“In time of war, we restore hope”

You spent several years in Nepal and now you’re working in Iraq. How do these two countries differ?

Although the crises affecting these countries have had a significant and obvious impact on their inhabitants, the two contexts are different. In Nepal, after the earthquake, in April 2015, we had to deal with an emergency situation. But because the crisis was caused by a natural disaster, people got back on their feet fairly quickly. They knew that what had happened was out of their control and that it probably wouldn’t happen again anytime soon. In Iraq, we’re dealing with a chronic crisis and a conflict that has dragged on for decades. People are deeply traumatised. You really feel the anxiety, fear and frustration when you talk to our Iraqi beneficiaries. They generally find it hard to look ahead, to be optimistic about their future or their situation. That’s not something I had come across before I started working in Iraq.

You coordinate the organisation’s rehabilitation activities in the country. Are the people assisted by Handicap International in Iraq different from the organisation’s beneficiaries in Nepal?

Lots of our beneficiaries in both countries suffered and still suffer from fractures, spinal cord injuries, amputations and head injuries. The main difference is the cause of their injuries. Many people in Nepal were trapped beneath the rubble during the earthquake. People who had to undergo amputations generally had no other option because it wasn’t possible to “save” their arm or leg.

In Iraq, a lot of people are injured as they flee conflict zones. They often have to have an amputation following a lack of post-op care, serious haemorrhaging or other medical complications of that kind. Access to hospitals is difficult and controlled. Check points and other procedures often prevent the injured from receiving the health care they urgently need. And when they finally do reach health facilities, these are generally overcrowded and their staff completely overwhelmed. They can’t stay as long as they need to, in order to recover properly from their injuries. The lack of post-operative care really is the main issue in Iraq.

How are the services available to the injured different in both countries?

When you compare the Iraqi and Nepalese health systems, you realise how developed Iraq is. It will probably be ten years before Nepal builds facilities similar to those in Iraq. After the earthquake, most casualties were transported by helicopter to Kathmandu, the capital, for proper treatment. There are many more hospitals across Iraq. The main problem there, however, is the access to these hospitals. And the number of casualties differs too, which directly impacts the quality of care available to people.

The best example I can think of to illustrate this situation is the story of Khembro and Nirmala. These Nepalese girls were amputated in 2015, following the earthquake. Because the organisation provided them with appropriate care and regular follow-up, they were rapidly fitted with prostheses and learned to walk again. A few months ago in Iraq, I met a child from Mosul, the same age as these two girls. His legs had been amputated because he could not get rapid and proper treatment after his accident. The conflict almost killed him and deprived him of his legs. He’s still in a critical condition now and lives in an area that’s almost impossible for humanitarian actors to access.  I’ve lost count of the number of Iraqi children in the same situation. 

What about the emotional state of these people?

That’s the main difference between these two countries, I think. People in Nepal found it easier to overcome the trauma of the earthquake. They had no one to blame for what had happened, so it was easier to recover. In Iraq, the war has had a huge impact on people’s mental health. They generally take longer to get over their trauma, whether it was caused by an injury, their experiences over the last few years, the situation in the country, or all three. The conflict is directly linked to human actions, and battles are still going on. 

Most of our beneficiaries don’t know what’s going to happen from one day to the next, if they are going to be injured in an attack or will need to flee again. The whole Iraqi population is in this position. And in IDP camps^[1], it’s even more complicated. People can’t enter or leave the camps as they wish. They are not entirely free to move around and that has a big impact on their mental state. This is why we implement psychological support actions as part of the victim assistance activities. We think that it is vital to provide this support alongside physical rehabilitation, in such context.

Why is our rehabilitation program essential in Iraq?

There are always a lot of casualties in a country in conflict. Physiotherapy sessions enable the victims to minimise the impact of their injuries and help them get back on their feet. The fact that our teams provide the injured and disabled with regular assistance is also very important. We don’t simply help these people to recover physically. We give them hope and that’s what they need most, in time of war. Physiotherapy helps prevent disabilities or injuries from getting worse, but most of all it reminds our beneficiaries that their accident does not mean their life is over. We’re the ones who remind them that they need to move forward, despite their situation and their everyday struggles.

How has your personal experience been different in these two countries?

As a physiotherapist, my clinical approach is the same, regardless of where I am working. But the contact I have had with our beneficiaries made each experience unique. In Nepal, my relatives and I were directly affected by the earthquake and I understood exactly what the people I met were feeling. Here, I can only imagine what Iraqis have been going through every day, for the past decades. I find our beneficiaries’ stories very touching. The war has had a big impact on people’s lives and it affects every area of society. Everything seems complicated here and it’s easy to be defeatist in a situation like this. But I learned to find hope in small victories. That’s what keeps me working in this country.