HandSAP coordinators past and present.


Our HandSAP programme has been a part of STEP-IN’s work since our conception in 2015. Initially, the ever-motivated Dr Zuzana Ulman (see prev.) was seeking new ways to support patients who required medication and/ or treatment that we were unable to provide. Using her initiative, she started redirecting any remaining funds available to STEP-IN into what were temporarily named ‘social support cases’. Within six months this instinctive response to a need became a budding project, receiving its first grant and our dedicated program doctor (Martina Partelova) visiting prospective and ongoing cases in her free time. What began as 4 individual cases in 2016 had, by 2018, grown to 71 assessed and supported beneficiaries.

It was at this point that the HandSAP programme was officially named and its first coordinator – Lucia Pedulla – appointed! The programme became a full-time aspect of STEP-IN’s work and has supported many beneficiaries with surgeries, chronic medications, orthopaedic equipment, essential therapies, travel costs, and more. Our coordinators visit each beneficiary every few weeks to provide medication, reimburse receipts, and to catch up with the recipient and their families. The intention of our HandSAP programme is to interact with people not patients, and to understand the difficulties they face in their receipt of treatment outside of our doctors’ office.

Our HandSAP programme prioritises vulnerable people with urgent needs and less resources available to them. We frequently support internally displaced people (IDPs, majority from the heavily persecuted Yezidi community), ISIS victims, and families with low socioeconomic status’ (defined by a family’s income, education level, and occupational prestige). As HandSAP grows we would like to support more and more people in need whilst also empowering our beneficiaries to manage and understand their own circumstances, treatments, and the facilities available to them.


Far right: Current HandSAP Coordinator Natasha Page Bencke. Far left: Assistant Coordinator and Nurse, Hassan Rashw.

Hassan and previous HandSAP coordinator Selma del Riego.


Two of the main barriers our HandSAP beneficiaries face in their pursuit of consistent and effective care are the costs incurred and the general availability of their required treatment.
Government hospitals in Kurdistan are often lacking in stocked medications. The health demands of a post-crisis population invariably exceed the supplies and infrastructure available in the region. The presence and influx of refugees and IDPs since 2014 have only stretched this situation further. Even as IDPs and refugees arrive at hospitals to collect medications, they are often discriminated against by working healthcare professionals. There needs are frequently met last, if at all.
The Kurdistan Regional Government (KRG) is still heavily dependent on Iraq’s federal budget and according to the Minister of Health for the Kurdistan Region, Saman Barzinji, Kurdistan’s share only covers “43% of the region’s existing needs”. As such the “funds are not adequate for a fully-fledged healthcare system.” HandSAP aims to fill the gaps for the people most effected. Especially as there seems to be an increased reliance on private healthcare that, without any available health insurance in the region, is unattainable to most of the people we work with.
In addition to providing essential medications, we also subsidise transport costs. There are no public transport services available in Kurdistan aside from taxis and it continues to be rare for those residing in camps to have access to a car. However, a number of the people we support attend regular therapies in the city. This could include physiotherapy at one of our clinics, chemotherapy or surgeries at the local hospital, neurological support including mental health services, or even speech therapy for children with disabilities. By subsidising the transport costs these kind of treatments incur, we encourage increased and regular attendance.

Current HandSAP Beneficiary Khalida.


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