Nurses walk quickly around the wards; patient monitors beep in the distance, doctors assess their  patients in intensive care rooms - it’s  just another day for frontline health workers in Iraq. In Diyala and Kirkuk - and indeed across the entire country -  the speed and frequency of this routine has intensified with the continued rise of Coronavirus. 

Their efforts are supported by UNDP Iraq, who is working with the Government of Iraq to build much-needed COVID19 isolation units across 14 health facilities in Iraq, to effectively fight the pandemic and serve those most in need. 

In Diyala , known as the orange capital of the Middle East due to its production of oranges and citrus fruit in the country, the economy rests on agriculture, including  dates and olive groves. Falling into disrepair under ISIL’s occupation, and at one point used as a defensive line by ISIL forces, critical infrastructure and services crumbled. After liberation from ISIL in 2015, a number of rehabilitation projects were launched in the governorate, led by UNDP Iraq in consultation with authorities in Diyala, to restore much-needed  infrastructure and to provide  access to basic needs. 

Nevertheless, the unexpected outbreak and spread of Coronavirus in Iraq notably in this region put a temporary halt to  rehabilitation projects in liberated districts, and deepened socio-economic issues.

“The Coronavirus pandemic affected all aspects of life in Diyala Governorate especially for people with limited financial income due to the closure of businesses and the imposed curfew,” explains Talib Adnan, 40, the focal point in Diyala Governorate working with international and local organizations. “It also disrupted the administrative working hours to be reduced to 25% and caused a delay in the school year.” 

Inside Baqubah General hospital, located in the provincial capital of Diyala, the medical staff are working around the clock to provide Coronavirus patients with necessary healthcare while maintaining support to the rest of the patients.

“The virus impacted our work and daily life in general. Nowadays, our clothes must be exposed to the sun and washed regularly, and I cannot approach my children either,” says Dr.Ali Abdullah Abbas, 30,  a Senior Resident physician in Baquba General Hospital.  “In the hospital, we must wear full personal protective equipment in this hot weather with a double mask, a headcover, and a shoe cover. In addition to that, we wear suits designed for medical and paramedical staff to protect ourselves from contracting the virus,” he explains.

This new way of working is clearly  visible inside  the isolation wards, measures to keep frontline workers safe have intensified since a number of medical staff have contracted the virus across the country.

“This virus has put pressure on various units within the same health facility as efforts have focused on treating patients with COVID-19 whereas other patients, some with critical conditions, need also to be served,” says Dr. Haider Al-Muqdami, Director of Baqubah General hospital in Diyala since 2015.

“We face a number of difficulties including the lack of cooperation and respect for  preventive health measures by some citizens both inside and outside the hospital. Unfortunately, some patients come to the hospital very late after contracting the virus, which severely damages their respiratory system, and  complicates their recovery,” he adds.

Despite these dire times, the challenging nature of their work whether its informing bad news to patients who have tested positive,  or working in constant fear of contracting the virus themselves, ‘the white army’ still persists and pin their hopes on a better tomorrow for Iraqis.

“For me, I no longer want to enter my house because I am afraid of infecting my three-year-old daughter who has a Ventricular Septal Defect or my husband, who has Pulmonary fibrosis. I also keep away from relatives or family gatherings. I also raise the patients’ awareness to avoid gatherings and allow only one caregiver with the patient,” says Israa Karim Ahmed, 30, a nurse at the Baqubah General hospital for the last nine years.

“Still, I feel joy when I save someone's life. I am honored to serve this community by treating patients. I am very happy in my job, and even if I get infected with Coronavirus, I feel  pride because it happened while helping others,” she underscores her pride to serve her community.

To ensure improved healthcare in Baqubah General hospital in Diyala, the establishment of 20 isolation units, with support from UNDP Iraq, was completed in early September 2020. Provision of medical equipment including ventilators, defibrillators, Extracorporeal Membrane Oxygenation (ECMO) and Personal Protective Equipment (PPEs) will soon be handed over as well to the facility. 

North of Diyala  in Kirkuk, work to set up a new isolation unit to support COVID-19 patients was also completed around the same period. 

Kirkuk, one of the largest governorates in Iraq with an estimated population of 1.2million people, has been a melting pot of different communities. Today, Kirkuk city is home to Arabs, Kurds, Turkmen, and a variety of Islamic, Christian and other religious groups. Oil was first discovered in this city back in 1924. Its wealth also stems from the agriculture sector particularly in the district of Hawija which used to provide food for the entire Northern Iraq offering a variety of vegetables, fruits, yellow corns and cotton. Due to ISIL’s occupation, the farmers suffered from lack of spaces to dry the corn corps and fertile lands were drained. The grain tanks were also ruined after years of war and crop fires.

Since liberation from ISIL back in 2017, UNDP’s stabilization programme put a significant focus on the health sector in Kirkuk, where 36 Primary Healthcare Centres (PHCs), were rehabilitated and equipped, providing improved  health care to over 70,000 people.

Emad Mohammed, 44, decorator and now construction worker employed to help build Kirkuk isolation wards, describes precisely the effect of COVID-19.

“It affected us economically. In Iraq, it affected us mentally, too”.

“This virus has had an enormous impact on society especially in Iraq. The most important impact has been seen in the health system, since it has revealed the weakness of the health system, particularly in Iraq”, explains Dr. Mohammed Nusair, 43, a surgeon and director of the training department in the Kirkuk Health Department. 

“There are numerous weaknesses such  as the shortage of hospitals and of medical personnel which need to be solved  in the near future”, he adds. “Coronavirus may be a reason to reveal the tragedy occurring in the Iraqi health system, which is an outdated system that must be changed. Our health system is ‘sick’ in itself and needs to recover ”.

The medical staff, just like the rest of the world, were not prepared for this pandemic. With long working hours, the repercussions felt  by everyone else was experienced by them too. They  also underwent physical and mental stress. 

“The imposed lockdown had a very negative impact on our social and psychological lifestyle and the lifestyle of individuals we assist. This made it difficult  for us because we are dealing with people who are mentally and financially stressed. On top of all this, we ask people to abide by health preventive measures, but as time passes, people’s commitment has decreased. And as a result, the virus continues to spread widely, and all this was placed on the shoulders of doctors,” Dr. Nusair explains.

Against all odds, the ultimate pride and reward of health providers is to help patients when needed and to see them hale and hearty. 

“We had a patient named Samra, aged 30 , who was almost dying. With the health and nursing staff’s great efforts, she returned to her children safely. Samara is a source of pride for all of us.”                                             

“These moments make you forget the stress and make us proud of being part of this profession,” adds Dr. Nusair.          

About UNDP Iraq’s COVID-19 response

Since March 2020, UNDP has worked alongside the Government of Iraq and the international community on combating Coronavirus in Iraq. Measures under UNDP Iraq’s response package include increasing the testing capacity of laboratories, providing personal protective equipment to healthcare workers, establishing isolation wards, and undertaking assessments to establish post-COVID-19 recovery strategies. Focusing on the most vulnerable communities in Iraq, activities are rolled out in 13 governorates. UNDP Iraq’s COVID-19 response package is being implemented under the umbrella of UNDP’s stabilization programme. 

UNDP thanks generous donors USAID for funding the construction of the Kirkuk Isolation Ward and providing medical equipment and furniture, and the Netherlands for funding the ventilators. For the Diyala Isolation Ward, UNDP appreciates the support of Belgium, Sweden and Denmark.