Pangs of Isolation: Kha’azal's Journey to Recovery from TB

Mosul – Khaza’al, 32, is a father of three. In 2014, his family was displaced from Tel Afar – a town in Ninewa Governorate – to Mosul, due to the conflict with Islamic State in Iraq and the Levant (ISIL). He had always hoped to one day return to his home, but before life could give him a break from the strains associated with living in displacement, he started having serious health problems.

For weeks, a bloody cough, digestive disorders, dramatic weight loss, and other debilitating symptoms took a heavy toll on Khaza’al’s health and mental well-being. Khaza’al suffered a lot until, after visiting multiple doctors, he was finally diagnosed with tuberculosis (TB) in January 2020

“For a long time, I went to doctors trying to find out what was ailing me. I lost the ability to eat and drink and could not walk. I was so shocked when I was told that it was TB,” Khaza’al recalled.

“For a long time, I had to be cautious around my family. I was there, but it didn’t feel safe to hug my three children or feel their warmth; those two years of suffering were the worst period of my life, especially after my situation deteriorated to what doctors call multidrug-resistant TB, which meant recovery was more difficult.”

Khaza’al revealed that his condition made him feel “depressed,” especially after losing a lot of weight. “I was severely malnourished. I was weak and it was hard for me to move, work or have a normal life,” he added.

Iraq is considered to have one of the highest rates of TB in the Middle East and North Africa. Since 2014, the ISIL crisis and subsequent military operations to retake the areas under ISIL control further deteriorated capacity to manage TB across the country.

The humanitarian situation in Iraq continues to be volatile, and over one million people remain in displacement, with around 180,000 still living in camps for internally displaced persons. People in and out of camps often struggle to access basic services, including quality health care.

“I used the treatment that I received from the International Organization for Migration (IOM), and over the past one year and a half, I have been receiving regular visits from their Mobile Medical Team (MMT),” Khaza’al explained. “They call every day to check that I am taking my medication as prescribed and visit from time to time to see how I am doing.”

Saif Muhannad, an IOM Iraq MMT nurse in Ninewa said: “Early detection makes the treatment more effective and reduces the possibility of infection spreading among other people. TB has become a curable disease due to the availability of tests and treatments.”

“We advise anyone who has been coughing for two weeks or more, or experiencing sudden weight loss or fever at night, to visit the nearest centre for a sputum examination. Following diagnosis, treatment will be given free of charge,” he continued. IOM deployed team members to provide direct observation therapy (DOT) to ensure completion of the treatment course and avoid treatment interruptions for people with TB.

IOM’s MMT in Ninewa and other locations support the Government of Iraq’s National TB Programme (NTP) in implementing activities to curb TB, including awareness-raising campaigns, initial screening, sputum sample collection, presumptive TB case transportation, contact tracing, Directly Observed Therapy (DOT), food distribution, and TB treatment follow up.

IOM also supports the NTP with joint supervision visits to all NTP clinics across Iraq, on job training for lab staff, procurement of TB medication and laboratory supplies, updating and printing guidelines, providing personal protection equipment and infection and control materials, diagnostics tools such as GeneXpert machines, capacity-building training, and more.

Although efforts by the NTP and IOM have been fruitful in treating thousands of people with TB across Iraq since 2014, more needs to be done to curb the spread of TB in Iraq. This includes increasing the number of MMTs across the country to widen the geographic coverage and help treat cases among vulnerable populations in camps, returnee communities, and host communities where care might otherwise be hard to access; increasing TB management units and opening diagnostic centres in each governorate (currently there are 135 functional TB management units in Iraq); making TB medication more available; and organizing additional mass awareness-raising campaigns.

With assistance from IOM’s MMT and regular access to medication, Khaza’al’s situation has considerably improved since his original diagnosis. “I am recovering; I have gained more than 10 kilos and I feel settled here in west Mosul with my family with me,” Khaza’al explained. “For almost two years, I couldn’t walk for more than five minutes; thankfully, I can walk again for hours and enjoy my family life again.”

IOM’s TB response in Iraq is possible thanks to support from the Global Fund.This story was

written by Sarah Ali with IOM Iraq.