Rapid assessment Hammam Al Alil, Al-Shura and Al Raseef 09 November 2016 Rationale Areas north of Al-Hood such as Al-Shura, Al Raseef and more recently Hammam Alil have been retaken by security forces. Access to such locations allows for assessments to understand the space and modality for a humanitarian intervention, if needed. Purpose of the Assessment Purpose of the trip for WHO/Health Cluster: Identify location and capacity for trauma/stabilization unit closer to Mosul city Identify existing health facilities in the area Assess the extent on damage and rehabilitation needs of the existing health facilities of locations visited The visit was led by UNOCHA and included staff from UNOCHA, UNMAS, WFP, WHO, and the health cluster. This brief report is drafted on 10 November, 2016 with a focus on health. This draft can be used for operational planning purposes, with the understanding that the information below was valid on 09 November 2016. Areas Visited: Location GPS Coordinates Brief Description Hammam Al Alil Al Raseef Al Shura MGRS: 38SLE4437487500 The area is located approximately 140 km north-west of Erbil, about 5-7 km from the current frontlines on the date of the assessment. The location can be reached easily with a few checkpoints north of Qayarrah. Journey time from Erbil to Hammam al Alil using the acrow bridge was approximately 2 hrs and 45 minutes 3 hours on mostly tarmac road. Estimated population of 71,000 individuals, of which 30,000 were reported as IDPs. Referral to higher level of care in Qayyarah is approximately 30 kms south of Hammam Alil. Some PMF presence. Under control of the Federal Police. Population estimated at 170 families. Estimated 30 35 families reported as residing in Al 1
Shura on the date of the visit. The majority of the population was reported as displaced to Jad ah IDP camp. Description of the area: The towns of Hammam al Alil, al-shura and al-raseef are located on the west bank of the Tigris River. The current route to access these areas is by driving north of Qayarrah after crossing the river using the Acrow Bridge. Driving north of Qayarrah, vehicles were seen going in both directions, with passengers and some commercial goods, often bearing white flags. Most of the traffic was going south towards Qayarrah town, where the main street market is active. Approximately 20 km before reaching Hammam Alil, the Mishraq sulphur factory appears on the eastern side of the road with some stockpile of sulphate visible from the main road. The outskirts of Hammam Alil appear to have more structural damage and fewer people walking along the road side. On approaching the first roundabout, there is a school building on the main road where the federal police have set up a temporary clinic. The parking lot had three DoH ambulances parked (white vans with 122 written), as well as at least four federal police ambulances. The federal police had reportedly been in Hammam Alil for 2-3 days and are controlling the area. Local police will replace the federal police as the front line moves forward. In speaking with the mayor of Hammam Alil we gathered the following background information: -No official screening process is taking place but the mayor collects the IDs to check for any new individuals or families or distributions. -The agricultural college was destroyed. Two days ago there were clashes near the agricultural area and reports of a mass grave with many children. The route to the agricultural college is not considered safe. -Population of Hammam Alil and surrounding village is 71,000 individuals, including 30,000 IDPs. 2,000 2,500 individuals were reported as taken against their will towards Mosul. Mayor reports 2013 figures of 5,295 families in the main city centre for Hammam Alil and 14,000 individuals in the surrounding areas. -Police and armed forces are clearing areas in the city, but not all areas are clear yet. -Mayor reported 25% structural damage. However, this reported level of damage was not observed. -Limited access to clean water. The residents have drinking water in storage but once that runs out they will no longer have safe water. The water pumping station was damaged -Electricity is expected to be restored in 2-3 days 2
-Clinic damaged due to an airstrike after the military operations that started on 17 October, reportedly because ISIL was treating their patients in that location. Some health staffs remain in Hammam Alil. -IRCS, federal police and MoDM have conducted some distributions. One MoDM truck was observed handing out distributions before the group left the town. Small shops were observed carrying basic commodities including some fresh produce. Cash was cited as a challenge where families did not have the cash to make purchases. -Needs identified by the mayor are food, education and health. Goal and objectives: The main aim of the assessment is to identify gaps in services addressing trauma/stabilization capacity as well as primary health, Specific objectives of the assessment focused on: 1. Identify existing health facilities in the area based on 2. Assess the extent on damage and rehabilitation needs of the existing health facilities of locations visited. Methodology: The assessment is completed during a one-day visit to all three locations. The visit in Hammam Alil was conducted to primary health care center (PHCC), and adjoining delivery room as well as the school location where the federal police were providing medication. The assessment data were collected from discussions with two key informants and observation. The key informants were the mayor and Dr. Riyadh who said that he was the PHC manager in Hammam Ali. No PHC was present in al-raseef, even prior to 2014. We were not able to visit the PHCC in al- Shura Key Findings: Federal Police clinic in the school: -Staffing from federal police was reported as 3 pharmacists, 1 surgeon, 7 paramedics -Three DoH ambulances available in the parking lot. Patient transfers reportedly with a driver and a paramedic to Qayarrah. -4-6 Federal Police ambulances present on site. -Running water was available outside the school building through tap stands. -Pharmaceutical supply dispensed by pharmacist and doctor to women, children and men after asking for chief complaint. Basic medication was available, supplied by the federal police, such as antibiotics, bronchodilators, topical burn ointment and wound dressing equipment. 3
-Three patient observation tables available without privacy screens. Two medical doctors on site were observed as taking vital signs, and doing dressing changes for previous injury -Speaking with the medical doctors, they reported the majority of cases were respiratory illnesses and fever sometimes. No reports of diarrhea. Referrals were to Qayarrah. All deliveries were referred to Qayarrah. Conflicting reports about whether or not the ambulances sent to Qayarrah would also stay for the counter referral back to Hammam Alil. -During the 15 minutes at the school building there was a steady flow of persons visiting the temporary clinic, and leaving with medication in hand. Hammam Alil PHCC: -Damaged by a direct airstrike hit to the main building. Major rehabilitation work will be required. A register book for non-communicable diseases, funded by USAID, was on the floor of the entrance to the damaged PHCC. Figure 1: View from the entrance inside Hammam Alil PHCC after the airstrike Discussion with Dr. Riyadh, PHC in-charge: -Hammam Alil population previously served by PHCC and delivery room. Referrals were previously to Mosul which could be completed in approximately 30-60 minutes -Diagnostic equipment available were sonar and x-ray 4
-Basic laboratory services were previously available -2 doctors, 4-5 nurses, 2 female doctors, 4 lab assistance, and 4 pharmacist assistants are still present in Hamaam Ali. Two midwives were previously in Hammam Alil but they have since left for Mosul. -Vaccination for polio was conducted 10 days ago but no records are available. -Since the start of the military operation, Dr. Riyadh has done medical consultations in his home and patients were given prescriptions to be filled by a private pharmacy. -Adjacent to the PHCC building, there is a delivery room with four rooms for labour, delivery, postdelivery, and operation theatre room with OT lights installed from the ceiling attached. There are also latrine, shower and kitchen facilities available. The structure is intact, but the outside wall is damaged and medical equipment, medical supplies and furniture will need to be replenished. Four water tanks are on roof. No incinerator visible. Generator is not present on site. Figure 2: Delivery room equipment lying outside the -Visited the bank building with approximately 6 rooms and a wide open space on the ground floor. Dr. Riyadh and the mayor said that the building may be used for stabilization/trauma care if needed. This discussion needs to be taken forward. Will need to check on electricity, water supply and minor rehabilitation for broken windows. 5
Figure 3: Bank building as a potential stabilization site Al-Raseef: No PHC in the town and there wasn t a PHC prior to 2014. 170 families resident at the moment. WHO zone coordinator requested to respond with a mobile team for medical screening and vaccinations to Al- Raseef, as per the HOC action request. Al-Shura: 30-35 families remain in the town. Mine clearance is still ongoing in the location. Federal police and EOD teams were seen. A visit to the PHCC was not possible. Recommendations: Health Assess possibility of using the bank building as a stabilization/trauma unit. Other suitable space may not be available in the town at this time. Mobile team for primary health care services, including reproductive health care Talk to DoH and Dr. Riyadh about vaccinations Rehabilitation of PHC to be discussed for longer term 6