Improving Health Access for Displaced Women and Girls in Iraq
In 2014, when ISIL militants began their rampage, millions of Iraqis raced to flee their homes. From large cities and tiny villages, an estimated 1.6 million Internally Displaced Persons spread across Iraq; a May-June 2019 International Organization for Migration (IOM) study showed that 32 per cent of these individuals still live in camps.
Internally Displaced Persons (IDPs) are often vulnerable. They need protection and assistance to meet food, water and shelter needs. They also seek livelihood opportunities and access to essential services.
“In early 2018 we conducted focus group discussions in a few camps and learned that many women had sexual and reproductive health issues and limited access to adequate care,” explained Mohamed Abdelhamid, Protection Officer at IOM Iraq. “We learned that we had to take meaningful action to address these needs in the camps where IOM operates.”
This year, IOM Iraq’s Protection and Health units conducted similar discussions in Sharya and Haj Ali: IDP camps in Duhok and Ninewa governorates respectively. During these discussions some women expressed concerns about sexually transmitted diseases, unwanted pregnancies and post-partum complications. The two units then designed a pilot programme for the camps: gynaecologists, general practitioners and nurses were hired to do free health screenings and provide medication and dignity kits (including sanitary pads, soap, underwear, a towel and other items necessary for female hygiene and self-care) to girls and women between the ages of 14 and 45.
There are 38 IDP camps in the Kurdistan Region of Iraq (KRI); 21 are in Duhok, the region’s northernmost governorate. Sharya, just south of Duhok City, hosts 16,000 Yazidis who left their cities and villages after ISIL militants besieged their ancestral lands in August 2014. IOM is one of the UN partners working with the Yazidi population in Sharya camp to address their protection and health needs.
On the morning of 14 August, Dr Eleane Ayou and Dr Atta Yelda led an awareness-raising session for girls and women in Sharya Camp, addressing topics like breast feeding, breast cancer self-examination techniques, and vaccinations. The presence of Drs Ayou and Yelda, and their nurses, has been a boon — many of the patients did not feel comfortable discussing their health concerns with male doctors or men. After the sessions they settled into their temporary office to start the third of eight scheduled health screening sessions; by midday, they would see 60 patients.
“We meet the same patients from the awareness-raising sessions in consultation, so when they see us, they open up [more easily] and tell us the things that they can’t share with others,” said Dr. Ayou.
Selection criteria for the target group included having been in ISIL captivity, pregnancy, women who got married young and those in need of immediate gynaecological care. The 14–45 age range was chosen because this demographic group is most likely to have sexual or reproductive health challenges. Urinary tract infections (UTI) are the most common problem, and the doctors see several patients with post-natal complications.
“I underwent surgery during my pregnancy, then suffered from inflammation that never fully went away,” said Sima*, a 24-year-old mother. “The doctors gave me treatment for my condition today.”
The consultation room is full of boxes of multivitamins, antibiotics, oral contraceptives and more. When patients have problems that can’t be addressed on-site, the doctors make referrals.
“I have pain in my legs, and I get bad headaches. Today I got medication for my headaches, but the doctors here don’t have what I need for my rheumatism,” Nazanin, in her forties, explained. “But I’m very satisfied with my consultation because I felt comfortable and I had privacy, so I could tell the doctor exactly what I need.”
Follow-up care and medication are provided for such patients once their test results are received. The screenings will continue until the end of August and allow the doctors to identify gaps in service.
Further south, in Ninewa Governorate, the post-conflict transition is complex; the May — June 2019 displacement tracking exercise found that Ninewa had the highest number of returnees, but also the largest number of IDPs. Hajj Ali camp, managed by IOM, currently hosts 9,500 people and was chosen as the second location for the health screening pilot programme.
An August 18 visit found the Hajj Ali operation in full swing; several children ran around the waiting area while their mothers took part in an informational session led by Dr Wassan Abd Alkader and two nurses — Valentina and Linda.
The team encourages their patients to ask questions after each session and takes time to respond to each one, so as to share the most useful information with the whole group.
The programme’s components are almost identical in both camps: awareness-raising sessions, individual consultations and free medication for patients. In Hajj Ali, the medical team screens 50 women per session. The programme’s challenges are similar too: some of the necessary medication isn’t available on-site; the absence of female doctors (due to security risks and the lack of female doctors in Ninewa Governorate) had restricted options for female patients in the past; UTIs are the most common problem.
“Access to clean water is a challenge, and this is one reason for the infections,” Dr. Abd Alkader explained. “This is why patients keep coming back with the same problems.”
One key difference in Hajj Ali is the presence of a laboratory in the camp, which allows for quick follow-up care. The repeat consultations and information sessions help spread awareness of best practices and deliver medicine to more women for free.
During both visits, protection officers carried out qualitative surveys with the patients to find out what was working and what could be improved. Patients gave valuable feedback about topics that could be interesting for future informational sessions, including subjects like early marriage and vaccinations, and several stressed that these sessions taught them something new and useful.
“[My session] addressed many things that I didn’t know before,” added Sima, the young mother in Sharya Camp. “Now I know how to check for lumps in my breasts and I will screen myself.”
The programme will continue through the month of August; lessons learned during this pilot phase will inform the programme’s implementation for the future.
The health screenings in Sharya and Hajj Ali camps were coordinated by IOM Iraq’s Protection and Health units. The programme was funded by the State Department’s Bureau of Democracy, Human Rights and Labor (DRL) and by USAID’s Office of U.S. Foreign Disaster Assistance (OFDA).
This story was written by Vanessa Okoth-Obbo for IOM Iraq’s Public Information Unit.
