“Iraqi patients would die without dialysis”

Some 20 patients are currently treated with dialysis at Kirkuk hospital, in northern Iraq. This number represents just a fraction of those in need.

It is still very difficult to work in Iraq. The security situation improved somewhat in the past two years, but it remains unstable. It is within this troubled environment that Médecins Sans Frontières (MSF) is trying to assist Iraqis. Among other activities, the medical organisation is lending its support to the hospital in Kirkuk, an oil industry centre in northern Iraq, is disputed between the Kurd and Arab communities.

Iraqis have faced two wars, several years of embargo and seven years of instability and violence, leading to the disruption of the country's health system. The health structures in Iraq suffer from shortages in staff as well as highly over-stretched emergency rooms and operating theatres. Like other countries in the region, diseases such as diabetes and kidney disease, heart disease and high blood pressure are on the rise. Responding to these challenges is doubly difficult for a war-affected country.  

In Kirkuk, MSF trains Iraqi staff for specialist care, namely the treatment of renal failure with dialysis. To make up for kidney disease, an artificial replacement – a dialysis machine – cleans up toxins from the patient’s blood. This treatment is complex and requires highly-specialized skills. Medical staff needs training for these skills to be brought up to standards. Before the 1991 Gulf war and years of embargo, Iraq had an advanced health care system. MSF’s objective – not an unrealistic one – includes plans to increase the capacity of the unit to treat 80 patients on dialysis three times a week.

Patrick RUEDIN, a doctor from Sierre, Switzerland, visited Kirkuk in October to assess the level of care being provided there. A nephrologist for more than 25 years, he took part in a number of humanitarian missions in the Middle East and Chad in the 1980s. Here Dr Ruedin shares more about MSF’s project in Iraq.

How long did you stay in Iraq?
Patrick Ruedin: A week, including two days in Kirkuk. I already visited back in October 2009 for a first assessment. At the time, the building where the patients were being treated with dialysis was being refurbished. The service was not operational. Some 20 patients have been benefiting from this life-saving treatment since January 2010. The population in the Kirkuk region is around one million people. In Switzerland, for the same population sample we would have 600 patients on dialysis. So much remains to be done.

Is it the role of a humanitarian organisation like MSF to enter such a complicated domain?
The number of patients concerned is indeed very limited. However, they would die if they couldn’t get the treatment. One could look at dialysis as an elitist treatment whilst there are more glaring needs, but Iraq has the means of reintroducing this speciality; they just need a bit of a boost. MSF has asked me as a nephrologist to assist as they don’t have the expertise in-house, so it is a very interesting partnership. We have just sent 10 dialysis machines to Kirkuk. This equipment was used in Swiss hospitals before. MSF has conducted much-needed training in hygiene and nursing procedures for patient care and is co-ordinating the technical follow-up of the water supply and dialysis equipment.  

What are the next steps of the collaboration with Kirkuk hospital?
Now the Iraqi personnel must be trained to provide the best possible care in this advanced domain. As a nephrology specialist and president of the humanitarian commission of the Swiss Society of Nephrology, I will continue acting as the guarantor of the quality of care provided in Kirkuk. I can also act as the link between the Iraqi and Swiss hospitals, in particular with the nephrology service of Geneva’s university hospitals where I am a consultant and professor at the faculty of medicine. We are considering boosting contacts, thanks to the Internet in particular. We need this collaboration, especially for certain analysis. To clean a patient’s blood, very clean and pure water is required. A dialysis machine uses 30 litres of this water per hour. Yet the most accurate water analysis cannot be done in Iraq and even in Switzerland. Specialized labs are needed.

What were the security conditions during your visit to Kirkuk?
My stay was very short but I didn’t notice any particular tension. The trip to the hospital, in the city centre, takes about 15 minutes. MSF doesn’t use armed security there as they don’t want to be confused as being part of any side of the conflict. There are a lot of different forces present, but on the other hand, it appears calm. In the hospital, the different communities work side by side without obvious problems. It is important to support this hospital because it brings together people from different communities and goes beyond Iraq’s recent divisions.

Despite the ongoing conflict in Iraq, which has made it difficult for humanitarian organisations to be present in the country, MSF is striving to provide medical care to the Iraqi people. Since 2006, MSF has implemented programs all over Iraq and also in neighbouring countries such as Jordan and Syria.

As an international medical emergency organisation, MSF strives to provide free medical assistance to communities affected by natural disasters, armed conflicts, disease outbreaks and suffering from a lack of access to health care.  MSF offers neutral and impartial assistance regardless of race, religion, gender or political affiliation. MSF is an independent, non-profit organisation founded in 1971. Today MSF teams of medical and non-medical staff work in close to 65 countries.

In order to ensure its independence, MSF does not accept funding from any government, religious committees or international agencies for its programs in Iraq. The organisation relies solely on private donations from the general public around the world to carry out its work.