PHA-Exchange> health report Iraq

Sat Apr 10 04:26:15 PDT 2004

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 random survey on the health situation and the health care infrastructure in Iraq, after one year of occupation. He visited hospitals 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 Organization, the new Ministry of Health and with several war victims of last year.

Dr. Van Moorter is specialized in emergency medicine and tropical diseases. He made a study and published on child mortality and has experience in public health and post traumatic stress disorder. (Contact: geert.van.moorter at skynet.be, tel. +32 (0)486 79.37.98. Medical Aid for the Third World, info at g3w.be, tel. +32 (0)2 209.23.60)

Summary:

Increase in child mortality expected

The purchasing power, the food situation and the living conditions 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 doubled 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 already 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The medical infrastructure and the medical material were already outdated and malfunctioning as a result of the twelve years' embargo. One year after the onset of the war, these have not yet been renewed. War victims and other patients do not receive optimal 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 disposable 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 difficult.

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. Doctors 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 visited 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 conditions 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 regularly 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 diminished, access to food is less assured. Unicef notes that malnutrition 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 organized. 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 probably 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 Disorder. Symptoms of this are bedwetting, aggressive behavior (verbal 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 widespread emotional and psychological traumas among medical emergency teams of doctors and nurses.
Together with the bad economic situation, the insecurity is today'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 police, 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, patients 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 malfunctioning 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 rehabilitation center, which is supposed to provide the entire country of prostheses and physiotherapy. Or as in the burns section of the Al Nour Hospital, where there is no possibility of sterile 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 medication, 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 increases. This is the case for e.g. epilepsy, hypertension, angina pectoris, diabetes, chronic asthma,.

Doctors may prescribe, but patients, who used to get their medicines 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, cotton, syringes, gloves, sutures,. In one 'popular clinic' we visited, 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 solution.

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 better 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 combating the symptoms in order to divert attention from the real prevention of illness and disease, by attacking the root causes such as purchasing power, the food situation, the living conditions, 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. Security, jobs, an income, food and decent living conditions are all part of this. All these factors have a major impact on public health. 

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