Some health facilities adapted to functioning under these changed circumstances, while others did not. Īpproximate extent of ISIS control in Iraq, 2015 There is a widespread perception that recovery of civil society post ISIS has stalled in the four governorates, with health services severely impaired. Facilities in these areas often had difficulty obtaining medicines and vaccines, as well as difficulties retaining and paying staff. In Salah al-Din, 36% of health facilities were destroyed and by 2018, only 30% of hospital beds in Ninewa were functioning. Some facilities continued to function under ISIS control, but other facilities were abandoned or sometimes destroyed by military action. Many health workers fled, particularly those from minority ethnic and religious groups. Many health facilities had little warning of the impending assault by ISIS, although the jihadists had been active for a period of time in some locations. The impact of ISIS on a health system, already weakened by years of conflict and underfunding, was great. In 2021, 1.3 million people remained internally displaced, mainly in the north and west of the country, while 4.7 million have returned to their place of origin. The conflict displaced nearly 6 million people. ISIS control in Iraq effectively ended with the recapture of west Mosul by Iraqi government forces June 2017. During the next months, the invasion of parts of two other governorates, Salah al-Din, and a small part of Kirkuk occurred (Fig. In June 2014, control of Mosul, Iraq’s second city was seized and soon afterwards almost all the Ninewa governorate. In January 2014, fighters of the Islamic State of Iraq and Syria (ISIS) seized Ramadi, capital of Iraq’s Al Anbar governorate and shortly after that, Fallujah, Al-Anbar’s principal city. Rebuilding lost community trust in the public sector is proving difficult. Some heavily damaged facilities are still functioning, but below pre-crisis level. (3) Restructuring or transformative activities In most areas, health services recovery was continuing in 2020. Ill persons would sometimes consult health workers in their houses at night for security reasons. In most locations, maternal, neonatal, and child health (MNCH) preventive and promotive PHC services stopped. (2) Adaptation After the initial shock, many health facilities adapted by focusing on urgent needs for injury and communicable disease care. Private pharmacies and private clinics in some places withstood the initial shock better than the public sector. (1) Absorption The shock to the public sector health services by the ISIS invasion caught health services in the four governorates unprepared, with limited abilities to continue to provide services. There were many common themes across the four governorates, with local variations. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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