Village of Sheikhkan, June 20, 2022 – There was a knock at the door. It opened up and Abdi, 64, peeked behind it. His eyes sparkled when he saw Salar and Adil standing at the door. “Come in, come in, brothers,” Abdi said, leading them into his house with a big smile on his face.
“Salar and Adil have visited me so many times that they are now part of the family,” he explains.
The two are part of the International Organization for Migration’s (IOM) Duhok-based Mobile Medical Team (MMT), a service designed to provide essential medicines and healthcare to vulnerable populations across Iraq. Abdi and his family were displaced during the Islamic State in Iraq and the Levant (ISIL) conflict in 2014. The family now lives in Sheikhkan, a remote village nestled in the western region of Sheikhan District, Iraqi Kurdistan, in the governorate of Duhok.
Salar and Adil have been in daily contact with Abdi for almost six months. They met in early January 2022, when the Sheikhkan Medical Center referred Abdi to the Salar team because he was coughing up blood and phlegm and constantly vomiting.
“I didn’t know what it was. I had a stomach ache. I lost my appetite – everything I ate I immediately threw up. In a few weeks, I went from 76 kg to just over 40 kg,” recalls Abdi of the first few weeks before being referred to MMT.
Having seen such symptoms before, Salar – a trained nurse and IOM focal point for tuberculosis (TB) in Duhok Governorate – had strong suspicions about Abdi’s disease. He immediately transported Abdi and his wife to Duhok City Tuberculosis Center for urgent examination. Sure enough, Abdi tested positive for tuberculosis.
Iraq has one of the highest rates of tuberculosis in the Middle East and North Africa. Since 2014, the ISIL crisis and subsequent military operations to retake areas under ISIL control have further deteriorated the capacity to manage TB across the country.
The humanitarian situation in the country continues to be unstable and more than one million people are still displaced, of whom around 180,000 are still living in camps for internally displaced persons (IDPs).
There are six districts in Duhok Governorate, but only four TB treatment centres. Sheikhan district – home to many displaced people and vulnerable host communities – does not currently have an active TB management centre.
Although tuberculosis is curable, Abdi’s case was particularly difficult due to his diabetes and heart problems.
“It’s a problem for a TB patient because sometimes TB drugs can interfere with their heart or diabetes drugs. Patients have to undergo very rigorous and continuous treatment for it to be effective,” says Salar.
“Another problem is that since the patient is diabetic, he cannot eat many types of food which are very important for a patient because he has to take the course on tuberculosis drugs.”
Nonetheless, Abdi made a remarkable recovery in just six months. “When I first saw him he was very weak. Now he has regained weight, he is healthy, his diet is in order and he will be fully recovered soon,” continues Salar.
“It’s hard to take all these different drugs – one affects the other and they cause me different pain – but I know it’s necessary and I have to do it to beat TB,” says Abdi.
“My cough has stopped, there is no blood or phlegm and I have regained my strength. I can eat normally without fear of vomiting; I am a little under 70 kg now. I am truly grateful for all the support that IOM MMT has given me. They have been with me in one way or another every day for the past six months.
Although Abdi can now be counted among people across the country recovering from TB, there are still many who need lifesaving help – including displaced people living in camps and informal settlements, people in secondary displacement, recent returnees, refugees and members of the host community. .
“We have over 60,000 displaced people and over 60,000 refugees in camps in Duhok, not counting those from the host communities we cover, and it’s a huge area. It has been easy to monitor and trace contacts in the camps as there are frequent sensitization campaigns and mass screenings to look for suspected cases,” notes Salar.
“But there are so many places that we simply cannot reach because they are in remote areas and we already have a large number of cases to deal with in the camps and some communities.”
IOM maintains seven MMTs in five crisis-affected governorates with high numbers of IDPs, returnees and vulnerable host community members: Ninewa, Duhok, Kirkuk, Salah al-Din and Anbar. Due to a high number of cases, Khanke camp in Duhok governorate has become a tuberculosis hotspot, Salar tells us.
IOM’s MMT in Duhok and other locations assists the National Tuberculosis Control Program (NTP) of Iraq to implement activities aimed at combating tuberculosis, including through outreach, initial screening, collection of sputum specimens, transportation of suspected TB cases for investigation, contact tracing, directly observed therapy (DOT), distribution of food parcels and monitoring of TB treatment.
IOM is also supporting the NTP with joint supervisory visits to all NTP clinics across Iraq, on-the-job training for laboratory staff, procurement of anti-TB drugs and laboratory supplies, updating and printing of guidelines, provision of Personal Protective Equipment (PPE) and Infection Protection and Control Materials (IPC), providing diagnostic tools such as GeneXpert machines, capacity building trainings abilities and more.
Efforts by NTP and IOM to curb the spread of TB have been successful in treating thousands of patients across Iraq since 2017, when the Global Fund began supporting the Iraqi government’s program, but it much remains to be done.
This includes increasing the number of MMTs across the country to expand geographic coverage and treat cases among vulnerable populations in camps, returnee communities and host communities; increase TB management units and open diagnostic centers in each governorate (currently there are 135 functional TB management units in Iraq); making more TB drugs available; and organize more mass awareness campaigns.
Tuberculosis is a curable disease. Measures like these would save more patients like Abdi.
IOM’s response to TB in Iraq is possible thanks to support from the Global Fund.
Written by Raber Y. Aziz with IOM Iraq