Since the start of the military offensive in Mosul, thousands of displaced people have fled south to the town of Hammam Al-Alil. Philippa Collins, a nurse from Kununurra in remote Western Australia, recently set up a primary health care centre in the town.
“The original primary health care centre in Hammam Al Alil had been hit by an airstrike, leaving people without access to general medical care. So Médecins Sans Frontières decided to support the Department of Health to set up a new facility in a bus station, using shipping containers as the consulting rooms. The initial challenge was that we were managing about 500 patient consultations a day, while still setting up the facility. My main role was to support the local staff with training, because they are the ones who will be there long term. That was fantastic because they were so motivated and eager to learn, and so grateful to be able to use their skills. I was also involved in all aspects of setting up the centre, from establishing security systems, introducing Médecins Sans Frontières’ clinical guidelines to the consults, setting up the pharmacy and placing our first supply order.
"The region hadn’t experienced malnutrition in the past, so the staff didn’t have experience in managing it"
The clinic included an ‘ambulatory therapeutic feeding centre’ (ATFC), as there were some cases of malnutrition in the area. That was quite new: the region hadn’t experienced malnutrition in the past, so the staff didn’t have experience in managing it. We had 20 patients in the ATFC program but I think we were just starting to scratch the surface, and the numbers became higher the longer I was there. Now, there are more than 150 patients. Many of the patients in the nutrition program were babies under six months. Many of the patients in the nutrition program were babies under six months. It was anticipated that malnutrition in this age group may be high due to the understanding that most women exclusively formula feed their babies in this region. Many women, however, did breastfeed their babies, but there was also a lot of mixed feeding, using formula supplementation. This was problematic because although there was some formula available, it was very expensive and many families couldn’t afford it as they hadn’t been paid in months or years. After speaking to families, I also found that women knew what weaning foods to give their babies, but those foods just weren’t available or affordable. The problem came down to poor access to food. Hammam Al Alil had doubled or nearly tripled in size due to the huge displaced population – causing major food shortages. That was challenging because it was not something we could easily address.
In addition to malnutrition we saw a mix of medical conditions, from respiratory infections to diarrhoea, and communicable diseases like chicken pox, mumps and scabies. We also saw a lot of people with non-communicable diseases. The medical system was quite good before the conflict, and people with chronic conditions like diabetes, epilepsy or mental health conditions were on the same kinds of medication that we would see in Australia. Then, when the war broke out, they no longer had access to those drugs. So MSF was in the process of re-establishing people on the relevant medications.
One particular patient who made an impact on me was a little girl who came in with her father. She was probably around two years old, and she was beautiful, very alert – but just malnourished. Her mother was not around. We did an assessment and then quickly began treating her with PlumpyNut, a therapeutic food. She came back each week for follow up, and we could see good progress with her. Before I left, her father came in to thank us and let us know how much better she was, how much she had changed.
This field placement was challenging, there were definitely tough days. But those moments where we met families, and saw the relief and gratitude on parents’ faces that there was something they could do – that was what made it all worthwhile.”
The primary health care centre in Hammam Al-Alil is conducting about 500 consultations per day for the host population, displaced people hosted in the community and people from a nearby Internally Displaced Persons’ Camp. The centre also follows up wounded patients referred from Médecins Sans Frontières’ trauma hospital in the town.