From ONE Magazine

Health on Wheels

Evene George considers her toddler a living miracle. During the fifth month of her pregnancy, Islamic State warriors stormed her hometown of Mosul. After a brief moment of confusion that hot June night in 2014, she managed to escape with her family.

For six hours she walked, sensing an intensifying pain in her swollen feet. Then her neighbors pushed her in a cart. Gradually overcome by exhaustion, she felt certain she would miscarry.

Finally, after settling down among tens of thousands of other similarly displaced Iraqi Christians, Yazidis and Muslims in nearby Kurdistan, Mrs. George gave birth to a healthy boy.

The 27-year-old now resides with her husband, three sons and two teenage sisters in Nafkandala, a small, desolate Assyro-Chaldean village in northern Kurdistan, a semiautonomous region of Iraq protected against Islamist militants by Kurdish Peshmerga forces. While they survive with support from charities and aid groups, the full extent of their needs remains great. For days now, her son, Massis — now 13 months old — has been suffering from a persistent cough and a sore throat.

“To get medical treatment for my son, we have to drive in a taxi for miles to reach the nearest city. My husband is jobless and we are drowning in debts. We cannot afford it,” she says. Aside from keeping her son warm and out of the sharp, chill winds, it had seemed that Mrs. George’s only recourse was prayer.

One morning, when a white van serving as a mobile health clinic arrived in this village near the Turkish border, the inhabitants greeted it with enthusiasm. Learning about the clinic by word of mouth, Mrs. George carried her son and headed to the village’s main hall with dozens of other residents. There, the basic elements of a clinic were quickly put in place: a green, three-panel privacy screen, an orange stretcher and a table serving as the doctor’s desk — complete with a stethoscope, a blood pressure meter, an oxygen tank and assorted medical instruments.

Funded by CNEWA, the mobile clinic is an initiative of the Rev. Yousif Jamil Haddad, the pastor of the Virgin Mary Syriac Catholic Church in Zakho, a bustling city close to Turkey and a commercial hub for the export of oil from Kurdistan.

“Many refugees are staying in poor, remote villages where they have no access to medical care,” says Father Haddad, explaining the motivations behind the project that began its operations last June.

Today, the mobile clinic visits 22 villages scattered throughout the hilly northern edges of Kurdistan, serving a population of roughly 15,000 internally displaced Christian, Muslim and Yazidi families. Staffed by a doctor, a pharmacist, an administrator and a driver, the van departs from Zakho around 9 a.m., five days a week. Each morning, the van is loaded with supplies stored on the premises of the Syriac Catholic parish. It then makes its way to one or two villages where, typically, the clinic’s doctor provides medical consultation to some 140 patients.

In the daily efforts of this small operation, displaced from all walks of life have found a lifeline — enabling many of the region’s most vulnerable people to reclaim health and hope.

“People here are very desperate, so when we come, they are very happy to see us,” says Dr. Karam Nahal, a general practitioner who works with the mobile clinic in the morning while filling the afternoon and night shifts at a hospital in Zakho. Dr. Nahal is himself displaced from Mosul.

The most common ailments Dr. Nahal encounters include influenza and bronchitis caused by cold weather and poorly heated homes, and skin diseases and urinary infections resulting from poor hygiene and overcrowded dwellings. But Dr. Nahal says he also sees many patients suffering from chronic conditions, such as diabetes and hypertension and even cancer.

In Mergasora, a village of bare one-level homes and farm animals, men and women wait on plastic chairs for their turn with the doctor. Some elderly Yazidi women wear traditional white headdresses. Children frolic, turning a deaf ear to dispirited-looking parents trying to rein them in. The patients carry numbers they received after they registered with the mobile clinic’s administrator.

Eid Faleh, 22, enters the village’s public hall, which currently serves as the clinic space, overlooking the valley. Carrying a large, transparent folder full of medical reports, prescriptions and an X-ray scan, he helps his elderly mother sit down.

“She has been feeling very tired lately,” says Mr. Faleh, a shepherd who fled Mosul after ISIS killed his cousin. His mother, Naima Khalif, had her breast removed because of a malignant tumor. There are fears, however, that cancerous cells have spread to her blood vessels. Mr. Faleh says that in Mosul his mother underwent chemotherapy but that in this Kurdish village they had no means to treat her.

Unfortunately, the drugs she needed were not available at the mobile clinic. The doctor could only prescribe painkillers to ease her suffering.

Later, making the most of the clinic’s visit, Mrs. Khalif brings her grandchildren to the doctor for a checkup.

“There are many cases that we are unable to treat,” says Sandar Salem, who oversees the daily operations of the mobile clinic. Difficult medical cases are usually referred to specialists in Zakho. But transportation, even to nearby cities, remains a prohibitively costly option.

The situation of the displaced is dire all over Kurdistan. Yet the presence of well-equipped free medical facilities — such as those supported by generous CNEWA donors in urban centers such as Dohuk and Erbil — makes it easier for displaced people to receive medical care. These centers, created as a response to the refugee crisis in August 2014, typically include specialized pediatrics and gynecology clinics, X-ray and medical labs and even dental services.

The mobile clinic has far fewer resources, however, particularly where psychological concerns arise. Out of work for many months after losing their homes and possessions, people feel hopeless and powerless. Depression is common. This translates physically into loss of appetite, extreme fatigue, sleep disorders and, sometimes, erratic behavior.

“Today, I examined a 40-year-old woman who suffers from an obsessive compulsive disorder,” says Dr. Nahal. “She washes a chicken five times but still doesn’t find it clean enough.”

Patients and their families often refuse to acknowledge mental health concerns. Even in the current situation, acknowledgement of psychological disorders remains taboo in Iraq. There are many Yazidi men who suffer from post-traumatic stress, Dr. Nahal adds. ISIS has torn their families apart, and forced wives and daughters into sexual servitude. For those facing such horrors, the doctor says, the clinic can do little to help.

Outside the town hall, the van is parked under a tree. From its open rear door, the mobile clinic’s pharmacist, Falah Ahmad, distributes medicines prescribed by the doctor. Drugs donated by local medical authorities in Zakho include everything from antibiotics to painkillers, ointments for allergies and drugs for diabetes and stomach flu.

“We give away hundreds of medicine packets, but it’s never enough. There are many shortages,” says Mr. Ahmad.

Safwan Elias, 32, a Yazidi farmer from Sinjar in the Nineveh province of northern Iraq, takes cold medication for his five children, his wife and himself.

“We all have the flu because of the cold,” he says. Mr. Elias says he was trapped with his family for two weeks as ISIS besieged Sinjar in late 2014. He witnessed shelling just miles from his home and at one point suffered such desperate hunger that he resorted to eating leaves from trees. Though he was able to escape before ISIS militants took over their town, thousands of Yazidis in Sinjar were not so fortunate.

Today, Mr. Elias lives in a modest house offered to him by friends. As with many displaced people in these isolated villages, he is unemployed. Only a few have managed to secure employment — usually odd jobs in construction or work as seasonal laborers.

Despite the scarcity of work in these villages, many of the displaced prefer to live there rather than stay in urban centers, where costs of living and rent are prohibitively expensive. Before their arrival, Kurdish villages and towns were full of empty houses; their residents had long since left to seek better economic opportunities in Iraqi cities or abroad. To accommodate the thousands of displaced families seeking shelter in their communities, the mayors opened these mostly rundown houses for free. Some were gradually repaired and refurnished, with plastic shields replacing glass windows and basic furniture and appliances donated or bought from secondhand shops.

For food and other basic needs, displaced families receive monthly coupons from CNEWA and Caritas, the charity of the Catholic churches in Iraq. But the value of rations has decreased over the months — in some cases from $30 to $12 per person.

Another problem facing the displaced is schooling. Mr. Elias cannot afford to send his children to school. Only some of the larger villages offer free classes in Arabic for displaced children, but transportation costs remain an impediment in smaller municipalities, such as Mergasora. Moreover, public schools in Kurdistan teach in Kurdish, a language that most displaced children do not speak.

Awatef Youssef, a 30-year-old mother displaced from Qaraqosh, a once-thriving Christian town now occupied by ISIS, is more fortunate. The Syriac Catholic church provides transportation to take three of her four children to a school in nearby Levo.

“I am glad my children are getting an education, but the level here is so much lower,” says Mrs. Youssef. “There, they were good students. Here, they seem distracted all the time.”

Much has changed for Mrs. Youssef and her family since they moved to this village a year ago. Her home, once a well-appointed house with a garden, is now a modest dwelling with unpainted walls, bare floors and minimal furniture.

“Naturally, my children ask me for toys and new clothes,” she sighs. “But I can’t offer them anything.”

Mrs. Youssef says she finds solace in prayer and in keeping her family’s spirits high. She tells her children they will someday soon go back to their home and their friends, despite her growing doubts. Also weighing on her mind are the deaths of distant relatives who drowned as they attempted to cross to Europe from Turkey.

“It has left a scar on my heart,” she says. The unfortunate news was widely publicized among the Christian community in Kurdistan.

“My children ask me whether we will also go on a boat. They constantly express fear of the sea,” she says.

For many exiled Christians, the situation is at a deadlock. Even if their towns are one day liberated from ISIS, most doubt they will be able to return safely. Many say their trust in their Muslim neighbors has been shattered. Yazidis from Sinjar say much the same. Although Kurdish forces overtook the region last November, it remains largely uninhabited, with neither water nor electricity. The displaced from Sinjar say they would only go back if protected by international troops.

The one upside of the current situation in Nafkandala, according to the village’s mayor, Bassem Hamid, is that it is fostering unity among people of different faiths.

Originally home to 30 families, Nafkandala today accommodates 70 displaced families — Christian, Yazidi and Sunni Turkmen alike.

“It’s much livelier. The church is packed now during the Sunday liturgy. Even Yazidis attend,” he says, adding that the local village church has introduced new religion classes for children.

At around 2 p.m., as the number of patients dwindles, Father Haddad and the mobile clinic’s staff start packing up to leave. A few people arrive before the van departs, asking Dr. Nahal for a quick last-minute consultation.

For Father Haddad, the need for medical support exceeds what they are able to offer.

“There is a need for more mobile clinics to cover the villages more than once a month,” he says, adding that they are badly in need of a nurse to help administer treatments, care for wounds and remove stitches.

Other challenges include inclement weather, when rain makes it difficult to reach faraway villages — especially those without properly paved roads, where vehicles can become stuck in the mud.

Still more cause for concern are two Assyro-Chaldean villages the clinic visits — Sharanish and Dashtatakh — that lie in areas controlled by the P.K.K., the Kurdish rebel group fighting for an independent Kurdish state within Turkey. Technically located within Iraq, the villages are shelled routinely by the Turkish military.

“We have to wait sometimes for hours to get permission to get into these towns,” Father Haddad says. “But we make sure to go as often as we can; this is where the most desperate cases are.”

Raed Rafei is a Beirut-based journalist and independent filmmaker whose writing has appeared in The Los Angeles Times, Forbes Arabia and the Daily Star of Lebanon.