Emergency Surgery in War-affected Areas, Iraq In the liberated areas of Nineveh Governorate, secondary health services were either completely destroyed and/or looted during the conflict, rendering all hospitals non-functional for in-patient care. The objective of this project is to re-establish basic second-line health services in Telafar district, through a needs-based surgical response which contributes to improved health outcomes for the population and prepares for Mosul emergency displacement. The project will bridge current gaps in referral pathways, enabling primary health care providers to refer patients to second line care at district level, opposed to current practice where all referrals need to attend tertiary hospitals in Dohuk or Zakho.  In addition to revitalising health infrastructure and creating access to essential surgical care, it will also provide strategic contingency capacity to treat war-wounded and injured civilians, in Rabbia, in the event of Mosul displacement. Beneficiaries are considered to be all the population Telafar district, totaling approximately 118,500 people and potentially a further 100,000 newly displaced in respect of Mosul emergency. The services will be available to IDPs / refugees and host populations, as well minority and hard-to-reach communities within the district. 
Surgical care will be delivered from a new surgical unit, established at Rabbia PHCC, and will be staffed by 2 national surgical teams, providing 24 hour access to care, 7 days per week. In Rabbia, CDE is working in collaboration with IOM on the creation of an OT and recovery room suite within the PHCC compound. A contribution to surgical equipment for Rabbia PHCC will be provided by this project. Medical and surgical consumables and anaesthetic drugs etc. will be provided by either DoH Nineveh or Dohuk and supplementary or non-available supplies directly by CDE. Seriously injured or emergency cases requiring tertiary care will be stabilised before referral to Dohuk, ensuring safer transportation and optimising chances of better tertiary care outcomes. The project will ensure close coordination and follow up system of referral cases by a Referral Coordinator. To enhance referral links to tertiary facilities, the project will also provide an international expert surgical team (in orthopaedics and traumatology) to Dohuk Emergency Training Hospital. The international team will enhance emergency surgical capacity at the hospital through clinical exchange of skills and new surgical techniques, while working alongside national counterparts. A specialised senior OT nurse will be deployed to the Emergency Hospital to focus on refresher training for OT nursing staff, particularly in standard operating procedures, hygiene, sterilisation, infection control and patient care at all stages of the surgical intervention. An international field OT nurse will be deployed to Rabbia to assist with set up of the surgical services and refresher training in OT and post-operative care nursing skills, hygiene, infection control and to ensure quality in sterilisation techniques. 
In the event of Mosul Emergency, a specific contingency plan has been developed whereby both national surgical teams will be on stand by to respond. In Rabbia (Zone 2), teams will either provide immediate surgical assistance in the static unit or provide mobile triage, stabilisation and referral assistance at reception locations. Activities are complementary and in coordination with MSF-Swiss Field surgical unit also planned for Zone 2. Both CDE and MSF facilities provide similar bed capacity (12 and 10 beds respectively). WHO has approved support to surgical facilities in Zone 2 through the pre-positioning of a complete trauma kit for Rabbia. In the longer term perspective, Rabbia will continue to provide surgical referral facilities for newly displaced population in Amalla camp and those living in temporary accommodation sites within Telafar district.