Singaporean Assigned to Iraq: What It’s Like to Work at Doctors Without Borders

Not many can say that they’ve pursued their dreams with single-minded passion, but Abu Jihad Hanafi, a 31-year-old field worker from Médecins Sans Frontières/Doctors Without Borders (MSF) can.

His 10-year long journey began during his initial week in nursing school, where a friend’s offhand sharing intrigued Abu to learn more about the organisation. Says Abu, “I was so blown away with all the things they were doing. After that, it was at the back of my mind, a long-term goal to aim for.”

Offering medical humanitarian aid to over 70 countries around the world, MSF is revered for its dedication to free, quality care for populations in need. To even qualify to work for the non-governmental organization (NGO) required years of professional experience; it was also recommended for applicants to complete tropical medicine courses – to develop the technical know-how in treating diseases prevalent in tropical, developing countries.

In applying for his tropical medicine course in the UK, which was not accredited in Singapore, Abu deviated from the norm of acquiring a specialist diploma in a recognised institution, which would have granted him stable pay increments upon completion. It was one of several fork-in-the-road moments where he would have to choose the path less certain; the other being the acceptance of his assignment to Iraq.

Says Abu of his choices, “When family members would ask why I wanted to get into this course, I’d say it’s because I want to get into MSF”. Later, after self-funding his way to course completion, and getting accepted into MSF, he’d explain his decision to give up everything to serve in Iraq in pretty much the same way.

Abu got the email while working at his full-time role as Senior Nurse at a governmental hospital in Singapore – a couple of weeks before he was set to begin further studies in nursing. He’d signed the offer after rejecting several previous opportunities (MSF requires workers to be available for 6-12 months); so the email from MSF was “out of the blue”.

Says Abu, “it was a once-in-a-lifetime opportunity”, and in part, it’s because most first-timers receive assignments to less chaotic regions as part of a facilitatory “buddy system”. From December 2019 to March 2020, Abu was the only Singaporean to be working in Kirkuk project, Iraq, where he served as an emergency response (ER) nurse and activity manager with Doctors Without Borders.

Hawija hospital, Kirkuk base, Iraq

Hawija city, the largest district encircling Kirkuk Governorate, had been taken over by the Iraqi forces after an almost four-year Islamic State (IS) control in the area. The military intervention in 2017 drove thousands of Iraqis to flee and reduced healthcare resources to a dribble. When Abu arrived, reconstruction had begun, but limited resources still defined the hard-hit town.

The hospital had been renovated in 2018, post-IS, in coordination with Iraq’s Ministry of Health (MOH). In Hawija, it was one hospital for a population of 200,000, supported by about 30 national and international staff who worked in the city. The primary goal, as international staff, was to provide the technical support for local professionals to help set up an independent, self-sustaining healthcare system – one that would be able to provide basic medical care, ER, and maternity services for the surrounding population.

Daily life in Iraq

For Abu, typical working hours were from nine hours a day. Yet, small but significant differences marked his time being on the frontline in Iraq versus in Singapore. It took two hours, for instance, to travel between the project base and the hospital. No one travelled after dark due to security concerns, which meant that his workday was usually shortened not as an indulgence, but because it was a necessity.

At the hospital, Abu worked with his team members to teach courses – on cardiac life support (CPR) and mass casualty exercises – while training up local nurses on new triage systems for capacity planning. Says Abu, “Due to the lack of functional health facilities, locals were coming to the hospital for very minor ailments, anything from headaches to abdominal pain and checking of blood pressure. Then there were many who suffered from trauma due to road traffic accidents (due to the lack of an established traffic system in Hawija). Everyone was being sent to the hospital, but there was no proper system to prioritise the cases”.

Unlike in Singapore, where there is organised entry into ER, the hospital had multiple entrances, which meant patients would stream in at any time seeking treatment. Staff did the crowd control, because hiring a receptionist (like in Singapore) would have been an additional cost.

Explains Abu, “There was initially resistance from national staff – we were foreigners after all, going to leave in a few months – so implementing the triage system took several months. We had to learn to give and take, and pick up the best way that is good and comfortable for Iraqi medics and patients. Change takes time.”

Application to everyday life

Leaving right before the COVID-19 response in Iraq, Abu returned home to join Singapore’s fight against the pandemic. Says Abu, “Aside from donations and being on the frontline, there continues to be many ways we can make a difference to humanitarian crises in our everyday lives.”

“For starters, we can read more and actively expand our worldview. Watch documentaries, like in MSF’s upcoming film festival, and advocate for a cause on social media. Volunteer with smaller NGOs; you can help as long as you know about situations going on in the world. If not us, then who else?”

In encouragement to those following their calling, Abu adds, “Don’t let anybody stop you.” As one of just 17 MSF field workers in Singapore, he is inspiration that the way forward is with unrelenting effort and tenacity.

MSF Film Festival (6 – 8 November 2020)

Featuring stories like Abu’s – of aid workers in action and the realities faced by vulnerable populations around the world – the Doctors Without Borders Film Festival paints parallels between the current fight against COVID-19 and the need for restoration of dignity in affected populations.

Three critically-acclaimed documentaries will be screened virtually, in light of COVID-19 safe distancing measures – Diaries from the Field, Restoring Dignity, and Panorama – Ebola Frontline (which is also produced by BBC).

Diaries from the Field

A snapshot of the current Rohingya refugee crisis in Bangladesh, the film is crucial insight into one of the biggest humanitarian crises of the world today. At Cox’s Bazar – the world’s largest refugee camp – we track the emergency work MSF has been doing for over 700,000 displaced Rohingya refugees, for which the COVID-19 pandemic has only exacerbated the situation at hand.

Restoring Dignity

Noma is a neglected disease, something most of us might not have even heard of. Gangrenous and disfiguring, the disease is preventable, but difficult to avoid in extreme poverty pockets due to factors like lack of hygiene and malnutrition. The film highlights the realities faced by survivors of Noma, and sheds light on a disease that would otherwise be forgotten.

Panorama – Ebola Frontline

The last film highlights the realities faced by aid workers during the fight against Ebola, the deadly infectious disease that devastated West Africa in 2014. The exclusive footage, shot through a state-of-the-art head camera, offers insight into a high-risk zone in Sierra Leone for one month.

With the current pandemic, the film prompts us to draw parallels – a timely reminder of how more vulnerable communities around the world are impacted even more during these times.

Live sharing sessions

After each film screening, experienced field workers from Doctors Without Borders, as well as the film director from Restoring Dignity, will talk about their first-hand experiences, and answer questions from the audience.

It’s an incredible opportunity to learn and engage, as the film festival is free and open to the public. You can register here.


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