Decades of war have resulted in a high demand for prosthetics – and patients are anxious to visit clinics as they finally reopen

First published by the Guardian 

Concentration is etched on Hussein’s face as he walks along a scuffed yellow line painted on the floor of the clinic’s rehabilitation room. He’s getting a feel for his new prosthetic.

Hussein lost his left leg below the knee in 1987 when he stepped on a landmine while fishing at Lake Dukan, around 100km (62 miles) east of Erbil in the Kurdistan region of northern Iraq. Mines and other unexploded remnants of successive wars litter the landscape, causing new injuries every year. More than half the clinic’s 15,100 patients are amputees. Roughly 4,600 of them lost limbs as a result of conflict – 2,500 of these to landmines.

Hussein’s new leg had been gathering dust in the clinic’s storeroom since Covid-19 lockdown measures were introduced on 11 March, and the clinic was forced to close.

“After a while, I just could not do it [construction work] anymore,” he says. Although Hussein is concerned about Covid-19, he says attending his appointment and getting the prosthetic leg is more important because this could allow him to work again so he can support his four children.

A man wearing prosthetic leg in the Red Cross rehabilitation centre, Erbil, Kurdistan, northern Iraq.

Mines from successive wars cause new injuries every year. Photograph: Miran Sirwan

Following decades of violence, Iraq has one of the largest populations with disabilities in the world. Although the governments in Baghdad and Erbil have passed legislation designed to protect the rights of people with disabilities, and challenge deep-seated social stigma, implementation has been slow. Family shame keeps many people hidden from public view, while access to healthcare and rehabilitation, education, training and employment remain limited.

The coronavirus pandemic is adding to the problems.

“Even if you don’t have the illness, you’re worried. Since it began, people don’t want to go outside and meet others and their livelihoods are not doing well,” says Hussein, who receives around 140,000 IQD (about £93) a month from the government to supplement any additional income.

Sardar Kadeer Seeda, a prosthetic and orthotic technician, says people can’t afford to stay away from the clinic. “Especially for amputees, if the prosthesis is broken, he cannot do anything at home or at work. So it’s an emergency. It’s necessary for his life. For his social life,” he says. “They want to come to the centre. They are not afraid. It’s a higher priority than the virus.”

As of 16 July, over 10,000 Covid-19 cases and 370 deaths had been recorded in Kurdistan – relatively low compared to Iraq as a whole, where, according to the WHO, there have been more than 90,000 cases confirmed and more than 3,600 deaths.

Work at the clinic, which is run by the International Committee of the Red Cross (ICRC), came to an abrupt halt when lockdown was announced. All 41 staff were ordered to stay home.

The clinic was allowed to partially reopen in April but it is still operating at just 40% capacity to ensure social distancing. Masks and gloves are mandatory for all visitors while hand washing and temperature checks are supervised at reception.

Ayman Rahman Abdullkareem, 24, finally managed to get an appointment at the clinic after his original slot was postponed in March. He’s being measured for an ankle-foot orthosis.

A stroke last year left Abdullkareem paralysed down his left side. Although many of his motor skills have returned, the loss of sensation in his lower leg has left him with a debilitating foot drop.

The university graduate blames his disability for his failure to find work. “No one is hiring me. It’s not because there are no jobs. It’s because, I know, if I am an employer, I would not hire someone with a foot drop,” he says, looking at his feet. He is hopeful the new orthotic, if delivered quickly, will turn his fortunes around.

Prosthetics being prepared in the Red Cross rehabilitation centre, Erbil, Kurdistan, northern Iraq.

Prosthetics being prepared in the Red Cross rehabilitation centre. Photograph: Miran Sirwan

In the clinic’s segregated rehabilitation room for women and girls, Shilan Majeed Saed waits to be fitted for a new leg brace.

A major peripheral nerve was severed when a bullet passed through both her legs 11 years ago. Saed’s husband, a Peshmerga soldier, had left his loaded weapon on the sofa in their family home. Unnoticed, it discharged when Saed sat down.

“They say that you can’t even get treatment for it in the US. I don’t know if God almighty will heal me or not,” Saed says, seated on an examination table, her swollen toes visible at the hem of her black abaya.

Saed has supported her family with a clothing business she set up with a grant from ICRC but lockdown has decimated her customer base. Now she must borrow money to make rent and continue paying the wages of her one employee. She is hoping for another grant to help save her business.

“I don’t want to close down. I want to keep working. But when you see that there is no money coming in, you have no other choice,” Saed says. “The coronavirus ruined everything for all of us.”