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Iraq: "I thought I would be able to drive my tuk-tuk to save more people"
In Iraq, tuk-tuks are known as the "ambulances of the nation". A young driver risks his life to rescue those wounded during anti-government protests in Baghdad.
On 1 October 2019, people took to streets of Baghdad to protest the Iraqi government's failure to provide basic services, create jobs and stamp out corruption.
The unrest soon spread to other parts of the country and the authorities responded with violence, using live ammunition, tear gas and stun grenades against protesters.
As Baghdad's hospitals were inundated with wounded men, women and children, MSF teams visited facilities and donated emergency medical supplies where needed.
We also expanded the capacity of the Baghdad Medical Rehabilitation Centre, from 20 to 30 beds, in response to the increased need for post-operative care and early rehabilitation.
Among those referred to the centre in recent weeks is Ali Salim, a 20-year-old tuk-tuk driver who spent his days ferrying wounded people to hospitals before he ending up in a hospital bed himself.
“From October 1, they started firing at people and as a tuk-tuk driver, or the 'ambulance of the nation' as people call us, I started evacuating wounded people,” says Ali.
“I have seen some injuries that really damaged me. I couldn’t just go back home, put my head on a pillow and fall asleep. Some get hit by 'smokers' [Iraqi slang for tear gas canisters] in the head, others in the leg – my convictions didn’t allow me to leave.”
While trying to help people, Ali was hit in the leg by a stun grenade. He was taken to hospital for surgery and told he needed to stay for two weeks to properly recover.
But Ali could not rest as he saw the influx of wounded arriving at the hospital alongside him.
“I thought I would be able to gather my strength, stand up and drive my tuk-tuk to save more people,” he says.
Ali discharged himself against medical advice after just two days.
In the firing line
Ali was soon back at Tahrir ferrying wounded people from al-Jumhouriyah Bridge, which runs over the Tigris river, linking the main square to the Green Zone where government buildings and foreign embassies are located.
“When we drive onto the bridge we turn off our headlights, but they aim towards us and fire,” he says.
“When they shoot, I move my head sideways as the tear gas and stun grenades or bullets penetrate the windshield – it was as if you’re watching a Bollywood film,” Ali continues, adding that he is surprised to still be alive.
But the worst was yet to come for Ali.
On November 7, while posing for journalists with his heavily damaged tuk-tuk, a medical volunteer asked Ali to take him to al-Shuhada Bridge where there were reports of live ammunition being used.
Once on the scene, Ali and the medic found three injured people. The medic asked for permission from security forces to aid those injured, raising his hands over his head. They refused.
“He looked at me, smiled and told me: 'son, wait here',” Ali says, poignantly describing the last words uttered by the medic.
He was shot in the chest almost immediately as he ran to assist the wounded.
Appalled by what he had just witnessed, Ali rushed to collect the medic and the other wounded people. But just as he was about to drive out to safety, his eyes caught sight of another injured man.
“He was an old man, I was truly devastated,” he remembers.
As Ali approached the man, a security member shouted for him to go back. But he refused and was shot in the thigh from point-blank range.
Ali was taken to hospital for surgery and his tuk-tuk was never seen again.
Trauma care in Baghdad
MSF opened the Baghdad Medical Rehabilitation Centre in 2017 to provide early medical and physical rehabilitation to the scores of people wounded in the war to retake Iraqi cities from the Islamic State group.
As the war fell from the headlines, the centre's admission criteria was expanded and our staff began treating survivors of non-violent trauma, such as those involved in traffic and industrial accidents.
In recent months, the beds have been filled with people injured in the ongoing violence in Baghdad.
There, they receive early physiotherapy and post-operative care, including mental health support to ease and treat accompanying mental health issues.
Early rehabilitation leads to better reintegration
Inside the Baghdad Medical Rehabilitation Centre, a team of specialised doctors, nurses, physiotherapists, psychologists and non-medical support staff care for patients not only in the centre but also those well enough to go home and receive treatment as outpatients.
The work begins almost as soon as a patient’s anaesthetic wears off and the patient is referred to the centre by a network of doctors in Baghdad’s hospitals or by the MSF team touring hospitals in the city in search of patients in need of intensive post-surgery care and rehabilitation.
“Early medical rehabilitation plays a role in reducing the short-term medical ramifications and long-term physical and psychological consequences of injuries,” explains Dr Aws Khalaf, the Medical Activity Manager.
He says that the consequences of not receiving early post-operative care can include blood clots and infection.
By reducing the impacts of the injuries and accelerating the patients’ recovery, the medical staff at the centre “help them to reintegrate in their communities as active individuals, not a burden on other people”.
They see mental health support as an essential part of rehabilitation.
During frequent sessions, psychologists and counsellors work to address depression and anxiety amongst patients, and help them adjust to their new realities and deal with their often traumatic memories.
To date, 75 percent of the patients treated by MSF in the Baghdad Medical Rehabilitation Centre have been discharged with an improved mental health status.