It was a United States-led, 72-nation military coalition, including the Iraqi Army,and their enemy the Islamic State group that ensured the near-complete destruction of the city of Mosul in Iraq. But one year after the battle to retake Mosul from the Islamic State, there has not been a 72-nation coalition of states willing to rebuild the city.
This has ongoing emergency consequences for the health of the population in Mosul.
The battle for Mosul, which led to extreme violence being unleashed on a dense urban terrain,lasted for nine months but continues to this day to result in war-wounded. The residents of Mosul may no longer be wounded by bombs and bullets but currently 95% of the trauma cases seen by Doctors Without Borders (MSF) in Mosul are a result of unsafe living conditions — such as falling rubble or buildings collapsing. Mosul city was reduced to eight million tonnes of debris.
I worked on the outskirts of West Mosul during the peak of the battle in 2017, when thousands of war- wounded streamed out of the city as the Iraqi army, backed by the US-led military coalition, closed in on the urban core of Mosul.
There was a near-constant flow of trauma patients coming out of the city — often under the cover of darkness — as the frontline edged closer to the old city, where the ultimate showdown took place in the streets.
Entire families were killed, parents had to carry their children’s bodies out of the city. Malnourished children and adults arrived at our hospital with war wounds.
In some cases the surgical team in our trauma hospital worked around the clock to operate on patients who finally succumbed to their extreme injuries. No one was spared in the violence. The lucky ones made it to our hospital in time to be saved. Many remained trapped in Mosul under airstrikes because they couldn’t cross the frontline.
The dead are yet to be officially counted, because of the inevitable questions that will arise about civilian casualties and whether the war was fought with enough restraint.
Many of those patients who survived require follow-up surgery, rehabilitation and postoperative care. Yet nine out of 13 public health facilities were damaged or destroyed in Mosul. They are still not rebuilt.
Mosul, which once had a well-functioning health system, has had a 70% drop in bed capacity as a result of the war. There are currently fewer than 100 beds for a population of more than 1.8-million people. MSF is trying to fill the gap by running two health facilities. This is a drop in the ocean of destruction.
Healthcare provision is the ongoing casualty of the Mosul war. The inability to provide healthcare for a population that suffered an epidemic of war wounds unnecessarily extends the pain and misery of the active combat. In May alone, 4 600 people returned to Mosul. The health system will need to keep up with those who are returning to rebuild their shattered lives. Mosul needs affordable medicine, reconstruction of health infrastructure and a restocking of medical equipment. The Iraqi government cannot achieve this on its own.
The lack of interest shown in Iraq’s war-wounded by those wielding the weapons is not unique to this reconstruction phase. During the peak of the battle for Mosul, the international military coalition showed a lack of willingness to support the Iraqi army by picking up the sick and wounded from the frontline and providing them with impartial treatment in accordance with their obligations under international humanitarian law.
Instead, they subcontracted this frontline responsibility to the World Health Organisation (WHO). The WHO in turn contracted small organisations to be embedded with the Iraqi army and private companies to receive the wounded. Many lives were saved.
But many states may be emboldened to use a similar model in the future in which their responsibility is absolved and their control over humanitarian actors is ensured. Essentially, the humanitarian version of Blackwater Security Company was crafted out of the battle for Mosul.
What I witnessed in Mosul was a willingness shown by the international military coalition to defeat the Islamic State group at all costs, while subcontracting the immediate response to the devastation. We are yet to see a willingness to rebuild what was destroyed in the process. This is resulting in a new wave of war-wounded who need treatment but few options are available amid the rubble of Mosul.
Jonathan Whittall is the director of the analysis department at MSF. Heison Twitter at @offyourrecord