Household recovery in Mosul one year after the defeat of ISIS
Authors: Lafta R. , Al-Nuaimi M. , Sultan L. R. , Burnham G. 
Published: January 2020

Abstract
Background
Widespread devastation to structures and households in Mosul occurred during the three years of ISIS control and the military liberation campaign by Iraqi forces assisted by coalition forces. Military operations, particularly airstrikes, resulted in a greater loss of life than during ISIS control. In 2016/17, we assessed living circumstances in Mosul immediately following defeat of ISIS. In September 2018, we reassessed many of the same indicators in Mosul households to determine the extent of recovery.

Methods
For the 2018 survey, a random selection of 20 clusters were drawn from the 40 clusters surveyed in 2016/17. Of these 20 clusters, 12 were in east Mosul and 8 in west Mosul, the same proportion as the original survey. In each cluster, 30 households were interviewed. No households were included in both surveys. A team of four interviewers collected information using questions adapted from the 2016/17 questionnaire.

Results
Among the 3375 persons from the 600 households in the 2018 survey, there had been 18 deaths reported in the year since the end of ISIS control, a mortality rate of 6.1/1000 (CI95% [2.4–9.8]). This compares with a mortality rate of 30.7/1000 (CI95% [28.3–33.2]) during ISIS control and liberation. Fifteen deaths were from disease, one from a non-intentional injury and two deaths due to intentional violence. Damage to dwellings had been fully repaired in only 22 (5.5%) of houses, mostly in less damaged east Mosul. Dramatic improvements in access to water and electricity have occurred, with three quarters of households reporting uninterrupted access to both. The previously reported large number of early marriages among household members stopped with the departure of ISIS. Of the 31 household marriages reported over a 12-month follow on study, 6 (19.4%) involved a female member of the household. This compares with 131 household males and 688 household females married during ISIS occupation. If marriages had continued at the same rate as for ISIS years during our one-year follow-on study, there would have been and expected 24 marriages of household males and 126 marriages of household females (OD 32.8, CI95%[10.5102.8]) p < 0.001. There were 657 children reported by households to be in primary school. However, by household listing there were only 380 of children in the usual primary school age range (6–11), suggesting older children are catching up on primary schooling missed during ISIS years. One report of physical violence between spouses occurred. By comparison, the adjusted number of reported violent spousal events during ISIS control and military action would have been 72.7 (OR 316.7, CI95% [44.42259.9]), p < 0.001. Reported complications of pregnancy also declined (OR 10.3, CI95% [5.4,19.4], p < 0.001.

Conclusions
Substantial improvements in household measures have occurred since the end of ISIS control and military action, though much remains for full recovery. Many household members are now employed, primary school attendance is high and early marriage of girls was not found. There are fewer reported complications of pregnancy than in the previous study.