Iraq

IRAQ

In 2017, Iraq experienced yet another surge in violent conflict during the final push by Iraqi, Kurdish, and coalition forces to regain territory held by ISIS, with large-scale offensives launched in West Mosul, Tel Afar, and other areas.[1] The conflict has killed nearly 30,000 civilians and has wounded over 55,000 since January 2014, and the trend in civilians shouldering the bur­den of the conflict continued in 2017.[2] Although Iraq’s prime minister declared victory over ISIS in December, roughly 2.9 million people remained displaced after the close of military operations, the country has suffered massive infrastructure loss, and human rights groups report that scores of Iraqis have suffered human rights abuses and violations of humanitarian law by all parties to the conflict.[3]

Medical care in Iraq was greatly impacted in 2017 not only from intense battles and deliberate attacks but also from retaliatory or discriminatory practices by pro-government entities. In 2017, there were at least 35 attacks on health workers and facilities in Iraq including one incident impeding access to care.

The main perpetrator of attacks in 2017 was ISIS, allegedly responsible for 12 attacks on health facilities or staff. Allied or coalition forces carried out five attacks— one military search of a medical facility and one use of chemical weapons near a hospital—and in at least three cases, Iraqi government officials hindered access to care or detained or punished medical workers who had lived and worked under ISIS rule. In two cases, damage to hospitals occurred during fighting between two conflict parties.

Of the 27 attacks on health facilities in 2017, perpetrators used targeted explosives in 12 incidents. Unnamed perpetrators launched four rocket or missile attacks on health buildings that killed three health workers, wounded 12, and damaged at least two hospitals and at least one ambulance.[4][5][6] ISIS claimed responsibility for a suicide attack and a car bombing in Baghdad. The car bomb exploded outside Al-Kindi Teaching Hospital and killed three civilians,[7] and ISIS militants with firearms and suicide vests attacked a health center,[8] killing eight people and wounding 37.[9] In two other attacks, explosives were hidden on medical premises, one triggering a “booby-trap” explosion that killed a health worker and his son as they tried to enter Rawah General Hospital in Anbar province.[10]

Two explosive attacks involved chemical weapons, one in which six health workers suffered symptoms such as watery eyes and breathing difficulties after an explosion from an unknown source near their medical post.[11] In another event, on June 3 in West Mosul, the US-led coalition admittedly launched white phosphorus close to the ground near Al Jamhuri Hospital.[12] While Iraqi and coalition sources stated the white phosphorus was used as a smokescreen to provide cover for civilians fleeing the hospital, Human Rights Watch criticized the use of the agent so near to the ground in a civilian area, risking fires and severe thermal and chemical burns.[13]

ISIS continued the occupation of medical facilities in 2017, reportedly seizing or continuing control for military purposes of at least seven hospitals and one medical building in Mosul, and at least one hospital in the Hawiga district.[14][15][16] Occupation of Al Salam, Mosul General, Ibn Sina, and Republican Hospitals since 2016 or earlier, as reported by Human Rights Watch, continued into 2017.[17] Al Shifa, Al Jamhuri, and a general public hospital were also occupied, as well as the Bab Sinjar medical building in the Jamhuri complex. Iraqi and coalition forces launched attacks destroying two of the occupied facilities in 2017, Al Salam Hospital[18] and the Bab Sinjar medical building, though military officials stated the buildings had not been used for civilian medical treatment for some time, according to intelligence reports.[19] [20]ISIS burned down Mosul General Hospital and a public hospital as pro-government forces closed in, completely looting the premises of the former and executing 12 civilians inside the latter.[21][22] ISIS militants also burned down Ibn al-Athir Hospital, one blood bank, and 12 medical warehouses, destroying a total of at least 16 medical buildings by fire.[23][24]

Takeover of medical facilities and systems hindered or completely blocked access to medical care for civilians living in ISIS-controlled territory. Amnesty International described frequent denials of medical care to civilians under ISIS rule in Mosul,[25] while the REACH Initiative described a severe lack of health care access leading to patient deaths in Hawiga district, with health facilities deserted or lacking staff and supplies and the hospital reserved for ISIS militants.[26] In a report by the Guardian, one Mosul doctor described a “two-tiered” system, in which “[ISIS] members and their families were given the best treatment and complete access to medicine, while the normal people…were forced to buy their own medicine from the black market. ...As a doctor, I am supposed to treat all people equally, but they would force us to treat their own patients only.”[27]

Most attacks (17 out of 35) occurred in Mosul during the battle to take back the western part of the city from ISIS. Baghdad also saw six attacks on health facilities and workers, and others occurred in Anbar, Kirkuk, and Kalar provinces. Attacks destroyed 18 health facilities and damaged three. In addition, three doctors, one dentist, and four other health workers were killed, along with 24 civilians on medical premises, though it is unclear if any of these were staff or patients. Eighteen health staff and 37 patients on medical premises suffered injuries, two doctors were kidnapped, and two endured administrative or judicial punishment for having worked under ISIS rule.

A third of recorded attacks on health workers, patients, or civilians in medical facilities occurred with the use of explosives, as described above. Other attacks on medical staff included convoys or vehicles coming under fire, the murder or kidnapping of medical staff, and assault by a patient or beneficiary on a health worker. Four targeted attacks on clinicians occurred in Baghdad: a doctor killed in his clinic, a dentist murdered in her home, and two doctors kidnapped in separate incidents.[28] [29]

Medical staff also suffered from campaigns by Iraqi, Kurdish, and allied groups to root out and punish ISIS members and anyone possibly associated with them. Human Rights Watch reported that not only have these campaigns employed arbitrary arrest, torture, and extrajudicial killings, but the Iraqi government has threatened or exacted punishment on medical personnel for providing care while under ISIS control, including a plastic surgeon who faced possible charges by the counterterrorism court. The Guardian reported that the Iraqi Ministry of Health denied one doctor permission to take medical exams, effectively barring her from practice in Iraq, because she had worked in Jamhuri Hospital under ISIS control. Though she had risked her life by running an underground hospital to treat civilians, she stated, “the ministry said they won’t give me security clearance because I had worked under ISIS administration.”[30]

Civilian access to medical care and humanitarian aid has also been restricted for those with alleged close ties to ISIS fighters. Iraqi security officials barred some members of “ISIS families” from leaving displaced persons camps for medical care unless they left behind their identification documents, and government workers restricted food aid to others, according to Human Rights Watch.[31] [32]