Objectives
The 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.
Methods
Health 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.
Findings
There 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.
Conclusion
Health 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.