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“The security situation is still very fragile”

Enzo Cicchirillo - Field coordinator
Enzo Cicchirillo, Field Coordinator for MSF in Iraq, relates his experience of managing an MSF hospital in the recovering city of Mosul.

    What is the current situation in Mosul, Iraq?

    Since West Mosul was retaken from the Islamic State (IS) group last year, people have started to return to the city. But homes, infrastructures and services have been almost completely destroyed. Most hospitals and clinics were bombed and there is a severe lack of services, equipment, medical staff and medication.

    The security situation is still very fragile. Violence is recorded daily in and around the city. Improvised explosive devices, mines and unexploded ordnance are also a risk for people as they return home.

    What are the needs of the population and how does MSF respond to them?

    The MSF hospital in West Mosul is one of only two functioning hospitals in that part of the city, and is operating around the clock to keep up with the demand. When Mosul was being retaken, the first phase of our intervention was focused on war-wounded patients.

    Today, in post-conflict Mosul, our intervention has transformed into a more regular service for the community. We converted a former healthcare centre into a hospital where we have a maternity ward, a paediatric and new-born department, an operating room, and an emergency room.

    Each month, we delivered 400 babies, performed 120 surgeries and admitted more than 2,000 patients in our emergency room. We have expanded our sexual reproductive program to offer antenatal, postnatal and family planning services.

    Sadly, winter is further exacerbating the inadequate living conditions. Many children and adults are living without access to clean water and electricity, and as temperatures dip close to zero degrees Celsius, MSF is seeing a growing number of children in our facilities with respiratory infections. The poor living conditions are also causing skin diseases, diarrhoea and neonatal sepsis (bacterial infection in new-born babies).

    MSF has an important role: to provide free quality health services to the most vulnerable populations.

    In this period of reconstruction for Mosul, where the health structures are slowly restarting but still lack essential resources, MSF has an important role: to provide free quality health services to the most vulnerable populations.

    What is your role on site and what challenges do you encounter on a daily basis?

    I am the Project Coordinator, which mainly consists of two components: hospital management and security management for expatriate and national staff. The daily challenges of this mission relate to the high number of personnel to be managed, two hundred and ninety, of whom almost all the medical personnel is assigned to us by the Ministry of Health. We are very grateful to them, but it also means that the staff needs to be trained in our MSF protocols and our quality of care requirements for patients.

    Another challenge is to find healthcare facilities where we can refer patients that we cannot treat. The resurgent health structures are saturated and lack resources.

    And finally, the management of safety with, several times a day, incidents whose impact on us and our activity must be assessed instantaneously and to which we must give a proportionate response, without unduly endangering us, nor inconsiderately stopping our medical activity with all the consequences this would have for our patients.

    The most common example is the closure of certain areas of West Mosul for military operations, sometimes adjacent to our hospital. During these situations I have to ask myself: "What are we going do? Should we leave the hospital to avoid endangering our medical teams? Or do we keep it open because our patients need us?" I have to consider different solutions, such as working with a reduced team or shortening the time we spend in the hospital.

    A similar dilemma appears when we have to take one of our ambulances into an area considered a “no go” zone for security reasons. Often we have a child who needs to be referred to another hospital for emergency surgery. Again, I must weigh up the options. If we send the ambulance we may risk the lives of our ambulance driver and nurse. But if we don’t, will the child die? Managing these situations is part of my daily job.

    How does it feel to be on the field during the holiday season? How is the spirit of MSF staff (national and expatriate) at this time of the year?

    The end of the year festivities are always a bit special. It is a time when you would like to be home with your friends or family. I've been spending these holidays on the field for a few years now. On the Mosul project, we had a quiet celebration, on the one hand because the activity is intense and the teams are tired, but also because we are still in a country that is hard hit. 

    Do you have any anecdote to share?

    There are lots of moments that touched me on the field.

    Most people know that we provide high quality of care for free and are sometimes come from very far away to our MSF hospital. It was the case of Khawla, 20 years old. She came to the MSF hospital to deliver her second baby, Noor. She had a caesarean section at 4am on 14 January. She wanted to come to the MSF maternity because “they provide better medical services and also because of the good reputation of MSF.”

    It is always heart-breaking for MSF to have to refer toddlers to other health facilities that often don’t have all the necessary medicines, oxygen, or equipment because we are unable to cope with the influx.

    Header image: a patient arrives at the MSF post-operative hospital by ambulance, south of Mosul, Iraq. April 8th, 2017.© Diego Ibarra Sánchez/MEMO