Dr Natalie Thurtle has just returned from Iraq where she was working as an emergency doctor in a Médecins Sans Frontières hospital close to Mosul. She describes her encounter with Iraqi suffering through the stories of her medical colleagues.
“Early in the morning, on the journey to the hospital, I lean my cheek against the searing hot window, looking for a home without its skin pockmarked by artillery, or even one, in some suburbs that remains standing. I count the fallen electricity pylons, trying to take in what a very fresh war leaves behind. I am just here for a short time. I’m a little nervous that I won’t ‘get it’. But when we walk into the emergency room (ER) such introspection seems suddenly superfluous and evaporates.
"Sometimes, on initial assessment, we can’t tell if they are shocked from blood loss or not, because of this grey colour"
The blunt grey pigmentation of most patients arriving in the ER in West Mosul now is distinct. They are infiltrated head to toe by the fine particles generated by the razing of a large city. Sometimes, on initial assessment, we can’t tell if they are shocked from blood loss or not, because of this grey colour. More than once I have put my hand on someone’s wrist, expecting to feel nothing, instead feeling a florid pulse full of vitality. But not always. Children arrive alone, staring and hungry, some with days-old blast and crush injuries.
Médecins Sans Frontières has rebuilt and renovated a small hospital that was destroyed during the conflict. We have set up trauma (ER and operating theatre) and emergency maternity facilities. There is only one other functioning hospital in this part of the city so the need is high. The ER has nine acute beds and nine doctors from Mosul have been recruited to work in the ER and I am here to support and work alongside them, as well as support maternity.
"Children arrive alone, staring and hungry, some with days-old blast and crush injuries"
Dr Fatima: “I’m psychologically traumatised”
I introduce myself to the senior Iraqi gynaecologist on call, Dr Fatima. In response to the normally rhetorical question of ‘how are you?’ she tells me she is psychologically traumatised. I sit down. The rest of the team – midwives, nurses, and translator – become quiet around the table. Dr Fatima tells me that a few days ago her parents, her brother, and his family escaped from the IS group held area. She was elated as they made their way out, expecting to see them finally after many months. Three hours later they were hit by a mortar. Her mother, brother, and his two children were killed.
Her brother’s wife has had bilateral above-knee amputations. Her 80-year-old father survived – he weighs 35 kg, the weight of a nine year-old boy. Now he sits in her house in the east, waiting for her to come home. He asks for his wife. Dr Fatima hasn’t told him yet. She shows us pictures of her family on her smart phone, pictures from before. She and we around the table, let tears fall. We gather ourselves up and I say, not knowing really what to say, ‘Do you need time off?’ ‘No. I need this’. An hour or so later she expertly performs an emergency Caesarean section.
"Her 80-year-old father survived – he weighs 35 kg, the weight of a nine year-old boy"
Dr Mahmoud* treats children like they were his
One day, I eat falafel sandwiches with Dr Mahmoud. He tells me he was a paediatrician, before. Then he tells me about the escape. After two years working under duress, living under siege, he felt that it was too dangerous to wait. He thought that he and his family would die if they waited. So, they ran – he planned it and escaped from ISIS-held territory in the middle of the night with his children. ‘It was very dangerous,’ he says. I nod. People from Mosul rarely use such statements, so I cannot imagine it. Somewhere close a dull thud, an IED maybe or a mortar, punctuates his sentence. We finish up the falafel sandwiches and go back to work. He treats injured children that day, and every day that I work with him, gently, carefully, like they were his.
Maternity. A new life is being squeezed out, the perineum carefully protected by midwife Maha. It all moves smoothly in my peripheral vision as I sit at the little plastic table sifting through patient notes. A little while later she sits quietly at the table. She doesn’t speak much English but gets her phone out and shows me pictures of something. It is flattened, there is nothing left, it is just rubble. ‘Your home?’ I ask. ‘Yes’.
What drives Médecins Sans Frontières partly, is the idea of equity. That people may not have the same health needs, but they surely have the same right to care and compassion, no matter what they have done or what has been done to them. This is not difficult for me. There is simply a patient. But for our staff that all have a similar story, it is much more complicated. Imagine an armed group has taken your worldly possessions, your home, and your chances at an education, but also your friends, your family, your mental and physical health, your security, your city and your identity. They have forced you to work, under duress, in a warzone, for three years. Imagine it.
"Imagine an armed group has taken your worldly possessions, your home, and your chances at an education, but also your friends, your family, your mental and physical health, your security, your city and your identity"
To say that you will stand up and treat everyone the same, equitably, is extremely complex. But they did it. It wasn’t easy, it wasn’t always absolute, but they did it. Working with the staff in Mosul was humbling. Because no matter what suffering they had been through, they continued to uphold Médecins Sans Frontières’ principle of equity, of providing the same care and compassion to all patients. On the way home from the hospital, even on a difficult day, I would notice the sunflowers. Fields of bright yellow sunflowers, upturned in the setting sun, cheek by jowl with the checkpoints and the rubble and all of the scars of war.”
*Names have been changed