[afro-nets] Health Report Iraq

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

Health Report Iraq
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From: Bert De Belder

One year after the fall of Baghdad: how healthy is Iraq?

Report of Medical Aid for the Third World

by Dr. Geert Van Moorter, M.D.
based on a fact-finding mission to Iraq, March 2004

Dr. Geert Van Moorter was already in Iraq on various missions
for the Belgian non-governmental organization Medical Aid for
the Third World, in April 2002; before, during and after the war
in March/April 2003; in July/August 2003; and in March 2004. He
made, together with Iraqi doctors and health workers, an at ran-
dom survey on the health situation and the health care infra-
structure in Iraq, after one year of occupation. He visited hos-
pitals and clinics in Baghdad and Basra. On a health conference
in Basra, he was able to talk to colleagues from all over the
country. He had contacts with Unicef, the World Health Organiza-
tion, the new Ministry of Health and with several war victims of
last year.

Dr. Van Moorter is specialized in emergency medicine and tropi-
cal diseases. He made a study and published on child mortality
and has experience in public health and post traumatic stress
disorder.
(Contact: mailto:geert.van.moorter@skynet.be, tel. +32-486-793-
798. Medical Aid for the Third World, mailto:info@g3w.be, tel.
+32-2-209-2360)


Summary:

Increase in child mortality expected

The purchasing power, the food situation and the living condi-
tions of the majority of the population have all deteriorated.
Half of the active population has no job and no income. The
prices of basic necessities, food and transportation have dou-
bled or tripled. The quality of the drinking water is not being
controlled, the sewage system of Baghdad has been damaged by the
bombings, garbage is often not collected. Iraq has become one
big garbage belt. All this brings Unicef to the conclusion that
child mortality will probably increase further, if it hasn't al-
ready done so.

Medical infrastructure and medicines: no improvement

The medical infrastructure and the medical material were already
outdated and malfunctioning as a result of the twelve years' em-
bargo. One year after the onset of the war, these have not yet
been renewed. War victims and other patients do not receive op-
timal treatment. Complicated operations cannot be performed.
Everything is lacking, including medicines for acute as well as
chronic ailments. This results in deteriorating conditions or
even the death of patients, and in extra handicaps for the
wounded. On March 17, right after the explosion at the Mount
Lebanon Hotel in Baghdad, we helped care for victims in the Ibn
Al Nafis hospital. We observed there that there were no dispos-
able gloves, no appropriate intravenous fluid to treat shock, to
ultrasound, no well-functioning monitors.


Findings:

1. Testifying about the situation in the hospitals is made dif-
ficult.

Access to hospitals is very limited, the press is not allowed to
enter. It was only with difficulty and through personal contacts
with medical doctors that we could enter several hospitals. Doc-
tors who dare to testify before the camera are intimidated and
put under pressure. We talked to two doctors who had given an
interview. Afterwards, someone from the Ministry of Health vis-
ited them. They were forced to sign a letter stating that they
wouldn't give any interviews anymore, or else that they would
lose their job in the hospital.

2. The purchasing power, the food situation and the living con-
ditions have deteriorated. An increase in child mortality is to
be expected.

According to the CPA (Coalition Provisional Authority, the US
administration led by Paul Bremer), 35% of the active population
is jobless. Other sources speak of 60 to 70%.
During the embargo, several foodstuffs were distributed for free
among the population, mostly dry goods such as rice, tea, beans,
sugar, wheat, milk powder, oil, salt and things such as washing
powder and soap. This distribution is being continued, but regu-
larly some goods are lacking. E.g. in March, there was no rice.
As a consequence, everybody was forced to buy rice on the free
market, which pushed prices up. And anyhow, the food that is not
contained in the food basket - vegetables, fruits, meat, fish,
cheese, eggs,. - has to be bought on the market. Their prices
have increased two- or threefold over the past year.
The majority of the population has less cash available, while
the cost of living has increased. Their purchasing power has di-
minished, access to food is less assured. Unicef notes that mal-
nutrition today is higher than after the first Gulf War of 1991,
and the number of people with acute malnutrition rose sharply in
the first months after the onset of the 2003 war.

The provision of electricity in Baghdad has deteriorated. Water
services are still in worse condition than before the war, and
nobody knows the quality of the drinking water. In some places
there is still no water coming out of the faucet.
The sewage system was already in precarious condition before the
war. It has been hit by the bombings and hasn't been repaired
ever since. In many poor quarters of Baghdad, dirty water is
standing in the streets. Garbage collection is not yet well or-
ganized. Garbage is all around the place.

The three main factors that influence child mortality (under
five mortality) at the level of the family are the purchasing
power, the food situation and the living conditions. All three
of them have deteriorated over the past year in Iraq. The local
Unicef representative confirmed that child mortality will proba-
bly increase further, if it hasn't already done so.

3. Insecurity creates psychological traumas.

According to the director of the psychiatric center in Baghdad,
lots of children are faced with serious emotional and behavioral
problems as a direct result of the war, the fear, the hate, the
occupation. This is what is called Post Traumatic Stress Disor-
der. Symptoms of this are bedwetting, aggressive behavior (ver-
bal and physical), sleeping and eating disorders, depression,
fear, nightmares, concentration and memory disorders, auto-
mutilation, developmental disorders and phobias.
Repeated exposure to war dead and wounded has resulted in wide-
spread emotional and psychological traumas among medical emer-
gency teams of doctors and nurses.
Together with the bad economic situation, the insecurity is to-
day's major problem, causing quite some psychosomatic disorders.
There is insecurity because of the presence of the occupation
troops. And there is the problem of the inefficiency of the po-
lice, which has led to an increase in criminality.

4. Access to health care is severely limited.

The problems with the telephone networks make it difficult to
impossible to call an ambulance. Because of the insecurity, pa-
tients as well as doctors don't dare go to the hospital at
night. We experienced ourselves how, after a major car accident,
an unconscious patient could not be brought to the hospital in
an ambulance. He had to be brought with a taxi.
High transportation costs are another factor that renders going
to the hospital difficult. Same thing with the road blockades. A
recent Unicef report states that less than 50% of the Iraqi
population has access to the health care they need, because of
the insecurity.

5. The hospital infrastructure has not improved over the past
year.

We visited some 25 hospitals, clinics and pharmacies. Nowhere
had any new medical material arrived since the end of the war.
The medical material, already outdated, broken down or malfunc-
tioning after twelve years of embargo, had further deteriorated
over the past year. In places where looting had taken place,
there is now less material than before, as in Baghdad's reha-
bilitation center, which is supposed to provide the entire coun-
try of prostheses and physiotherapy. Or as in the burns section
of the Al Nour Hospital, where there is no possibility of ster-
ile treatment, as a result of which all patients with major
burns are doomed to die. Or as in the intensive care unit of the
Kahdemya Hospital - which has 8 of the 16 high intensive care
beds for Baghdad -, where only three respiration machines are
functioning.

6. Medicines and medical material are lacking.

In the hospitals, some specific medicines are lacking, e.g. for
burns. In several emergency units, specific live-saving drugs
are not available.

In the 'popular clinics' there is a constant lack of medication.
The Ministry of Health itself is distributing lists of medica-
tion, where for every drug the amount of products delivered is
mentioned. We saw one such list containing 32 products. For 10
of them. 0% had been delivered! Many patients don't get their
medicines, or they get only half of the dose they need. Results:
life quality diminishes, while the risk at early death in-
creases. This is the case for e.g. epilepsy, hypertension, an-
gina pectoris, diabetes, chronic asthma,.

Doctors may prescribe, but patients, who used to get their medi-
cines for free, have to buy them now on the private market. For
most of them, this is beyond reach. And many needed drugs are
not always available on the market. There are also doubts as to
the quality of these medicines, as they are not being stored in
optimal conditions.

There is also a lack of disposable material, such as gauze, cot-
ton, syringes, gloves, sutures,. In one 'popular clinic' we vis-
ited, three doctors had to share one single stethoscope, while
one and the same iron tongue depressor was being used for all
patients.

7. The plans of the CPA and the Ministry of Health are no solu-
tion.

Until last year, a number of contracts for medical material that
had been signed by the previous regime were blocked by the UN
Sanctions Committee 661. 90 % of them because of a US veto, 10 %
because of a British veto. It concerned contracts for a total
value of more than 500 million dollar. This money, which came
from the sale of Iraqi oil in the framework of the oil-for-food
program, was available on a UN account in New York. After the
lifting of the sanctions, this money has been turned over to the
CPA, and yet those contracts have not yet been executed.

The CPA and the interim government are now talking about new
plans to invest in medicines and medical equipment. This can at
most be part of the solution, but even then it is a case of 'too
little, too late'. There are plans for a new pediatric hospital
of more than 50 million dollar. This money would be put to bet-
ter use by upgrading the existing hospitals. Much of the money
will go to expensive US firms, and it can be feared that these
investments will have a high PR value. This is a case of combat-
ing the symptoms in order to divert attention from the real pre-
vention of illness and disease, by attacking the root causes
such as purchasing power, the food situation, the living condi-
tions, the insecurity.

In any case, these investments will not free the occupying power
of its duty to guarantee all necessary services to the Iraqi
population, as it is stated in the Fourth Geneva Convention. Se-
curity, jobs, an income, food and decent living conditions are
all part of this. All these factors have a major impact on pub-
lic health.