In June 2017, pockets of Northern Iraq, including Mosul and Tel Afar, were still controlled by Daesh, with other areas having been liberated only weeks or months before. Many of the units who made the liberation possible are part of the Peshmerga, the official military of the autonomous region of Kurdistan. Despite being unified under the name “Peshmerga,” the force includes several militias that independently formed under different political parties, primarily the Kurdistan Democratic Party and the Patriotic Union of Kurdistan. The militias eventually pledged allegiance to the Kurdistan Regional Government (KRG) with the president of Iraqi Kurdistan serving as official military head. The substantial variability in training and equipment among various Peshmerga units reflects the heterogeneous composition of the force. Some units are trained and equipped by US Special Operations Forces, others are trained by conventional forces, coalition forces, and humanitarian groups. Units lack basic medical supplies and are largely funded and supplied by the individual members themselves out of necessity.
The Peshmerga have no frontline field hospitals and no more than 25 ambulances for more than 150,000 soldiers; the expectation is that an injured soldier will walk back to safety. For perspective, a fully staffed US Marine Corps Infantry Battalion is 903 men2 to whom are assigned 67 US Navy medical providers, including two physicians.3 Using those numbers, the US Marine Corps would have a combatant to medical provider ratio of approximately 13:1. Presuming one medical provider per ambulance, that would give the Peshmerga a combatant to medical provider ratio of 6,000:1.
Complicating this was the grim reality that, with the massive volunteerism of members of the community to service under the Peshmerga and local defense forces, the ratio of new recruits with little to no medical training was even worse.
Working with local community leaders we sought out the newest members of the volunteer forces and provided courses on trauma care. This entailed travelling into areas that were often occupied by numerous armies besides the peshmerga and Da’esh, but also units from Syria, Turkey, Iran and elsewhere.
This effort required extreme cultural awareness, a deep liason with the Yezidi people and careful listneing to assure that our efforts were directed to those members who were at the greatest risk. In addition we adjusted our core curriculum so the skillsets were applicable in daily life; as most if not all of the ad-hoc peshmerga spent the vast majority of their time in farms or in construction, school teaching, etc.
Additionally while there we took the time to operate sick call clinics for farms and villages around the stand up peshmerga bases. This led to ventures with local hospitals to assist in repairing and maintaining their facilities.
