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In June 2014, ISIS fighters swept into Mosul, Iraq’s second-largest city, and easily defeated the Iraqi Security Forces, armed with advanced American weaponry but unready or unwilling to engage in close combat against the Salafist militants. The campaign to liberate Mosul from ISIS may be the purest expression yet of twenty-first-century warfare. It was highly politicized, ideologically charged, fought in a fractured state among civilians by a coalition of the willing, with great power involvement on all sides, exposed to the world on social media. The air war, too, represented an intensification of recent operational trends: enhanced command and control measures, universal employment of precision munitions, increased intelligence, surveillance and reconnaissance capabilities, ubiquity of remotely piloted aircraft, and decreased tolerance for civilian casualties. None of these factors was new in 2016, but each of them was manifested over Mosul to a degree not previously seen.
Our objective was to compare care-seeking patterns in Mosul, Iraq, in 2018, 1 y after Islamic State of Iraq and Syria (ISIS) control, with findings from neighborhoods that had been sampled in 2017
Methods:
For this multi-stage randomized cluster household survey, we created one cluster in each of 20 neighborhoods randomly selected from the 40 neighborhoods in the 2016/17 survey; 12 in east Mosul, 8 in west Mosul. In each, 30 households were interviewed beginning at a randomly selected start house. Questions were derived from the 2016/2017 post-ISIS survey.
Results:
We interviewed the head of household or senior female in 600 households containing 3375 persons. One year after ISIS, some household demographic shifts had occurred. Diarrhea in children during the past 2 wk decreased from 50.1% to 7.5% (P < 0.001); however, cough/difficulty breathing increased from 15.5% to 33.6% (P < 0.01). Among adults, care-seeking for noncommunicable diseases increased from 22.3% to 43.5% (P < 0.001). Emotional and psychological complaints common in the previous survey were now nearly absent. Pregnancy complications diminished from 65.2% to 15.4% (P < 0.001).
Conclusions:
Communicable diseases predominated among children and noncommunicable diseases among adults. Access to health care substantially improved, although barriers remained. Satisfaction with services was mixed, with dissatisfaction expressed about testing, medicine access, and costs, but the work of health providers was rated highly.
This chapter explores the foreign policy discourse of the old Anglosphere coalition during the third phase of the crisis and civil war in Syria. First, the chapter considers the Anglosphere response to the rise of Islamic State, as the Anbar Campaign saw the group seize territory in northern Iraq. Second, it analyses the re-working of discourses of the War on Terror to articulate and frame the new threat for Anglosphere audiences. Third, it explores the discursive war of position that structured foreign policy debates in the USA, UK and Australia. The chapter explores how, despite some resistance, the Anglosphere rallied against the new threat in contrast to the Syrian Civil War’s first two phases.
ISIS seized Mosul in June 2014. This survey was conducted to assess health status, health needs, and health-seeking behavior during ISIS control and the subsequent Iraqi military campaign.
Methods
Forty clusters were chosen: 25 from east Mosul and 15 from west Mosul. In each, 30 households were interviewed, representing 7559 persons. The start house for each cluster was selected using satellite maps. The survey in east Mosul was conducted from March 13–31, 2017, and in west Mosul from July 18–31, 2017.
Results
In the preceding 2 weeks, 265 (5.4%) adults reported being ill. Some 67 (25.3%) complaints were for emotional or behavioral issues, and 59 (22.3%) for noncommunicable diseases. There were 349 (13.2%) children under age 15 reportedly ill during this time. Diarrhea, respiratory complaints, and emotional and behavioral problems were most common. Care seeking among both children and adults was low, especially in west Mosul. During ISIS occupation, 640 (39.0%) women of childbearing age reported deliveries. Of these, 431 (67.3%) had received some antenatal care, and 582 (90.9%) delivered in a hospital. Complications were reported by 417 (65.2%).
Conclusions
Communicable and noncommunicable diseases were reported for both children and adults, with a high prevalence of emotional and behavioral problems, particularly in west Mosul. Care-seeking was low, treatment compliance for noncommunicable diseases was poor, and treatment options for patients were limited. (Disaster Med Public Health Preparedness. 2019;13:758–766)
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