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Background: Widespread devastation to structures and households in Mosul occurred during the three years of ISIS control and the military liberation campaign by Iraqi forces assisted by coalition forces. Military operations, particularly airstrikes, resulted in a greater loss of life than during ISIS control. In 2016/17, we assessed living circumstances in Mosul immediately following defeat of ISIS. In September 2018, we reassessed many of the same indicators in Mosul households to determine the extent of recovery. Methods: For the 2018 survey, a random selection of 20 clusters were drawn from the 40 clusters surveyed in 2016/17. Of these 20 clusters, 12 were in east Mosul and 8 in west Mosul, the same proportion as the original survey. In each cluster, 30 households were interviewed. No households were included in both surveys. A team of four interviewers collected information using questions adapted from the 2016/17 questionnaire. Results: Among the 3375 persons from the 600 households in the 2018 survey, there had been 18 deaths reported in the year since the end of ISIS control, a mortality rate of 6.1/1000 (CI 95% [2.4-9.8]). This compares with a mortality rate of 30.7/1000 (CI 95% [28.3-33.2]) during ISIS control and liberation. Fifteen deaths were from disease, one from a non-intentional injury and two deaths due to intentional violence. Damage to dwellings had been fully repaired in only 22 (5.5%) of houses, mostly in less damaged east Mosul. Dramatic improvements in access to water and electricity have occurred, with three quarters of households reporting uninterrupted access to both. The previously reported large number of early marriages among household members stopped with the departure of ISIS. Of the 31 household marriages reported over a 12-month follow on study, 6 (19.4%) involved a female member of the household. This compares with 131 household males and 688 household females married during ISIS occupation. If marriages had continued at the same rate as for ISIS years during our one-year follow-on study, there would have been and expected 24 marriages of household males and 126 marriages of household females (OD 32.8, CI 95% [10.5102.8]) p < 0.001. There were 657 children reported by households to be in primary school. However, by household listing there were only 380 of children in the usual primary school age range (6-11), suggesting older children are catching up on primary schooling missed during ISIS years. One report of physical violence between spouses occurred. By comparison, the adjusted number of reported violent spousal events during ISIS control and military action would have been 72.7 (OR 316.7, CI 95% [44.42259.9]), p < 0.001. Reported complications of pregnancy also declined (OR 10.3, CI 95% [5.4,19.4], p < 0.001. Conclusions: Substantial improvements in household measures have occurred since the end of ISIS control and military action, though much remains for full recovery. Many household members are now employed, primary school attendance is high and early marriage of girls was ...

BackgroundMeasurement of mortality and injury in conflict situations presents many challenges compared with stable situations. However, providing information is important to assess the impact of conflict on populations and to estimate humanitarian needs, both in the immediate and longer term. Mosul, Iraq’s second largest city, was overrun by fighters of the Islamic State of Iraq and Syria (ISIS) on June 4, 2014. In this study, we conducted household surveys to measure reported deaths, injuries, and kidnappings in Mosul, Iraq, both during the occupation of the city by fighters of ISIS and the months of Iraqi military action known as the liberation.Methods and findingsMosul was overrun by ISIS forces on June 4, 2014, and was under exclusive ISIS control for 29 months. The military offensive by Iraqi forces, supported by coalition artillery and airstrikes, began on October 17, 2016, in east Mosul and concluded in west Mosul with the defeat of ISIS on June 29, 2017. We conducted a 40-cluster population-based survey as soon as the security forces permitted access for the survey team. The objective of the survey was to measure reported deaths, injuries, and kidnappings in Mosul households during 29 months of ISIS-exclusive control (June 2014–October 2016) and the nine months of Iraqi military action known as the liberation (October 2016–June 2017). In east Mosul, the survey was conducted from March 23 to March 31, 2017, and in west Mosul from July 18 to July 31, 2017. Sampling was based on pre-ISIS population distribution, with revisions made following the extensive destruction in west Mosul. The 1,202 sampled households included 7,559 persons: 4,867 in east Mosul and 2,692 in west Mosul. No households declined to participate. During the time from June 4, 2014, to the time of the survey, there were 628 deaths reported from the sampled households, of which 505 were due to intentional violence, a mortality rate of 2.09 deaths per 1,000 person-months. Over the entire time period, the group with the highest mortality rates from intentional violence was adults aged 20 to 39: 1.69 deaths per 1,000 person-months among women and 3.55 among men. In the 29 months of ISIS-exclusive control, mortality rates among all males were 0.71 reported deaths per 1,000 person-months and for all females were 0.50 deaths per 1,000 person-months. During the nine months of the military liberation, the mortality rates jumped to 13.36 deaths per 1,000 person-months for males and 8.33 for females. The increase was particularly dramatic in west Mosul. The leading cause of reported deaths from intentional violence was airstrikes—accounting for 201 civilian deaths—followed by 172 deaths from explosions. Reported deaths from airstrikes were most common in west Mosul, while reported deaths from explosions were similar on both sides of Mosul. Gunshots accounted for 86 cases, predominantly in west Mosul where ISIS snipers were particularly active. There were 35 persons who were reported to have been kidnapped, almost entirely prior to the military offensi...

The purpose of this article is to examine and analyse the incidence of violence against women in Iraq. Until recently, gender‐based violence has been viewed in this country as a private or family matter. Nevertheless, there gradually has been a shift in thinking in the past few years on this phenomenon, and it is now viewed as both a public health problem and a violation of human rights. As a first step toward understanding this problem, the authors conducted an experimental analysis of women in Iraq, focusing on gender‐based violence. The results show that violence against women is principally carried out by their husbands and by brothers. The article explains the reasons behind this violent behaviour by analysing a sample survey of 1,000 women and 100 men. The findings show that gender‐based violence is a prevalent medical and social problem in Iraq that requires prompt and in‐depth intervention so as to prevent or at least control it. This study was undertaken in order to understand the possible solutions to prevent gender‐based violence and to change the accepted norms of gender‐based social roles and social tolerance.

Background: The recent events in Iraq following the 2003 war render Iraq as a country with a high level of all types of violence. Exposure to violence, as a witness or a victim, is related to a number of longer term emotional, behavioral and social problems. Objectives: To investigate the impact of witnessing and experiencing community violence and tragedy as a factor contributing to mental health disorders among Iraqi women in the city of Mosul. Methods: A population-based cross-sectional study of 500 women were selected by a multi-stage random sampling technique. Four catchment areas of primary health centers of Mosul city were selected. Community violence with nine commonly associated social, economic, emotional, physical and mental health symptoms were recorded by questionnaire. Results: The study revealed that all the participating women had a history of exposure to at least one type of community violence within the last twelve months. A mainstream consequence of exposure to community violence was transportation difficulties, loss of husband's job, and family displacement. More than half of the women were classified as having severe emotional disturbances that may evolve to mental health problems in future. Conclusion: Women are bearing the consequences of the violence in Iraq. National commitment and action needs to be taken to curb the violence which is hugely affecting the people of Iraq. Treatment programs targeted at promoting emotional resilience may be effective at preventing mental health problems.

Background: Iraq is consistently exposed to large-scale traumatic events such as successive wars since 1980 to the present day, economic sanctions, sustained organized violence, and terrorism. These unsafe circumstances have negatively impacted the psychosocial status of the Iraqi community. Objective: To study the prevalence of witnessing or exposure to various types of violence, and its association with mental health problems in a sample of Iraqi men. Methods: This is a cross-sectional study that was conducted from April to September 2014. The target population were men from different age groups that were collected through a convenience sampling technique from two large cities; Baghdad (the capital city) and Mosul (the second largest city in Iraq). The source of data was from different institutions, colleges and lay people. The data collection process was done using the Self-Reporting Questionnaire 20 which is recommended by the World Health Organization for screening psychiatric disturbances. Results: A total of 480 Iraqi males agreed to participate in the study. The main type of violence reported was witnessing violence (55.4%), followed by exposure of friends or relatives to violence (51.4%), and witnessing or exposure to sexual assault was least reported (3.8%). The most frequent feeling recorded was of worry (72.9%), getting easily upset (65.4%), suffering from headaches (62.7%) and lethargy (59.4%). Severe psychological changes were evident in 68.5% of men, while moderate changes were present in 31.5%. Analysis of the feelings and behavioral changes in relation to the participants' history of exposure to violence revealed a significant association with witnessing shooting or stabbings, displacement, friends or relatives' exposure to violence, and viewing corpses. Conclusion: There is a high prevalence among Iraqi men of exposure to, or witnessing violence that showed an association with their mental condition, which, if proved causally, may be a leading cause for future devastating effects on their health, wellbeing and quality of life.

Background: Hospitals play a crucial role in providing communities with essential medical care during times of disasters. The emergency department is the most vital component of hospitals' inpatient business. In Iraq, at present, there are many casualties that cause a burden of work and the need for structural assessment, equipment updating and evaluation of process. Objective: To examine the current pragmatic functioning of the existing set-up of services of in-hospital emergency departments within some general hospitals in Baghdad and Mosul in order to establish a mechanism for future evaluation for the health services in our community. Methods: A cross-sectional study was employed to evaluate the structure, process and function of six major hospitals with emergency units: four major hospitals in Baghdad and two in Mosul. Results: The six surveyed emergency units are distinct units within general hospitals that serve (collectively) one quarter of the total population. More than one third of these units feature observation unit beds, laboratory services, imaging facilities, pharmacies with safe storage, and ambulatory entrance. Operation room was found only in one hospital's reception and waiting area. Consultation/track area, cubicles for infection control, and discrete tutorial rooms were not available. Patient assessment was performed (although without adequate privacy). The emergency specialist, family medicine specialist and interested general practitioner exist in one-third of the surveyed units. Psychiatrist, physiotherapists, occupational therapists, and social work links are not available. The shortage in medication, urgent vaccines and vital facilities is an obvious problem. Conclusions: Our emergency unit's level and standards of care are underdeveloped. The inconsistent process and inappropriate environments need to be reconstructed. The lack of drugs, commodities, communication infrastructure, audit and training all require effective build up.