IRAQ: in Fallujah, people are returning home after fleeing the war…
In the western part of Iraq, Ramadi and Fallujah are two iconic cities of Anbar governorate that were captured by the Islamic State of Iraq and the Levant (ISIL) between 2014 and 2015. In 2016, the Iraqi armed forces and their allies launched a military campaign that aimed to recapture ISIL-held areas. The targeted areas included these two cities, which are in a state of widespread destruction. In a region already largely ruined by the Iraq War years earlier, everything has to be rebuilt and the population is challenged to meet its most basic needs.
Informal Settlement in Ramadi, Anbar governorate, IRAQ – © Batiste Hostache Herrera | Première Urgence Internationale
During the period between 2014 and 2016, heavy fighting led to a massive population movement inside the country: a vast majority of the displaced people came from Anbar and Ninewa governorates, two areas strongly affected by the conflict.
7 years after the onset of the crisis, around 2.5 million people are still in need in Iraq. The conflict led to the internal displacement of 6.1 million people from their original areas to camps and other informal settlements.
Now both Ninewa and Anbar governorates are reporting the highest percentages of returns. Within Anbar, Fallujah District is reporting 92% of returnees and most of them are still living in severe conditions, either in informal settlements or in rental houses.
A health sector severely damaged by the effects of the conflict
The health sector is dramatically underserved in the area, and particularly in the sub-district of Amriat Al Fallujah (AAF). There, the main hospital had been the target of repeated strikes for months during the conflict, and the impacts are still visible on the walls.
When Première Urgence Internationale team assessed the needs of the facility, the hospital lacked medical equipment, materials, and medicines to cover all the needs of the population and to cope with the workload. The hospital was also unable to provide Mental Health services due to a lack of staff.
All people with mental health needs were systematically referred to Ramadi Hospital supported by Première Urgence Internationale through another project, and where the only psychiatrist of the governorate is based.
AAF Hospital, Anbar Governorate, IRAQ – © Batiste Hostache Herrera | Première Urgence Internationale
Première Urgence Internationale decided to support the recovery of the area while also strengthening the Anbar Directorate of Health (DoH) to meet the needs of the population in a sustainable way. Supporting AAF hospital clearly appeared as essential, as the facility is covering a catchment population of around 130.000 individuals and serving as referral point for eight Primary Health Care Centres (PHCCs) in addition to covering large informal settlements.
Première Urgence Internationale is currently implementing a multi-layered response to address the most urgent needs of the hospital and improve its service delivery. As distance and barriers to medical services can have an immediate impact on morbidity and mortality, this support will seek to close these gaps in the community around and reduce the burden on patients.
Première Urgence Internationale was able to provide core medical, laboratory and non-medical equipment like water pumps and heater, to ensure available and proper water for the patient and the staff. The hospital is also supported with trainings on proper stock management with rational resource allocation so that the pharmacy stock can be more accessible and efficient.
With this objective in mind, the team supports the rollout of a Health Information System (HIS) for the pharmacy and the warehouse, in close coordination with the Directorate of Health. This will help implement a better tracking for the long-term needs of medications, consumables and medical equipment.
The staff of the facility have been trained to ensure the proper use of this new software, and IT equipment has been procured as well to meet the needs of the hospital.
Provision of IT equipment in AAF Hospital, Anbar Governorate, IRAQ – © Yousif Ismael | Première Urgence Internationale
Strengthening the existing health system is key to maintain a sustainable recovery
The project implemented by Première Urgence Internationale aims at strengthening the health system already in place on a sustainable way by both delivering trainings to the staff of the hospital and providing the missing equipment.
Première Urgence Internationale team have conducted training sessions on Emergency Care as well as Infection, Prevention and Control (IPC) procedures. Thanks to a “Training of Trainers” approach, the attendees can train other staff and share their newly acquired knowledge, including environmental cleaning and medical waste management.
Première Urgence Internationale also provides a capacity-building component focusing on Mental Health and Psychosocial Support (MHPSS), including perinatal mental health topics, to medical staff selected by the Directorate of Health (DoH). It is also supporting the deployment of a psychologist and psychosocial worker in the hospital to conduct MHPSS consultations and co-counselling with the newly trained hospital staff.
In the meantime, the referral pathways for mental health services are improved to remain functional and beneficial for the patient after the project is completed.
This project is supported and funded by the French Ministry of Europe and Foreign Affairs
Crisis and Support Center (CDCS).
 Humanitarian Needs Overview, OCHA