned in hospitals
Before June 2014, MSF’s Iraqi staff say that hospitals in Mosul provided a very high level of medical care. There were skilled nurses, doctors and surgeons, adequate medications and high-quality equipment available and accessible to all. Under IS control however, the quality of services began to decline.
According to Dr Yasser*, a surgeon from Mosul, many medical workers decided to stay in the city despite the risks, in order to help the people of Mosul.
If someone had a serious medical condition, they had to ask permission to leave Mosul for treatment. If allowed to travel, a relative would be taken as a ‘guarantee’ in case they didn’t return.
"All the medical supplies and drugs were taken from public hospitals to supply a select few under IS control," he says. "Fewer and fewer clinics were able to operate because of this. If someone had a serious medical condition, they had to ask permission to leave Mosul for treatment. If allowed to travel, a relative would be taken as a ‘guarantee’ in case they didn’t return.”
After the battle for Mosul began last October, many health workers in IS controlled areas were reportedly forced to live within the confines of the hospitals - made available to treat wounded fighters.
Surgeons especially were imprisoned and couldn’t leave the hospitals.
“Surgeons especially were imprisoned and couldn’t leave the hospitals,” says Dr Wassim*, an MSF doctor. “Civilian injuries were neglected and fighters were prioritised over ordinary people.”
“It’s a disaster to be a patient in west Mosul”
Many medical workers reportedly remain amongst the estimated 200,000 civilians trapped in west Mosul. As fighting has intensified many hospitals have been damaged or destroyed by gunfire, shelling or airstrikes.
For the past two weeks, I worked in one and it was only me in my ward. There used to be eight to 10 staff per ward.
“Few hospitals remain in west Mosul,” says Ahmed, from his hospital bed. “For the past two weeks, I worked in one and it was only me in my ward. There used to be eight to 10 staff per ward.”
During the fighting some medical workers went into hiding, sometimes treating patients in their houses.
“We knew war was coming and we prepared ourselves months ago – we all did,” says Dr Wassim. “I had been stockpiling drugs and essential medical supplies for some time.There were many doctors in the neighbourhood, and each one had a street, block or area to cover. The equipment wasn’t sophisticated."
Most of the patients who needed intensive care have died, and a lot of others have died because they couldn’t reach a hospital in time.
"We had painkillers and antibiotics, but we lacked lifesaving equipment like chest tubes, so we had to improvise.One day, after an airstrike, a concrete pillar fell on the leg of a patient trapped under the rubble.They could not move him, so a general surgeon had to do the amputation with only morphine for pain relief, but he saved this person’s life.”
“It is a disaster to be a patient inside west Mosul”, says Ahmed. “Most of the patients who needed intensive care have died, and a lot of others have died because they couldn’t reach a hospital in time.”
During the battle for Mosul, many health workers have themselves been victims of violence or seen their relatives, friends or colleagues maimed or killed. Concetta Feo, an MSF psychologist, has been organising individual and group sessions to provide psychological support to MSF’s Iraqi staff as well as training them in psychological first-aid.
All of our Iraqi colleagues, medical or not, request mental health support,
“All of our Iraqi colleagues, medical or not, request mental health support,” says Concetta. "They say this is what they need most. They have all been through traumatic events, with medics in particular being exposed first-hand to the horrors of the conflict. For months, or even years, they have been risking their own lives to save others. After an airstrike, the ambulance drivers and nurses are often first on the scene to pick up the injured, or dig in the rubble, fearing that amongst the victims they will find relatives, neighbours or friends.”
"I'm a doctor and it is my duty"
"When we receive wounded patients, the first thing we ask is, ‘Where are you from?’” says Dr Wassim. “This is because all the areas in west Mosul are our areas – our families live there. My nightmare is that one day I will receive my family member in the emergency room. Sometimes we lose our professionalism and our emotions are too high. We are not stones.”
Despite the extreme challenges and deep sadness of daily life, the resilience of the health workers of Mosul is awe inspiring.
“Waiting for news and expecting bad news is emotionally and psychologically consuming," concludes Concetta. "But for many of our staff, working in MSF hospitals is healing. It means they are doing something concrete to support those still trapped on the other side."
On whether he sees his work in Mosul as heroic, Dr Wassim says: “There are no heroes in this story, only victims. We just don’t have a choice. Sometimes I fear for my life when I go out and retrieve wounded patients. But then I sit for a moment and think, ‘If I don’t go, this man will die – and it will be my fault, because I didn’t help.' I’m a doctor and it’s my duty.”
* Names have been changed
** Main picture: an MSF doctor takes care of the refugees who have just arrived at camp U2 in Mosul-South. © Giulio Piscitelli