The day Isis attacked Mosul, Wassan, an affable young doctor with a cherubic face, ran from the maternity ward to the emergency room at Jimhoriya hospital. Injured civilians had begun pouring in. Wassan had just graduated from medical school, and had no experience in treating trauma casualties. As the wounded continued to arrive, what she lacked in knowledge she tried to make up for with enthusiasm.

By the evening, the wards were overflowing, patients spilling into the corridors. Wassan slept overnight in the hospital, ignoring her father’s incessant phone calls to come home.

The next morning, when mortar shells started falling near the hospital, doctors and patients alike piled into ambulances and fled across the bridge to the east side of the city.

There, they heard the news. The governor and senior generals had fled. Western Mosul had fallen.

Q&A What is our Cities at War special series? Show Hide War is urbanising. No longer fought on beaches or battlefields, conflict has come to the doors of millions living in densely populated areas, killing thousands of civilians, destroying historic centres and devastating infrastructure for generations to come. Last year, the world watched the Middle East as Mosul, Raqqa, Sana'a and Aleppo were razed to the ground. Across Europe, brutal attacks stunned urban populations in Paris, London and Berlin, while gang warfare tore apart the fabric of cities in central and south America. In 2018, Guardian Cities will explore the reality of war in cities today – not merely how it is fought, but how citizens struggle to adapt, and to rebuild stronger than ever. Join the conversation at theguardian.com/cities

Her father called again. He was taking the family to safety in Erbil, in the autonomous Kurdish region. “Just leave my passport at home and go,” she replied. “I have sworn an oath to help the patients.” She hung up. Soon she was back at the hospital.

Three days after the first clashes, men carrying machine guns, their faces wrapped in scarves, entered the wards. Wassan and the few other young doctors who’d stayed behind had begun a new life.

Facebook Twitter Pinterest Pro-Islamic State demonstrators in Mosul in 2014. Photograph: AP

A two-tier system

Like many other diwans (ministries) that Isis established in Mosul, as part of their broader effort to turn an insurgency into a fully functioning administrative state, the Diwan al-Siha (ministry of health) operated a two-tier system.

There was one set of rules for “brothers” – those who gave allegiance to Isis – and another for the awam, or commoners.



“We had two systems in the hospitals,” Wassan said. “IS members and their families were given the best treatment and complete access to medicine, while the normal people, the awam, were forced to buy their own medicine from the black market.

Isis members and their families were given the best treatment, while [commoners] were forced to buy their own medicine Mosul doctor Wassan

“We started hating our work. As a doctor, I am supposed to treat all people equally, but they would force us to treat their own patients only. I felt disgusted with myself.”

For all their posturing, the Isis version of a city-state was neither properly efficient nor concerned with justice. Notwithstanding the archaic names and terminologies, or the new stationery printed with departmental logos, Mosul was operated on a melange of systems, ranging from capitalist free-market to a totalitarian command economy. Underneath it all, the same century-old rotten Iraqi bureaucracy prevailed.

State functionaries continued to file memos, write inventories in big ledgers and demand written orders from superiors before taking any action. People like Wassan lived in a surreal universe in which they remained employees of the Iraqi state, which continued to pay their salaries, while answering directly to Isis bosses who took a cut.

“The brilliance of Islamic State lay in its ability to bring together a world of contradictions, all for achieving the main goal,” said one former administrator. “The side issues were not important.”

Like their administrative system, he said, the new ruling elite were also a motley mix.

Facebook Twitter Pinterest Iraqis, who fled Mosul from Isis, wait in line for cooking and lighting fuel at the Khazer camp. Photograph: Mohammed Salem/Reuters

“They were an incoherent mix, a cocktail of different components with no common thread. There were two kinds: those who came to benefit, and those who came out of belief. But there were tribesmen from the countryside, and members of old families from the heart of the city; there were religious clerics and street thugs; foreign jihadis and former army officers.

“The Islamic State fulfilled the desires of each one of these groups. Those who came from the countryside were given houses in the rich neighbourhoods of Mosul, something unheard-of before, the foreigners were given women and power, and the officers were given back authority they had lost after 2003.”

When Wassan began to understand how different the Isis regime really was from everything that had come before, she tried to leave. But by then it was too late. A smuggler she had exchanged messages with was caught, and female members of the hisbah (religious police) raided Wassan’s house, confiscated her phone and informed her she was under surveillance.

She couldn’t leave her job: three days’ absence from work would get you arrested for desertion. She decided to rebel from within.

The secret hospital

“You can acclimatise to any condition in life, and this is how we survived the rule of Isis,” she explained. “We had parties for female friends who got married. We had birthdays and engagement parties. We had DJs but with very low sound. We tried to live our same old life without much change. In the hospital we would shade the cameras monitoring us and throw parties for the children in the cancer ward.”

One day she found one of the few cake shops still open in the city, and asked for a cake in the shape of Sponge Bob, a favourite character of a young patient with terminal cancer. The owner apologised: he was banned from baking any cakes with figures drawn on them. But as a compromise he gave her a square-shaped yellow cake.

Facebook Twitter Pinterest The aftermath of a car bomb eastern Mosul, in 2017, during the last push against Isis. Photograph: Ghaith Abdul-Ahad/The Guardian

As she told me these stories, she pulled out her phone and flipped through the pictures of these parties. Half of the children were now dead, she said, for lack of medicine.

Eventually she realised she had to move from passive rebellion to active resistance.

“Before the start of military operations, medicines begun to run out,” she said. “So I started collecting whatever I could get my hands on at home. I built a network with pharmacists I could trust. I started collecting equipment from doctors and medics, until I had a full surgery kit at home. I could even perform operations with full anaesthesia.”

Word of mouth spread about her secret hospital.

You can acclimatise to any condition in life, and this is how we survived the rule of Isis Wassan

“Some people started coming from the other side of Mosul, and whatever medicine I had was running out,” she said. “I knew there was plenty of medicine in our hospital, but the storage rooms were controlled by Isis.

“Eventually, I began to use the pretext of treating one of their patients to siphon medicine from their own storage. If their patient needed one dose, I would take five. After a while they must have realised, because they stopped allowing doctors to go into the storage.”

The punishment for theft is losing a hand. Running a free hospital from her home would have been sedition, punishable by death.

Beginning of the end

If the Islamic State was a kind of Ponzi scheme, dependent on constant expansion to reward its followers, that scheme begun to crumble when the Iraqi state stopped paying the salaries of government employees in Mosul.

Most stopped going to work. (Teachers had all but abandoned their schools already, after most of the students began staying home following changes to the curriculum by the new Egyptian head of the education ministry.) Those Isis deemed as essential, such as doctors like Wassan and engineers working in service departments, were ordered to show up anyway, and paid a 10th of their former salary.



To keep the city running, the state became more ingenious in attempting to fill its coffers. Taxation increased. Fines were added to floggings. Carrying prayer beads – considered a sin according to Isis teachings – was fined according to the number of beads. Those caught with cigarettes were sent to jail, and fined the black market price of their confiscated cigarettes.

The energy ministry began diverting electricity away from residential houses and into three cement factories, which generated a reliable income. All government cars were confiscated.

Facebook Twitter Pinterest Iraqi soldiers and federal police rest in the Old City of Mosul few days after the fighting ended. Photograph: Ghaith Abdul Ahad/The Guardian

Meanwhile, the US and its allies had started targeting fuel trucks travelling between oil fields in Iraq and Syria. The air raids on the city itself intensified; the elegant medical school building was bombed.

When Wassan’s hospital was appropriated by Isis fighters, her secret house-hospital proved essential. More than a dozen births were performed on her dining table; she kicked both brothers out of their rooms to convert them into operating theatres; her mother, an elderly nurse, became her assistant.

The fall of Mosul unfolded over many months. Every few weeks, Iraqi government forces would liberate a new neighbourhood. Meanwhile, the bureaucracy of Isis continued to function. They collected fees, distributed basic food supplies and enforced their strict religious codes, including on beards. Isis platoons searched for illicit satellite dishes mere blocks away from advancing Iraqi army troops.



The first thing Wassan did when Iraqi soldiers entered her neighbourhood was to go to the house of one of her cancer patients, an eight-year-old boy suffering from leukaemia, put him in a car and drive him north to Erbil to try to save his life: he hadn’t taken any medication for three weeks. A week later the child died.



She returned to the hospital. The walls were burned and gutted. There was almost no medicine, and most of the equipment was broken.

But the bureaucracy survived. Today, medics write names in big ledger books, just as they did during Isis rule and before.

The bureaucracy of evil: how Islamic State ran a city Read more

“The terror they imposed is what gave them power, not their numbers,” said Azzam, an electrical engineer who saw Isis come and go. “In the end, we realised that there were very few of them – in our street, no more than a dozen. People say, why didn’t we do anything? I answer: because terror paralyses.”



For Wassan, the ending of Isis rule in Mosul is bittersweet. After many attempts to reach Baghdad to write her board exams for medical school, she was told her work in the hospital for the past three years did not count as “active service”, and she was disqualified.

“The ministry said they won’t give me security clearance because I had worked under Isis administration,” she said. “I am back to square one. And you ask me why Mosul is angry? Of course we are angry, if you continue to treat us as if we are all Isis.

“Now there is a different kind of civil war in the city – between those who stayed and went through all the suffering of three years, and those who left. They say we were collaborators, and we say you didn’t suffer. Everyone wants to go back to 2014 and restart their lives from there. They can’t accept that the past three years have been for nothing.”

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