Providing healthcare under ISIS: A qualitative analysis of healthcare worker experiences in Mosul, Iraq between June 2014 and June 2017

Michlig, Georgia J.; Lafta, Riyadh; Al‐Nuaimi, Maha A.; Burnham, Gilbert

doi:10.1080/17441692.2019.1609061

Cited by 20 publications

(30 citation statements)

References 21 publications

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“…To protect HCWs, humanitarian organizations chose to withdraw from areas controlled by the organization. Working conditions for HCWs in the IS-declared caliphate have been described in a study carried out in Mosul, Iraq (Michlig et al 2019). Our findings confirm and underline the horrors that HCWs have experienced under IS control.…”

Section: Discussionsupporting

confidence: 81%

Caught in crossfire: health care workers’ experiences of violence in Syria

Kallström

Häkkinen

Al-Abdulla

et al. 2021

Medicine, Conflict and Survival

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Health care is attacked in many contemporary conflicts despite the Geneva Conventions. The war in Syria has become notorious for targeted violence against health care. This qualitative study describes health care workers' experiences of violence using semi-structured interviews (n = 25) with professionals who have been working in Syria. The participants were selected using a snowball sampling method and interviewed in Turkey and Europe between 2016-2017. Analysis was conducted using content analysis. Results revealed that the most destructive and horrific forms of violence health care workers have experienced were committed mostly by the Government of Syria and the Islamic State. Non-state armed groups and Kurdish Forces have also committed acts of violence against health care, though their scope and scale were considered to have a lower mortality. The nature of violence has evolved during the conflict: starting from verbal threats and eventually leading to hospital bombings. Health care workers were not only providers of health care to injured demonstrators, they also participated in non-violent anti-government actions. The international community has not taken action to protect health care in Syria. For health workers finding safe environments in which to deliver health care has been impossible.

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Section: Discussionsupporting

confidence: 81%

Caught in crossfire: health care workers’ experiences of violence in Syria

Kallström

Häkkinen

Al-Abdulla

et al. 2021

Medicine, Conflict and Survival

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“…Other demotivating factors were common for both male and female HCWs, including limited financial incentives, difficult working conditions, and lack of career progression [ 43 , 48 ]. A study exploring the experiences of HCWs under the governance of the Islamic State of Iraq and Syria (ISIS) found that males and females were strictly separated with limited communication and restriction of movement, particularly for females due to the implementation of strict religious norms [ 60 ].…”

Section: Resultsmentioning

confidence: 99%

“…In addition, one study attributed the lack of the sex/gender differences to the fact that the PDMH conditions were self-reported and not diagnosed medically, and additionally found that being a nurse and a medical technician was associated with increased reporting of PDMH conditions, as compared to other health professions [ 76 ]. Two studies that did not report on sex/gender differences for specific health outcomes found that PTSD, distress, anxiety, and depression were reported by both male and female workers [ 58 , 60 ]. Trauma, distress, and mental health problems were reported by both male and female workers to affect their overall wellbeing [ 79 ].…”

Section: Resultsmentioning

confidence: 99%

Sex and Gender in Research on Healthcare Workers in Conflict Settings: A Scoping Review

Habib

Halwani

Mikati

et al. 2020

IJERPH

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The occupational health literature has established that sex and gender are associated with all dimensions of the workplace. Sex and/or gender (sex/gender) factors play an important role in shaping the experiences, exposures, and health outcomes of male and female healthcare providers working in war and conflict settings. This study aims to (1) assess how sex/gender is considered in the occupational health literature on healthcare workers in conflict settings, and (2) identify the gaps in incorporating sex/gender concepts in this literature. A scoping review was carried out and nine electronic databases were searched using a comprehensive search strategy. Two reviewers screened the titles/abstracts and full-texts of the studies using specific inclusion and exclusion criteria. Key information was extracted from the studies and four themes were identified. Of 7679 identified records, 47 were included for final review. The findings underlined the harsh working conditions of healthcare workers practicing in conflict zones and showed sex/gender similarities and differences in experiences, exposures and health outcomes. This review revealed a dearth of articles with adequate consideration of sex/gender in the study design. Sex/gender-sensitive research in occupational health is necessary to develop effective occupational health and safety policies to protect men and women healthcare workers in conflict settings.

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“…The extent of mental health and psychosocial problems as well as physical injuries among health workers varied with the local context but were frequently cited reasons for limited sta ng available for restructure services. In some areas, ISIS deliberately targeted health workers leaving lasting trauma [5].…”

Section: Differences Among Governoratesmentioning

confidence: 99%

“…Some facilities continued to function under ISIS control, but in other cases facilities were abandoned or destroyed, sometimes by military action. [5] In Salah-al-Din, 36% of health facilities were destroyed and by 2020, only half of health facilities in Ninewa were functioning. [6] Facilities in these areas often had di culty with the supply of medicines and vaccines, as well as retaining and paying staff.…”

Section: Introductionmentioning

confidence: 99%

Resilience of Health Systems in Conflict Affected Governorates of Iraq, 2014-2018

Ibrahim¹,

Al-Dahir

Al-Mulla

et al. 2021

Preprint

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ObjectivesThe objective of this study was to assess the resilience of health services in four governorates affected by conflict from 2014-2018, and to convey recommendations.MethodsHealth managers from Al Anbar, Ninawa, Salah-al-din, and Kirkuk governorates assessed resilience factors of Primary Health Care services affected by the 2014-2017 ISIS insurgency. Additional information was gathered from key informants and a health facility Unicef survey. Three specific aspects were examined: 1) meeting health needs in the immediate crisis response, 2) adaptation of services, 3) restructuring and recovery measures. Data from and MoH/UNICEF national health facility survey were 2017-2019 analyzed for functionality.FindingsThere were many common themes across the four governorates, with local variations.1. Absorption. The shock to the public sector health services by the invasion by ISIS caught the in the four governorates unprepared, with limited abilities to continue to provide services. Pharmacies and private clinics sometimes withstood the initial shock better. 2. Adaptation. After the initial shock, many health facilities adapted by focused on urgent needs for injury and communicable disease care. In most locations, maternal, neonatal, and child health (MNCH) preventive and promotive services stopped. Ill persons would sometimes consult health workers in their houses at night for security reasons. 3. Restructuring or transformative activities. In most areas, health services restructuring was continuing in 2020. Some heavily damaged facilities are still functioning below pre-crisis level, with reduced service availability. Rebuilding lost community trust in the public sector is proving difficult, though in some communities, trust remained strong.ConclusionHealth services generally had little preparation and limited resilience to the ISIS influx. Governorates are, in places, still restructuring services after the liberation from ISIS in 2017. Disaster planning was identified by all participants as a missing component, as managers anticipated future emergencies.

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Providing healthcare under ISIS: A qualitative analysis of healthcare worker experiences in Mosul, Iraq between June 2014 and June 2017

Cited by 20 publications

References 21 publications

Caught in crossfire: health care workers’ experiences of violence in Syria

Caught in crossfire: health care workers’ experiences of violence in Syria

Sex and Gender in Research on Healthcare Workers in Conflict Settings: A Scoping Review

Resilience of Health Systems in Conflict Affected Governorates of Iraq, 2014-2018

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