Anfal Mahmoud Ali, shares how her experience living amid conflict shapes her work as a mental health and psychosocial support officer for Humanity & Inclusion in Iraq.

I remember May 5, 2017, like it was yesterday.   

My family had been hiding in our bathroom for days without food or water, clutching our IDs. Our neighborhood in Mosul had been liberated from ISIS, but fighting on our street persisted. Then the airstrike happened. Our family home crumbled around us. By a miracle, we survived and managed to escape first to a neighbor’s house, then to a displacement camp. 

Later that year, we returned to Mosul. We had nothing. A friend of mine told me that Humanity & Inclusion was hiring, so I applied. Since working here, I've been able to support my family, repair my house, and rebuild our lives.  

I've seen first-hand the effect that conflict has on civilians. They lose their loved ones, their jobs, and their homes. And they usually face poor conditions, even after the fighting is over. Violence and devastation can cause people to experience depression, sadness and sometimes suicidal thoughts. Some people suppress their feelings. Others develop physical or chronic illness as their mental health needs go untreated.  

My colleagues and I conduct awareness sessions with people experiencing psychological trauma, encouraging them to seek help and teaching coping mechanisms. When I meet all of these wonderful people, I am motivated to wake up in the morning and do my work with love. My neighbors understand that we need to stand by each other to survive. I thank those who are helping survivors of conflict, like me, access essential resources—shelter, rehabilitation, mental health support, and more. 

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One million people fled the fighting in the aftermath of the Battle of Mosul, which ended in July 2017. Some 500,000 are still living in camps for displaced people across Nineveh province. According to the United Nations, two million people need humanitarian assistance.

"Families still living in the camps are unable or unwilling to return home for several reasons,” explains Stéphane Senia, HI’s head of mission in Iraq. “They fear for their safety in this region controlled by a multitude of armed groups. They are afraid of the explosive remnants of war contaminating Mosul and surrounding villages. They often have nowhere to go because their neighborhood has been completely destroyed and its social and economic life no longer exists.”

Destroyed homes, hospitals, schools, and roads

In Mosul, 65% of houses and apartments have been damaged, according to the United Nations. Although life has resumed in the eastern half of the city, the western half—where most of the fighting took place—remains heavily contaminated by explosive remnants of war and improvised mines. Vital infrastructure such as schools and hospitals have been destroyed. Roads and bridges are still impassable.

"The western half of the city has been almost abandoned due to a lack of resources and political inability to organize weapons clearance and rebuild the city,” adds Stéphane. “In the short term, there is no prospect of things improving. The western districts are likely to remain as they are for several years." 

“The level of contamination is still unbelievably high in Mosul and the surrounding region.”

“Many families returning to Mosul won’t have any experience of explosive remnants of war and booby traps in particular. Residents are forced to take risks because they have no other choice. The western half of the city is so contaminated it’s like a minefield under the rubble.”

Humanity & Inclusion’s teams are working across nine camps—reaching 120,000 people—to ensure that people understand the dangers of explosive remnants of war, so that when they return to their homes, they can do so in safety. “They will travel throughout the city and get people to think about what a suspicious device looks like, what the risks are, and what to do if they find one. The goal is to reduce the number of accidents, which remains significant, two years after the fighting.”

An unofficial evaluation by iMMAP found an average of 40 weekly explosive incidents across the country at the end of February.

Major rehabilitation needs

Since July 2017, Humanity & Inclusion has been providing rehabilitation care and psychological support in two hospitals run by Doctors Without Borders—the first in Mosul itself—and the second near the village of Qayara. We also set up rehabilitation care and psychosocial support reception points across the nine camps. Since launching this support, our teams have provided rehabilitation care to 2,500 displaced Iraqis. But the needs remains high.

"We have to put people on a waiting list for rehabilitation care because the demand is so high and our response capacities are limited due to the disengagement of emergency funding bodies," Stéphane adds. We provide care to improve the mobility of patients and ensure that they can do everyday activities such as getting out of bed, going to the toilet, etc. as autonomously as possible. We also provide them with psychological counseling because many of them have anxiety or depression. We help many people who are totally lost and don't know what their future will be like." Since the summer of 2017, Humanity & Inclusion has provided psychosocial support to 1,500 people.

On July 10, 2017, Iraqi armed forces retook Mosul. Two years later, the abandoned, western-half of the city lies in ruin, contaminated by thousands of explosive remnants of war. Nearly 500,000 people are still displaced in camps and the lives of thousands of injured people depend on access to appropriate care. Humanity & Inclusion is calling on the international community to respond to this humanitarian tragedy to ensure that its victims are not forgotten, and that explosive weapons will no longer be used in cities.

"The situation in the camps is very worrying,” explains Thomas Hugonnier, Director of Humanity & Inclusion in the Middle East. “It’s been two years, and people still only have the bare minimum to drink, eat, and survive. The lack of hope in the future and their trauma is going to haunt them for generations.”

Thousands of victims are still awaiting treatment. “There’s a lot of demand and we lack the funding to provide an adequate response, so our waiting lists are growing longer and longer," says Hugonnier. “Some patients have been waiting for a prosthesis for more than a year. Due to a shortage of resources, we provide them with emergency care to improve their mobility and make sure they can go about their daily lives as independently as possible. But it’s a totally unacceptable situation.” 

Life has resumed in the eastern half of Mosul. However, the city's western half, where the bulk of the fighting took place, remains heavily contaminated by explosive remnants of war and improvised landmines. Sixty-five percent of homes have been damaged. The extensive use of explosive weapons has destroyed vital infrastructure, such as schools and hospitals. Roads and bridges remain impassable.

Some 1,500 explosive remnants of war have been found in Al-Shifa hospital alone.

"The western half of the city has been almost abandoned due to a lack of resources and a political incapacity to organize weapons clearance and rebuild the city," adds Hugonnier. "In the short term, there is no prospect of things improving.” As large numbers of people continue returning to highly contaminated areas, there is an urgent need to raise their awareness. “The people who live here are unaware of the dangers. Until the weapons are cleared, our job is to inform them as best we can about the threat from explosive remnants of war, how to recognize them and what to do if they find one."

As Humanity & Inclusion has witnessed the dramatic consequences of the bombing of towns and cities such as Mosul, the organization is urging all States to work on the political and practical solution to prevent the harm caused by the use of explosive weapons in populated areas.

"We can’t go on tinkering around the edges with a humanitarian response that in no way meets people’s needs," says Hugonnier. "The international community must take action, because it has a major responsibility for the extent of the damage caused.”

A group of States will gather in Vienna for a high-level conference in October 2019. Their goal? To draft an international political declaration to protect civilians in urban warfare. This historical diplomatic process is the only way to ensure an effective protection of civilians from the use of explosive weapons, as 90% of victims of explosive weapons in populated areas are civilians.

Millions of families have been forced to abandon their homes after years of conflict and violence. In places like Yemen, Iraq, and Syria, people struggle to stay alive in their communities, until they have no other choice but to flee.

This month marks two anniversaries that no one is celebrating: Four years of conflict in Yemen and eight in Syria.

The numbers

• An estimated 190,350 Yemenis have fled to neighboring countries
• More than 280,000 people are seeking refuge in Yemen
• An estimated 400,000 Syrians have been killed, according to the United Nations
• As of December 2016, 4.81 million Syrians have fled the country
• 6.3 million Syrians are displaced internally
• More than 10 million Syrians are exposed to the risk posed by explosive remnants of war
• 2.1 million Iraqis displaced inside the country
• More than 360,000 Iraqis displaced, living in unfinished and abandoned buildings

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Humanity & Inclusion provides emergency care to people with disabilities and injuries living in Jordan, Lebanon, Iraq, and Yemen. Every day, our teams meet beneficiaries who share horrifying stories of bombs, torture, terror, and escape. But we take stock of their strength. Their survival. And together we set new goals. We celebrate new victories, however small.

Abdelkrim, 60, from Homs, Syria

"One day, while I was in front of the house, I saw planes in the sky. I thought I saw an unmanned aircraft in the middle of reconnaissance. Then it launched a missile that exploded in the street. Shrapnel came into my left leg." Abdelkrim bandaged his leg and when he finally made it to a doctor, he was told it had to be amputated due to infection. Today, Abdelkrim is recovering thanks to the rehabilitation care he receives from Humanity & Inclusion's team in Jordan. "I wish the war would end and that everyone could return in peace and security."

Warda's family, from Iraq

In February 2017, Warda and her family were caught in an explosion as they were fleeing Mosul, Iraq. After having both of her legs amputated, the young woman recovered in a hospital on the outskirts of the city, with her husband and daughter, who were also injured. Humanity & Inclusion's rehabilitation team provided Warda and her family with psychological support and physical therapy.

Yesser, 12, from Yemen

Yasser was doing homework next to his father when they were both struck by an explosion. Yasser lost his leg and his father did not survive. Today, Yasser receives rehabilitation care from Humanity & Inclusion's team in Yemen.

Wafa, 42, from Homs, Syria

"The planes attacked the city and sent bombs without any mercy to the families and innocent children who still lived there." In July 2012, three bombs fell on Wafa's house. During the attack, Wafa broke her left leg. "When I came out of the coma, my burns and my leg were terribly painful. But this pain was nothing compared to what I felt when I learned that four of my children had died. I could not protect them." Today, Wafa receives rehabilitation care from Humanity & Inclusion's team in Jordan.

Ali, 1, from Iraq

In April 2017, Ali and his family were used as human shields in Mosul, Iraq. Caught in a bombing, Ali was severely injured and his parents and brother were killed. The young boy receives rehabilitation care from Humanity & Inclusion's team in Iraq. Our team also provides his aunt and uncle, who are taking care of him, with advice on how to help Ali with physical therapy exercises. 

Kamal, 15, from Dera'a, Syria

"I woke up with shards of glass all over my body and the bedroom door had collapsed on me. The air was dusty. My brother was trying to take me to my mother's room, but I could not hold onto both of my legs." The family manages, with difficulty, to bring Kamal to the nearest hospital: "My whole body was covered with blood. I was operated on briefly at first, then I had two operations to both my hand and my legs. I've never used weapons, and yet it was me that was bombed. I feel only sadness. When you do not feel safe in your own country, where can you be?" Today, Kamal receives rehabilitation support from Humanity & Inclusion in Jordan.

Ali, 20, from Syria

In 2013, Ali lost the use of his legs after being seriously injured in a bombing in Syria. The young Syrian refugee now lives with his family in a makeshift camp in the Beqaa Valley in Lebanon. Humanity & Inclusion's rehabilitation team has been helping him adapt to his disability through physical therapy. 

One year after Mosul’s liberation, eight million tons[1] of conflict debris, littered with explosive remnants of war, still contaminate the city, and thousands of injured people are trying to access medical treatment. Meanwhile, more than 300,000[2] displaced people are still surviving in camps and communities as Mosul, littered with explosive remnants of war, remains a ticking time bomb. Humanity & Inclusion (the new name of Handicap International), released a fact sheet about the situation in Mosul. Download it here.

Unprecedented contamination

Between October 2016 and July 2017, 1,717 airstrikes and 2,867 explosive hazard incidents hit the city of Mosul, leaving behind an unprecedented amount of explosive remnants of war. Added to this are the thousands of victim-activated improvised explosive devices left as traps by the Islamic State group. In Al-Shifa hospital alone, mine actors found 1,500 explosive remnants of war[3]. Even today, accidents are numerous and whole areas of the city remain inaccessible due to heavy contamination. Since July 10, 2017, Humanity & Inclusion received reports of 127 accidents involving 186 casualties in Nineveh province. This figure is likely higher, as the exact the number of casualties is uncertain.

The consequences for civilians are serious: death, severe injuries, permanent impairments, including a high number of amputations of upper and lower limbs. Between July 10, 2017 and March 15, 2018, Humanity & Inclusion provided rehabilitation services to 1,225 people. Among them, 34% were injured in the conflict[4], and out of these people 86% were injured by explosive weapons.

The massive presence of explosive remnants in the city prevents people from returning to normal life after years of trauma. As of May 15, 2018, 57% of displaced persons from the Nineveh district[5] did not plan to return to their homes. Among them, 22% cite the presence of victim-activated IEDs and explosive remnants as a reason for non-return.

Years to rebuild and clear

Humanity & Inclusion is calling on the international community to face up to its responsibilities. The disproportion of the attacks carried out, and the size of the remaining threat posed by victim-activated IEDs and explosive remnants make Mosul one of the most contaminated cities in the world.

"The urgent need is to clear contaminated areas, raise awareness of the dangers of explosive remnants and to ensure assistance to the casualties, survivors and indirect victims,” says Thomas Hugonnier, who leads Humanity & Inclusion’s mine action operations. "On the ground, we are operational, but the challenge now is for States to support demining operations in the long term. The international community must do everything in its power to remove the obstacles preventing the people of Mosul from returning to a normal life.”

NOTE TO EDITORS

Interviews available with Thomas Hugonnier, head of mine action operations at HI

About Humanity & Inclusion

Humanity & Inclusion (the new name of Handicap International) is an independent charity working in situations of poverty and exclusion, conflict and disaster. We work tirelessly alongside disabled and vulnerable people to help meet their basic needs, improve their living conditions and promote respect for their dignity and fundamental rights.

Since its creation in 1982, HI has set up development programs in more than 60 countries and intervenes in numerous emergency situations. The network of 8 national associations (Belgium, Canada, France, Germany, Luxembourg, Switzerland, United Kingdom and United States) works constantly to mobilize resources, co-manage projects and promote the principles and actions of the organization. Humanity & inclusion is one of the six founding associations of the International Campaign to Ban Landmines (ICBL), co-winner of the 1997 Nobel Peace Prize and winner of the 2011 Conrad N. Hilton Prize.

[1] UN Habitat and the United Nations Environment Programme

[2] Norwegian Refugee Council (NRC)

[3] United Nations Mine Action Service (UNMAS)

[4] These injuries include bullet wounds, explosive weapons and other forms of violence (including torture), and injuries caused by events related to the crisis

[5] REACH, CCCM cluster, Iraq: Camps Intentions Survey Round 2 National Level, January 2018

Last June, 11-year-old Omar had his left leg amputated after being injured in a bomb attack in Mosul. Today, he receives rehabilitation care from Handicap International at the Muharibeen Hospital in Iraq. 

Eleven-year-old Fetyan was out buying ice-cream with his cousin when he was caught in the middle of a terrorist attack. “It happened on June 23 at precisely 9:30pm,” Mohammad says of the day his son was injured in Mosul. “First, two suicide bombers blew themselves up in the street. Fetyan, his cousin, and the other customers managed to take shelter in the basement of the ice-cream shop. But then a third suicide bomber appeared and ran toward them. He blew himself up just next to my son.” 

The bombing of civilians in urban areas is commonplace in present-day conflicts. Bombing not only kills and maims civilians, it destroys entire neighborhoods. The bombing of homes has a terrible impact on civilians including forced displacement, extreme hardship for families, and the contamination of affected areas.