Iraq: Alongside families living in camps, to keep them safe from COVID-19

In Iraq and Kurdistan, Première Urgence Internationale is an important camp health actor, managing primary healthcare centres in three camps hosting refugees and internally displaced people. To continue responding to the needs of these vulnerable populations in these times of pandemic, the mission reorganised its functioning, putting in place quarantine areas and conducting awareness raising sessions.

A COVID-19 awareness raising session in Bardarash camp, Dohuk governorate. © Première Urgence Internationale – March 2020.

Première Urgence Internationale is managing three camp primary healthcare centers in Iraq and in the Kurdistan region of Iraq: one in Salamiyah camp, one in Bajet Kandala camp, both hosting internally displaced people, and the last one in Bardarash camp, hosting Syrian refugees. In all of these camps, the humanitarian needs are high: internally displaced people and refugees are among the most vulnerable people in Iraq, in acute need of humanitarian assistance.

Avoid the spread of the virus in the camps

Before the pandemic of COVID-19, Première Urgence Internationale was already intervening in these camps, managing the primary health care centers and providing integrated health, protection, water and sanitation services to the camp residents.

Along with the virus outbreak in the country at the end of February 2020, Première Urgence Internationale has been reorganizing and adapting its activities, in order to help populations face the pandemic and minimize the risks of contamination:

• Reorganizing the health facilities’ welcoming and waiting areas to maintain distance between the patients: the beneficiaries are now waiting outside in the open area and in a fair enough distance from each other in the pre-arranged seats. They are sent to the indoor waiting area in small numbers to ensure the required distance in the indoor waiting area as well. The triage considers those with the respiratory tract infections and complaints the priority.
• Community health workers are conducting awareness raising sessions on COVID-19 for the camp population on a daily basis, tent-to-tent, as well as in the waiting areas of the facilities. Première Urgence Internationale also displayed posters on the facilities walls.
• All staffs have been trained on case detection, referral and reporting. A strict follow up on cleaning and disinfection of the equipment and facilities is also ensured. When in the camps, the teams wear masks and make sure that all precautionary measures are taken, to avoid any spread of the virus in the camps
• In the three camps, isolation areas (rooms or tents) have been put in place outside of the health facilities, with a separate access pathway, for a temporary isolation of any suspected case until they are referred to the preassigned hospitals, by governmental ambulance and teams. These isolation rooms are equipped with PPE items, medical furniture and oxygen.

Isolation tent in Salamiyah camp, Ninewa governorate. © Première Urgence Internationale – March 2020.

Mitigate the mental health impacts of COVID-19

The current COVID-19 pandemic is causing a lot of anxiety and concern, especially among critical and vulnerable populations, which include children (whose normal daily routines are disrupted), people in quarantine, health workers as well as people with pre-existing mental health condition (depression, anxiety, psychotic disorder). Some of these conditions, if untreated, are life-threatening themselves and some of them influence the capacity of the affected people to follow the necessary preventive measures and observe their physical health.

Essential mental health services have therefore to be maintained even during this health crisis. But preventive measures which are currently in place, such as movement restrictions, impact the ability of affected populations to attain certain humanitarian services. “Movement restrictions have potential to influence negatively the mental health, especially among the camp populations, where families have to stay all day long in a small tent”, highlights Tiina Hokkanen, Mental Health and Psychosocial Coordinator on the mission. “Narrowness decreases the chances to use time in constructive ways (playing, physical exercising, handicraft) which increases the risk of using non-constructive coping strategies like sleeping too much, as well as alcohol and tobacco use. Crowded conditions increase the risk of family violence, child abuse included.”

Movement restrictions and limited working hours in the health facilities also increase the risk of patients running out of their psychotropic medication, which in turn increases the risk of relapse and risky behavior (violence, self-harming, and suicidality). The uncertainty, distress and possible stigmatization related to the pandemic together with the measures that are carried to control it, has potential to induce a mental health disorder in population who has vulnerability to that and potential to exacerbate pre-existing mental health disorder.

In order to work within the restraints of COVID-19, Première Urgence Internationale quickly adapted its programs, including the use of remote connection (phone) for individual follow-up of beneficiaries. Acute patients are reached by phone by psychologists and psychosocial workers: Première Urgence Internationale’s mental health field staff developed a list of the high risk beneficiaries, who hence need to be followed up by phone. In the first phase this included suicidal patients, severely depressed patients, patients with psychotic disorders, patients with severe alcohol or drug abuse and patients with high level of anxiety. In the second phase all beneficiaries under 18 years old were reached.

Première Urgence Internationale’s teams have also been collecting data of its remote counselling service in order to improve its quality. Maintaining privacy and confidentiality are given special attention, together with child protection and gender based violence issues. The staff is continuously trained in remote counselling and case management techniques.

Ensuring activity continuation

In parallel with these activities in camps, Première Urgence Internationale also continues intervening in other areas of Iraq, as Anbar governorate. During the month of April, Première Urgence Internationale delivered hygiene kits to vulnerable households living in war-damaged shelters in Al-Rummanah sub-district, Qaim district.

For now, the mission has centralized its COVID-19 response in the camps’ health facilities on preparedness, prevention, early detection, and referral for the secondary level. All other activities that are on hold in the rest of the country are intended to be resumed as soon as the restrictions are lifted, with specific protective and barrier measures in place. The group activities won’t resume in the coming months, until Première Urgence Internationale is sure the virus transmission is no longer on-going in Iraq and in the Kurdistan region of Iraq.

These activities are implemented thanks to the funding of the United States and the American people (USAID-OFDA) and of the French Government through its Centre de Crise et de Soutien. These activities are also made possible thanks to OCHA access facilitation.