SHIKHAN, Iraq—The gleaming surgical kits are lined up with precision—one for amputation, one for excising wounds, another for basic surgery.
The surgeon, anesthetist, and nurses are ready in the fresh-scrubbed but very basic operating room, awaiting patients on the way from Mosul’s front line. In the past 24 hours, they’ve saved lives, and limbs, of a young boy and a badly injured anti-ISIS militia member.
“If the Red Cross wasn’t here, my son would have lost his leg,” said Nashwan of his 12-year-old, whose leg required delicate but swift surgery to repair it.
At the Shikhan Hospital outside Mosul, the operating theater is basic, by design. Everything is pared down to save lives from battlefield trauma as quickly and simply as possible, all the while prepared to flee with those patients in case the battle shifts their way.
This is the International Committee of the Red Cross at work. But these frontline professionals find themselves somewhat at sea—under fire by an enemy that does not respect the laws of war, and uncertain that the incoming administration in the White House understands what they do, and will keep funding it.
Their concerns reflect that of a wide spectrum of non-governmental agencies who have read draft executive orders from the new Trump administration that aim to pare down U.S. contributions overseas, in deference to rebuilding American infrastructure at home. A draft Trump administration executive order that would re-open CIA “black sites” and ban Red Cross access to detainees caused another wave of concern for an organization founded to spread understanding of the Geneva Conventions, although President Donald Trump has since pledged to reject a return to Bush-era harsh interrogation measures.
The organization granted The Daily Beast rare access to their mission in Iraq because they are concerned the incoming administration may not know what they do, or how carefully they count the costs—concern leavened by President Trump’s tweet in December aimed at the United Nations, which he said “has such great potential but right now it is just a club for people to get together, talk and have a good time.”
The ICRC has been at pains to point out they work alongside United Nations aid organizations—but they don’t work for them.
“We are masters of our own decisions and we are not influenced by security council resolutions or political negotiations about where aid should go,” ICRC operations chief Dominik Stillhart said in an interview.
U.S. taxpayers fund a quarter of the ICRC’s $1.6 billion budget, so Stillhart visited Washington, D.C., after the inauguration to explain what America is getting for its investment, and to ask Washington to step up again. In meetings from the Pentagon to Capitol Hill, Stillhart made the case that more than 90 percent of that funding goes to missions overseas, with just 6.5 percent going to administration. The ICRC makes public a 600-page-plus budget every year so donors can track their money (an important distinction as its U.S. cousin, the American Red Cross, has faced controversy over how it spends its own budget).
“Our operations have grown by 60 percent in the past four years, whereas our headquarters has remained extremely lean, with growth limited below 15 percent,” Stillhart said. “We are making an effort at becoming more efficient and making sure that… it is spent on operations. It is not spent on bureaucracy in Geneva.”
In return for U.S. government funding to the ICRC, teams like the one outside Mosul provide emergency medical aid, and short term supplies like blankets that help keep refugees where they are, then easier to return home when the conflict ends—likely a selling point in a Trump administration that just announced a 4-month suspension of refugee travel to the U.S.
They are preaching to the choir in the U.S. State Department.“The work that ICRC conducts around the world, often in places that are difficult—if not outright impossible—for other agencies and organizations to reach, is critical,” said Simon Henshaw, Acting Assistant Secretary for Population, Refugees, and Migration, in a statement to The Daily Beast Monday. “There is no substitute for the assistance and protection that ICRC provides to vulnerable populations in some of the most conflict-affected regions imaginable.”
In Iraq, where some 3 million people have been displaced by the two-year-plus fight against ISIS, including roughly 100,000 from Mosul, the ICRC has gotten aid like emergency food kits to roughly 800,000 people, in addition to sending four surgical teams into the Mosul area. They’re part of a network of aid organizations serving displaced Iraqis, in coordination with local Iraqi and Kurdish officials.
Part of the problem has been reaching those in need in a fluid war zone, where ISIS “sleeper agents” stay behind in liberated villages to launch stealth suicide bombings on unsuspecting returnees. In December, an Iraqi aid organization was hit by ISIS mortars as it handed out aid, killing and injuring a number of aid workers and villagers, though the chaos at the scene meant no one is sure how many.
“How do we assist the people of Mosul without hurting them?” said Katharina Ritz, ICRC head of delegation in Baghdad. “Our first principle is do no harm. It’s not for our safety but also the safety of the people.”
A key tenet of the ICRC’s mission is staying neutral, and that means traveling unnarmed, as they are doing in Iraq. That means they can’t always get as close to the front as UN teams, which usually travel with armed protection. UN Humanitarian Coordinator Lise Grande gave the ICRC and Médecins Sans Frontières (MSF) grief for not being close enough to the front line, at a fall conference to help coordinate aid to Iraq.
“I identified exactly the same shortcoming,” said Stillhart, sanguine about the criticism. “As a neutral, independent humanitarian organization, we just need to make sure that we can provide sufficient security for those teams so we can work in that hospital structure.”
As Iraqi forces have now cleared most of western Mosul, he said the ICRC has been able to send additional teams. (Grande’s spokesperson did not respond to repeated requests for comment, and MSF declined to comment, adding that they’d set up a number of field facilities.)
The ICRC’s less visible work includes visiting the screening facilities where Iraqi forces question Iraqis fleeing combat areas, trying to spot ISIS fighters mixed in with the crowd.
“You have the people leaving a battle zone or village or neighborhood being ‘security screened’ and they end up arrested or charged and going to detention, or they go to an IDP (internally displaced person) camp,” said Ritz.
“What we look for is to see where the security clearance starts to have humanitarian consequences. We can then assist the government in dealing with such consequences.”
In the battle for Fallujah, the Iraqi government estimated there were some 50,000 civilians inside, and that it would take them weeks to exit. Instead, some 60,000 people poured out in a couple of days during Iraq’s boiling hot summer—and no one was ready. There hasn’t been a census across Iraq in decades, so the Iraqi government has to guess at how many people might be on the move.
“Suddenly we had thousands and thousands to be cleared,” Ritz said. “It was hot, people were sick and needed water.” The ICRC among others rushed in aid, but it took weeks to catch up with the backlog of need. That’s one reason why Ritz and other aid officers interviewed say they over-prepared for a surge from Mosul, that has been slower to materialize.
ICRC delegates, as the organization calls its employees, also visit official Iraqi detention centers, allowed to question the detainees in private about their treatment by their captors and exchange letters
An ISIS prisoner at one such detention center interviewed by The Daily Beast confirmed the ICRC regularly delivered letters to him from his family, a point of pride for the Iraqi officials that run the facility, which they say shows they are heeding international laws of war.
Kurdish officials confirmed they too have a longstanding relationship with the ICRC, which one Kurdish adviser said quietly told them their detention facilities weren’t up to par—so they’ve changed them.
As per its confidentiality, ICRC officials would not comment on their private conversations with either sets of officials.
The Red Cross interaction with the U.S. military stretches back decades—though some haven’t always appreciated the organization’s refusal to take a side. That treasured neutrality that has sometimes frustrated some American commanders means delegates from the Swiss-run organization can go where most others can’t.
An ICRC representative was able to visit the injured Black Hawk pilot Mike Durant in 1993 when he was captured in Mogadishu. Badly injured and convinced he would be killed, Durant said everything changed when his warlord captors told him a Red Cross representative was coming to see him. The captors moved him to better detention facilities and gave him some basic medical care in preparation for the visit, and eventually let him go.
A senior U.S. commander told The Daily Beast that the ICRC had also confidentially reported the abuses of Abu Ghreib prison by a handful of U.S. troops, several months before the case became public, but U.S. military chiefs didn’t believe those reports. Then photos of the abuse emerged, and the U.S. reputation in the region was shredded — a blot that remains in the Arab world’s memory to this day.
Now, U.S. commanders embrace the visits by the ICRC as a chance to check on their own.
“We opened to the ICRC all of our detention facilities in Iraq and Afghanistan, including those administered by special mission units, and the process was beneficial to us and reassuring to them,” said General David H. Petraeus (U.S. Army, Ret.), former commander of coalition forces in Iraq and Afghanistan and of U.S. Central Command, in an email to The Daily Beast.
Allowing inspections and access is a way to show the world that they are following the laws of war as articulated in the Geneva Conventions. The Geneva Conventions were first drafted in the late 1800s and updated after World War II, designed to limit what weaponry is permitted, allow access to prisoners of war, and allow aid to reach civilians. The United States technically drafted the conventions’ precursor, the 1863 Lieber Code (PDF), commissioned by President Abraham Lincoln to limit the devastation of the U.S. Civil War.
The hardest part of working in Iraq and Syria? ISIS doesn’t follow the Geneva Conventions, and has no desire to be seen as humane.
“ISIS is inaccessible even for us, but that doesn’t mean you just ditch your principles,” said an ICRC official who must remain anonymous because he works in ISIS territory. His team sticks to a simple mantra when working with the hodgepodge of forces involved in the ISIS fight: “We don’t question the motivations of the parties to the conflict. They’re just there. Now let’s make the best out of it.”
This story was reported in Shikhan, Erbil, Baghdad, and Washington, D.C.
UPDATE NOTE: This story was updated Monday to include comment from the State Department.