IRAQ HUMANITARIAN CRISIS

OVERVIEW

•Overview of the Iraq humanitarian crisis and 2017 Iraq

Humanitarian Response Plan

•Health Cluster strategy

•Health crisis update and response with focus on Trauma

Contents

An estimated 11 million Iraqis will need some form of humanitarian assistance; humanitarian partners aim to reach 6.2 million in 2017

• During 2017, as many as 11 million Iraqis will require some form of humanitarian assistance.

• The humanitarian crisis in Iraq remains one of the largest and most volatile in the world.

• Virtually all civilians affected by military operations to retake Mosul from ISIL are vulnerable,

• More than one million Iraqis have returned to their homes in the last year; up to 3-4 million may be outside their homes when anti-ISIL military operations conclude.

Cluster Strategy Strengthen collaboration with the Ministry of Health to provide an emergency health response to war wounded people in areas of conflict Coordination with health cluster partners with the aim to reduce morbidity and mortality through provision of critical, life-saving health interventions reaching the most vulnerable people across Iraq. Provide a comprehensive package of health services with a focus on transitioning toward support and recovery of the existing healthcare system in crisis-affected areas

Cluster Objectives 1. Provide critical emergency healthcare and psychosocial support to highly vulnerable

people as soon as they are accessible

2. Provide a comprehensive package of essential health-care services to people in priority locations

3. Help to strengthen national health care systems and upgrade health facilities in crisis-affected areas

9.7 million people

in need

million people to receive

assistance 6.2 |

IRAQ 2017 HRP: HEALTH CLUSTER STRATEGY

| million requirement in

US$ 109.6

FIRST-LINE RESPONSE Provide critical life-saving health services including trauma management to highly vulnerable people and detect and respond to disease outbreaks.

SECOND-LINE RESPONSE Provide an expanded range of health services including referral mechanisms to vulnerable people in priority locations and help to strengthen the supply chain of essential medicines and supplies

FULL CLUSTER RESPONSE Help to strengthen national health care systems and upgrade health facilities in crisis-affected areas

9.7 million people

in need

million people to receive

assistance 6.2 |

IRAQ 2017 HRP: HEALTH CLUSTER RESPONSE

Mosul Displacement since 24 October, 16

Insert Map

WHO as Provider of Last Resort (POLR)

• Response to Cholera outbreak 2015,

• Response to Anbar crisis 2016,

– strategies of Anbar using Mobile Medical Clinics (MMCs) and fixed locations,

– MEASURES, eCAP assessment,

– Response to management of toxic chemical exposure

• Response to provide immediate trauma care and referral

Trauma Working Group (Stabilize & Referral Plan)

• Trauma coordination for the Mosul Offensive is a high priority, and is well linked to other healthcare delivery priorities and programs thru the cluster;

• Trauma coordination model is based on the Emergency Medical Team (EMT) model and standards, but expanded to include the full spectrum of trauma care,

• There is a sense of common purpose, operational cohesion, and buy-in to the cluster coordination role by the majority of trauma stakeholders external to WHO;

Main overall observations; 1/2

• The high-risk security situation some of the coordination functions ‘outsourced’ to other providers (e.g. NYC Medics responsible for TSP coordination);

• The number of NGOs willing to operate health facilities in such a security environment, close to frontlines and military personnel, is limited, and hence private providers have been included for the first time.

Main overall observations: Contd 2/2

• Coordination of the whole system is under WHO based on Emergency Medical Teams (EMT) coordination model with supported partnership and agreed TORs

• First time EMT model used in conflict zone; Previously in natural disasters and then outbreaks (Ebola)

• Expansion of the EMT model to coordinate the whole of the trauma pathway; Providers are specific health cluster partners and some private organization (e.g. Aspen)

• Its complements other zonal planning for delivery of Primary Health care (PHC) at screening & IDP camps

• WHO Role: funding, support, quality assurance, Information Management, coordination;

Emergency Medical Teams (EMTs)

IRAQ: TRAUMA STABILIZATION POINTS IN MOSUL

• Since mid-October, 6,084 people

have been referred from frontline

areas to hospitals to receive

treatment for trauma injuries. A high

percentage of all casualties in Mosul

are civilians.

• Health partners have set up five

trauma stabilization points in close

proximity to Mosul. In all, 1,559

people (274 life-threatening) have

been stabilized by partners working

on the front line.

• Health partners have also

established three field hospitals with

surgical capacity; an additional two

field hospitals will open in April, with

two strengthened secondary

hospitals in Erbil

Health Cluster Coordinator (HCC) & Trauma Coordinator Linkage

• Communication • Role delineation • Leadership (structure) • Common information sharing through the cluster

• Trauma is very specific with specific limited partners while Health Cluster (HC) focuses more on PHC

• HCC has observer status at the TWG and in the HC the TWG present and update.

• WHO is clearly fulfilling its new operational and emergency management mandate.

• Sets precedent for working in conflict zones • Ability to use the EMT standards for type I, II, III hospitals and teams,

and tapped into EMT networks • Linking strongly in WHO country office allows leverage to other staff

and activities particularly the cluster activities (PHC, MMC, MMT, Essential medicines, IM, Logistics)

Strengths

• Constantly changing context for operation and population needs (frontline movement, IDP influx)

• Finding providers with capacity to work in security compromised locations (frontlines), and willingness to work in presence of military actors

• Access limitation - Doing field coordination at field level

• Assuring quality of care and making a formal evaluation of the new model

Challenges

• Its still hard to get a strong partnership between MOH and TWG

• Security incidents; • sometimes TSPs had to pull back due to nearby

military action • Other challenges – AWD, Nutrition, First line vs Second

line, funding.

• Strong link for efficient and effective referral pathway, data collection, coordination and planning

• Improve completeness of reporting (all points in the referral pathway)

Future (Way Forward)

• Standardize reporting, and then move to measure quality of care

• Opportunity to use this to improve data to inform planning for short, medium and long-term

Recommendations • HQ/RO/CO to develop if possible a more streamlined process for emergency

recruitment of non-WHO consultants.

• HQ to develop specific standards for Trauma Stabilization Points, similar to those for EMT type 1-3 facilities.

• HQ to develop an EMT/Trauma Coordination Records Management System and Protocols that can be used from day one in any EMT/Trauma Coordination Cell.

• CO to consider initiating short, weekly internal meetings of key country office staff handling various aspects of the Emergency/Trauma/Health cluster portfolios.

• HQ to re-engage with external partners (such as Karolinska Institute) to provide high level trauma-specific expertise, either in person or via email/phone.

• HQ to develop a Minimum Data Set (MDS) specifically for TSPs and Trauma-focused Field Hospitals, again building on EMT MDS.

• MOH to provide a staff member to work in with Trauma Coordination Cell.

IRAQ 2017 HRP │ CLUSTER DEFENSES

EXIT STRATEGY The exit strategy will prepare for handover to the health authorities through continued engagement, involvement, support and capacity building

• Handing over the field hospitals, mobile clinics and primary health centres in camps to the respective Directorates of Health through a pre-defined phase out approach. • To establish a field hospital costs $2.5 million; running cost is $1.0 million/month • Trauma Stabilization Point (TSP) running costs $66,000/month • Emergency immunization campaigns costs $3.7 million for 1 antigen • Average cost of Caesarean-section is $800

• Building the capacity of the national health workforce currently working with

cluster partners to take over management of health service delivery, supply chain management, and quality of care

• Working closely with WASH, shelter and protection clusters to build on inter-

sectoral linkages that have an impact on health outcomes • Supporting the health authorities to adopt and monitor the national guidelines

for health service delivery

Thank You and Q&A