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As Doctors Without Borders/Mdecins Sans Frontires (MSF) continues to provide lifesaving emergency and surgical care to men, women, and children wounded in the ongoing battle for Mosul, teams are also extending their response to cover gaps in hospital care left by the severe destruction of the local health system.

"Most hospitals in Mosul have been damaged or destroyed," said Marc van der Mullen, MSF head of mission. "In western Mosul, medical services are severely disrupted and the ongoing fighting is causing many injuries and deaths. In eastern Mosul, medical facilities slowly get back on their feet but there are gaps in medical services such as post-operative care, mother and child care, and inpatient care, so MSF is working on addressing them."

Today, MSF works in six medical facilities in and around Mosul, providing lifesaving emergency and surgical care including mother and child health care, as well as providing long-term post-operative care to those in need of follow-up and rehabilitation following major surgery. The teams also provide care for children suffering from malnutrition, as well as primary and mental health care in the newly established camps for people fleeing Mosul.

Through a strategy of advanced medical posts (AMP), which can be quickly opened and moved according to rapidly changing medical needs, MSF provides lifesaving stabilization and emergency care to people wounded in fighting in western Mosul. Over the last month, MSF received 175 patients in its two AMPs in western Mosul and referred them to other medical facilities with surgical capacity, such as the MSF trauma hospital in Hammam al-Alil, south of the city.

Today MSF is working to broaden its medical services and setting up facilities with surgical capacity, including for emergency maternal care, as well as an inpatient pediatric department. The objective is to fill urgent gaps in medical services to provide for the most vulnerable population groups until health authorities can resume services.

Hundreds of thousand of people are still trapped in western Mosul. The patients who reach MSF facilities report that water and food is running low, that the few supplies available are extremely expensive, and that access to health care is almost impossible.

In eastern Mosul MSF works in a former retirement home retrofitted into an emergency room, operating theater, and maternity and inpatient departments. Since the facility opened at the beginning of March, the team has treated 4,376 patients, more than half of whom were emergency cases, and performed 93 Caesarean sections.

Also in eastern Mosul, MSF opened a 15-bed maternity unit on March 19 to provide basic emergency services allowing women to deliver safely. Since the opening, the team has brought 130 babies safely into the world.

MSF also opened a 24-hour emergency room In a third facility in Eastern Mosul Hospital that has so far received 336 patients. The team is currently setting up a surgical unit and a 32-bed ward, which will be ready in the next few days.

Since its opening, 1,904 patients have been received in MSFs field trauma hospital in Hammam al-Alil, which was the closest surgical facility to western Mosul for more than a month. Fifty-five percent of the patients were women and children and 82 percent were war-wounded. To date, the MSF team has performed 160 major surgical procedures. MSF also supports the primary health care center in Hammam al-Alil, carrying out about 500 consultations per day both for the local population as well as for the people displaced from Mosul hosted in a nearby camp.

At the hospital in Qayyarah, MSF treats medical and surgical emergencies. Since January, more than 5,657 patients were admitted to the emergency room. The team in the emergency room sees patients wounded in airstrikes and explosions or by mortar fire. A four-bed intensive care unit was recently opened to provide care for burns victims, patients in shock, and other critical cases.

As the Iraqi army advanced into western Mosul, families were able to escape. MSF teams started seeing children with acute malnutrition, a result of food shortages in the besieged area. To treat malnourished children, mainly babies under six months, MSF set up a 12-bed intensive therapeutic feeding center in Qayyarah Hospital. In Hammam al-Alil, MSF runs an ambulatory nutrition program and refers most severe malnutrition cases to Quayyarah.

With thousands of people severely wounded in the fighting, many face long months of convalescence and rehabilitation. Long-term post-operative care will therefore be one of the main medical needs in the coming weeks and months. "A persons recovery does not end with their trauma surgery," says MSF medical coordinator Chiara Burzio. "They often need many months of therapy, both physical and psychological, to allow them to rebuild their shattered lives. Our patients will bear the scars of the battle of Mosul for the rest of their lives, but our team is helping them to adjust to their new reality, and hopefully return them to their families as healthy as possible."

In Hamdaniya, southeast of Mosul, MSF provides long-term post-operative care with rehabilitation and psychosocial support in the hospital in collaboration with Handicap International. Since March 15, MSF has admitted 100 patients, about 45 percent of whom are women and children. This 40-bed facility is the only one providing such a package of long- term post-operative care in all of Ninewa Province.

According to the United Nations, over 500,000 people have been displaced from Mosul. In 17 sites west of Erbil that host such people, MSF mobile teams provide primary health care, treatment for chronic diseases (mainly diabetes and hypertension), and psychological and psychiatric care. MSF's mental health program focuses on severe cases and its activities include psychological and psychiatric consultations, group therapy sessions, psychosocial counseling, and therapy for children. Since the beginning of 2017 the team has carried out 14,098 medical consultations and 8,238 mental health consultations.

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Iraq: Shoring Up a Ruined Health System in Mosul - Doctors Without Borders