BAGHDAD—After storming the Iraqi city of Mosul in June, the brutal Islamic State group quickly solidified its control. Gunmen enforced its laws and supportive imams preached at the mosques.

But the jihadists were missing something: doctors. So last month, the Islamic State issued an ultimatum to physicians who had fled: return to work, or we’ll seize your property and you can never come back.

The Islamic State’s efforts to run Mosul’s health-care system provide a glimpse into its efforts to build a caliphate, or Islamic state, in Iraq and Syria. Despite their victories on the battlefield, the jihadists have struggled as everyday administrators in Mosul, with the city’s hospitals grappling with daily power outages and shortages of medicine.

The Sunni fighters have also imposed measures that have alienated staff and compromised the lives of patients, doctors say.

The Islamic State’s rigidity and inexperience may ultimately cost it support in areas where some Sunni residents initially welcomed the group as an alternative to the Shiite-led central government. Already, the Islamic State has been forced to give ground on some of its stringent policies, such as barring male and female doctors from working together.

But the group continues to impose a harsh version of Islamic rule, according to medical personnel at four of the city’s seven hospitals, who spoke via telephone on the condition of anonymity out of security concerns. Female staff members, including doctors, are not allowed to work night shifts at the hospitals, they said. Female doctors must wear full-face veils.

Little dissent is tolerated. One doctor in Mosul said that earlier this month he witnessed a patient arguing with a physician affiliated with the Islamic State. The next day, militants brought the patient to the hospital lobby, where they whipped him and forced him to apologize to the physician.

“Of course, those of us who didn’t join them, we are all living in fear,” the doctor said.

The Islamic State emerged as a major player in the Syrian civil war in 2012 and 2013, and first tried governing in smaller cities in rural Syria. In its de facto capital in Raqqa — which has about 570,000 residents — the group has established Islamic law courts and revived clinics damaged by the war between the rebels and the Syrian government. It has even managed to run nearby oil refineries.

But Mosul, in Iraq’s north, is about twice as populous. And unlike Raqqa, which is part of an extensive region controlled by the Islamic State, Mosul has been largely isolated since it fell to the militants in June. The central government in Baghdad shut off its power supply, and Iraqi security forces, Shiite militias and Kurdish peshmerga forces control roads into Mosul.

“Mosul is a big city. It’s very difficult to govern,” said Ahmed Ali, Iraq senior research analyst at the Institute for the Study of War in Washington. Islamic State fighters, he said, “want to project an image of efficiency. But they are also very much improvising on the fly.”

One night over the summer, Islamic State officials prevented a male anesthesiologist from treating a woman in labour, a doctor said. The extremists deemed it improper for the anesthesiologist to see another man’s wife giving birth. With no women allowed to work the late shift, the pregnant woman went without medication.

In October, said rights activists in northern Iraq, militants arrested a pharmacist for selling medicine to a woman who was not considered properly veiled. The pharmacist has not been heard from since.

But amid the terror, the jihadists have had to relax some of their harsh measures and they have worked to keep the health sector afloat.

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The dress code for women prompted a strike by female personnel at local hospitals. A compromise was eventually reached. The militants have also allowed some female patients to see male specialists for ailments that are unrelated to pregnancy or sexual organs — such as a broken arm, for example, medical professionals said.

Citing concerns about its budget, the Islamic State in Mosul has allowed hospital staff to continue to receive salaries from the central Iraqi government in Baghdad. The fighters permit a single hospital employee to travel each month to nearby Kirkuk—which is controlled by northern Iraq’s Kurdistan Regional Government—to get the cash from government-approved banks.

The jihadists have also smuggled in basic medications to be distributed at public hospitals and clinics, where drugs had routinely been provided free by Iraq’s government.

The smuggling routes that criss-cross Mosul and its environs are some of the city’s few lifelines for food, fuel and medicine. Mosul’s residents and pharmacies use the corridors to bring in their own medicine, often at double or triple the normal price.

The jihadists in Mosul tolerate the practice. That appears to be in stark contrast to their behaviour in Syria, where Islamic State militants have obstructed the import of medicine by medical personnel to the eastern Hasakah province, the United Nations recently reported.

One of the Islamic State’s most harmful actions, doctors said, was to pilfer Mosul’s blood bank to treat its wounded fighters. Now civilian patients must bring their own blood donors to the lab.

But with the constantly flickering electricity, much of it cannot be stored safely.

“There is no life here, we live in the dark,” the female doctor said. “In Mosul, we are like the living dead.”

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