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Mariko Miller, a nurse working with MSF in Kirkuk, in northern Iraq.

Mariko Miller is a Canadian emergency nurse working with Mdecins Sans Frontires (MSF) in Kirkuk, in northern Iraq, where MSF teams are providing healthcare to people forced from their homes by armed conflict, and supportingemergency care in two hospitals.

Many of the displaced people come from Hawija, a district southwest of Kirkuk that has been under the control of armed groups for more than two years. Since the intensification of military operations to retake the district in August last year, it is estimated by the UNHCR that more than 80,000 Iraqis have fled Hawija. Many families tell us about lack of food and fuel in the area, and about perilous journeys to reach safety. However, despite the scale of people's needs, humanitarian assistance remains largely insufficient.

Mariko shares her account of assisting people arriving in Kirkuk:

"There are eyes darting around me in a crowd with a vigilance I haven't seen before, and I'm watching a little boy in his mother's arms. His hands are desperately grasping at the air around him with an acute hunger that is painful to watch. There is a packet of biscuits in a box in front of him and I watch his eyes focus on them. He grabs the biscuit, then struggles with the plastic wrapper, and this image of him stays in my mind. He is too young to be so hungry, too young to understand the decisions his family had to make to survive, or how this journey will define his future. Around him people are scattered in groups on the ground, huddled around boxes of food, eating desperately after six days of hunger and two years of suffering in areas under the control of armed groups.

The boy is among 647 people who have arrived safely from Hawija, a place suffocated by suffering. All these new arrivals chose to leave Hawija and undertake a journey that some people don't survive. The other night many families were executed after being caught trying to escape. Those who make it out of the town have to travel 7 kilometres at night through a desert scattered with landmines and improvised explosive devices, where snipers sometimes hit their mark. They have taken a calculated risk, knowing that they might die. But the people in front of me have made it, they are alive.

Many women who come to see me cry as they talk about the people they left behind in an area that is being hit by aerial strikes and where an offensive is expected. One young woman lost her entire family yesterday when they stepped on a landmine in the dark, and her grief is palpable, horrifying. There are many other people who sit silently, self-protective, eyes averted, eyes that have seen more than eyes ever should, in a state of shock that feels impenetrable, yet necessary, because they are not yet free. They must still survive.

There is an older man who sits alone, short of breath and with a loud audible wheeze. I am giving him some Ventolin so he can breathe, but instead of breathing better, he starts to cry, and tears fall.His son is in Hawija. This is all he needs to say.

Sometimes the hardest thing is to hear these stories and to maintain a professional composure. When I feel the tears build behind my eyes I don't know what to say other than, "Inshallah, [God willing] your son will arrive safely". The man looks at me with glassy eyes, repeats, "Inshallah" and looks up at the sky.

Two small children lost their mother in a landmine explosion yesterday. The air I breathe is blanketed in suffering, and it is shedding layer after complicated layer all over the land.

There is an eight-year-old boy whose little sister is sick. He says he has not slept in days because at night the women sleep, and the young boys keep guard. He is serious and strong, his emotions flat. I see children hiding food in their pockets, and the sight of this hurts because they are still in survival mode.

This week, several children have arrived with blast injuries and our doctor has removed shrapnel and metal from little limbs. The team has safely referred these children to the emergency hospital in Kirkuk, which MSF is supporting. We see only the ones who make it, the ones who have survived the perilous journey and reached the entry points beyond the frontline, and we know there are many who have been left behind.

At a different entry point, a young man collapses as he climbs from a truck. He is unresponsive and pale, but alive. He is carried to our clinic and, while I grind my knuckles into his sternum to get him to respond, I see tears spill out from the corners of his eyes. He lies on my floor, weeping, until finally he is able to sit up. He tells me how his parents were killed recently and his brother is in Hawija. His wife is pregnant with their first child and he feels overwhelmed by uncertainty. We sit on the clinic floor together and his pregnant wife joins us and they cry together. He thinks that I have saved his life and, with clasped hands, he tells me he will pray for me every night. His courage overwhelms me.

We are building our project from the ground up, and we are preparing for the days to come. We have started training staff in the main emergency hospitals and we are gaining access at entry points to provide a response for war-wounded and emergency arrivals. Our medical teams are growing quickly to build capacity, and the solidarity of the team makes it easy. Humanitarianism and medicine intersect here and remind us of MSF's identity. The need for our presence here is obvious. The gratitude from our patients is humbling and, as heavy as the air is in pockets here, we are all exactly where we need to be."

More:
Iraq: Assisting people displaced from Hawija - Mdecins Sans Frontires (MSF) International