As a woman living under Islamic State rule, Dr Amal Ibrahim wasn’t allowed to work openly. “Isis would never allow me to practice as a doctor, so I worked in secret. Most of the doctors had received threats by Isis and fled the city, so it became hard for people to find medical aid,” she says. “My office hours were very early in the morning and late at night, so nobody would notice. My patients were often poor, so we collected money from rich people to buy medication to give to them.”
It was a brave thing to do, because all around her in Mosul Isis was killing people for the smallest offence. “Seven of my neighbours were tortured and slaughtered because they made mobile phone calls to people outside of Mosul. One of the victims was only 16 years old.”
When Iraqi soldiers invaded the city, they sometimes carried injured people to her house. “I was the only doctor in the neighbourhood. They had no more than three army doctors and all of them were injured. They were very good to me: they threw food and medication through the roof.”
Eventually she managed to escape Mosul but her work hasn’t stopped. She is now in a refugee camp near Kirkuk, working in a mobile clinic to bring medical care to people who have managed to escape from Isis controlled areas. Her real name is not Amal Ibrahim, but to remain anonymous is a matter of life and death, she explains. “My father is still in occupied Mosul, taking care of my grandfather. If Isis find out I have fled and work as a doctor together with foreign aid workers of a different religion, they will kill my father immediately.”Her patients in the camp are mostly from Hawija, a city that has been under Isis control for almost three years. There are children who have not seen a doctor at all in their short lives. They haven’t been vaccinated and many are undernourished, or suffering from anaemia, diarrhoea or respiratory tract infections. Adults have chronic conditions that have gone untreated for a long time. Some have injuries from shelling. Psychological problems are rampant. It’s Monday morning and the mobile clinic has just opened. Under a red canopy a group of women is awaiting their turn. They are wearing black face veils or brightly coloured scarves and most of them have brought their children. With grave faces they recount the hardships they’ve endured.
“There was nothing to eat in Hawija. Daesh closed all the shops and took all the food,” Safia, 42, says. She fled the city together with her husband and six children. For fear of Isis she doesn’t want her last name mentioned. “We got very hungry. All we had was bread and water. We didn’t even have oil.”
Safia was badly beaten for going out with her face insufficiently covered. “My arms were dark blue,” she says. “As a woman, I wasn’t allowed to go out on my own. One time I crossed the street – only crossed the street. After that, they arrested my son and flogged him with an electric wire 25 times. For allowing his mother to cross the street. Another time they shaved his head only because he was joking with his friend.”
“Life was so difficult that sometimes we hoped to die,” Amira, a 41-year-old mother of 11 children, recounts. “If you said one word they didn’t like, they would sew up your mouth. They burned policemen alive – it happened to my cousins. They arrested my son and I am so afraid they killed him.”
The woman next to her, who is holding a child with a rash on his face, says: “We had only one meal a day and we didn’t have anything else but bread made of animal fodder.”
It is estimated that about 80,000 people have fled the Hawija region since August last year. Many of these displaced people have no access to regular basic healthcare, because existing facilities are overstressed or too far away. Mobile clinics are an important tool for NGO’s to respond to this problem.
A mobile clinic is a kind of pop-up clinic: it is set up wherever there is need among displaced people in areas that are hard to reach. “The idea is not to take over healthcare, but to fill in the gaps,” says Joy Wright, a British doctor who runs two mobile clinics of the NGO Medair in the region of Kirkuk. The project is financed by Echo, the European commission’s humanitarian aid department.
“We visit areas where big groups of internally displaced people recently have been coming in,” Wright says. “We see over a hundred patients per day. So it’s important to be there. We also go to parts of Kirkuk city where a lot of displaced people are living without a doctor or a hospital within reach.”
“A local staff is really important,” she says. “Because they understand the culture. It’s also important to have female GPs, because the women can’t be examined by a man. That some of our staff are displaced people themselves works really well: they have so much empathy for the patients.” In one of the tents, Dr Ebaa Shakir Mahmood, 28, who, like her colleague Ibrahim, fled Mosul, is examining a little boy. He’s two years old, but looks much younger. “He’s suffering from malnutrition,” she says. “I see a lot of undernourished children. I also see many patients with pneumonia, diarrhea and leishmaniasis, a disease that is caused by sandflies in the camp. Scabies is also a problem here, because of poor hygiene.”
There are always more female than male patients who call on her. “Often they have gynaecological problems. Most women here have many children. There are also a lot of miscarriages.” The mobile clinic with community health workers try to spread information about the importance of vaccinations, family planning and hygiene through volunteers who receive a training and visit families the camp.
Safia, whose son was punished by Isis, is one of these community health workers. “I regularly visit the women in their tents to talk with them about things like hygiene or skin diseases,” she says. “I get asked about birth control a lot, because the women don’t want to have so many children.”
Psychological problems are also a big issue in the camp. Just recently, a severely traumatised woman set fire to her tent because she thought she saw Isis fighters entering. She and her baby didn’t survive. “People have often seen terrible things and fled under very difficult conditions. I see patients who suffer from PTSS [post-traumatic stress disorder], depression and schizophrenia,” Shakir Mahmood says. “The stress of living in a camp exacerbates their problems.” The next day the mobile clinic is visiting a settlement of low-rise flats in the middle of the wasteland around Kirkuk, where many refugees from Hawija rent cheap apartments. The nearest health centre is miles away.
One of the patients is a 63-year-old woman with a black veil and a blue robe who suffers from high blood pressure. While waiting for her checkup, she recounts how she fled Isis by pretending to be very old and ill. “I was walking with a stick and made sure to stagger like a very old lady. When Isis fighters stopped me and asked me where I was going, I said I was going to see a doctor. They even gave me a ride! I had to be clever, otherwise they would have killed me.”
“Under Isis we faced many health problems,” a 35-year-old mother of five says. “Our son was sick. I myself suffer from rheumatism. But there were no doctors around. We escaped in the night on foot. It was so difficult, that at one point I said, just burn me here, I can’t go on.”
“I try to give my patients more than medication,” Ibrahim says. “I always say to them: there comes a day when you will go back home and get your life back. I try to put this hope inside their hearts.”