News and opinions on situation in Iraq
30/10/04 Iraq's Ill Health Ministry Report by Edward Teague
Through its system of 240 Hospitals and more than 1200 Primary Health Centres, the Iraqi Ministry of Health (MOH) is responsible for the health and well being of the people of Iraq.

Dr Ala'din Alwan Minister of Health in Iraq has published, at a meeting of donors to the Iraqi International Reconstruction Fund Facility in Tokyo, the first official government survey of Iraq's health since the “coalition of the willing” invaded in March 2003. This shocking and detailed report reveals a crumbling, under resourced, underfunded health service unable to cope with epidemics of typhoid, tuberculosis and other infectious diseases. Although around 12 per cent of hospitals were damaged last year, Dr Alwan said that all hospitals now require rehabilitation and have a pressing need for equipment. Improvements in the availability of clean drinking water and reliable power supplies were cited as being crucial. These two public utilities have suffered the most.

The report says the rising tide of disease in Iraq could kill more people than the invasion, it also highlights the link between poverty and poor health. One in three children in Iraq are chronically malnourished, putting their lives at serious risk from disease.

As well as addressing current health concerns, the report also details the Iraqi health service's 15-year decline under Saddam Hussein's rule. “More Iraqis may have died as a result of … neglect of the health sector over the past 15 years than from wars and violence,” says Alwan in the report.

Alwan adds that Iraq's health is now comparable with countries like Sudan and Afghanistan; 15 years ago it rivalled that of richer nations such as Jordan and Kuwait.

Despite the rise in infectious diseases, cardiovascular disease still ranks as the number-one killer in Iraq. This is principally due to poor diet and a very high prevalence of smoking, but it is exacerbated by a lack of public health initiatives to change the population's lifestyle. Whilst there are chronic shortages of drugs, cigarettes seem to be freely available, with American brands finding a premium price. The logistic skills of the Black Marketeers are evidently much superior to those of the conquering heroes of the liberation.

Water & Sanitation

Disruption to water supplies during the conflict means that roughly 20% of urban households now have no access to safe drinking water. . In rural areas, more than half of households are without fresh water or adequate sanitation.

5,460 cases of typhoid were reported in the Qtr1 2004,Measles and mumps are infecting thousands of children, partly because a third of them are chronically malnourished, it is reported. IN 2003 there were 454 measles cases reported in the first half of 2004, 8,253 cases of measles were notified with Basra hit particularly badly.

For the first 4 months of 2004 saw 11,821 cases of mumps, nearly 5,000 more cases than there were in the whole of the previous year.

Fewer than a quarter of diabetics receive insulin and there is a growing problem of post- traumatic stress disorder, especially among children, the report says.
Speaking in Amman on October 8th Roger Wright speaking at the public release of the new global report by UNICEF, said that UN economic sanctions imposed on Iraq in late 1990 had resulted in Iraq experiencing ''a bigger increase in under-five mortality rates than any other country in the world and since the war there are several indications that under-five mortality has continued to rise''.
Wright was speaking at the public release of the new global report by UNICEF.
According to the report, during the 1990s, the greatest increases in child mortality occurred in southern and central Iraq, where under-five mortality rose from 56 to 131 per 1000 live births. While some indications showed improvement in child health between 1999 and 2002, UNICEF believed that since the US invasion of Iraq in March 2003 the death rate among Iraq children has risen again, It estimates that there the under-fives mortality rate is now 125 per 1000 live births.

Services under immense pressure

The report claims a third of Iraq's health centres were looted of vital equipment, with one in eight hospitals suffering the same fate immediately after the “liberation”. The health service is being strained further by staff shortages, an unreliable electricity supply and the ongoing violence in Iraq, leaving it unable to stem the growth in infections.

“I'm not surprised by this at all. The breakdown of sanitation and public health services is a huge problem in Iraq,” says Gilbert Burnham, a public health researcher and co-director of the Centre for International Emergency, Disaster, and Refugee Studies at Johns Hopkins University, Baltimore, Maryland. Burnham has just published a report in the Lancet claiming that at least 100,000 civilians have died since the invasion, he is leading a team that is gathering its own evidence about the health impacts of the conflict. “Our research supports these conclusions,” he says. The team plan to publish more of their research in the next few months. Meanwhile the U based MEDACT are preparing their own report and Director Mike Rowson says that they agree with the Hopkins analysis but mention that it does not cover injuries, typically 3 times the fatality rate – and of course a continuing burden on health resource.

Famously, US General Tommy Franks is widely quoted as saying,”we don't do body counts”.

“The violence that still rocks Iraq is also an important factor” Burnham is quoted saying”, People are afraid to go out and get health care,” he says.

“Currently, the emphasis in Iraq is on training clinicians in emergency care. Basic public health concerns – clean water, food and so on – are low on the priority list,” Burnham says. “Whenever there are conflict situations, public health goes down.”

“One of the major issues of reconstruction is to put a decent public health system in place,” he adds.

The MOH website reports this week that the Al Alwiyah Paediatric Hospital received five new incubators as part of a shipment of 20 that recently arrived in Iraq.
The shipment includes five incubators already received by the facility and 10 delivered to other hospitals in the Baghdad area. Assessments indicate that as much as 65 percent of equipment in Iraq's hospitals is not functional or in need of repair or replacement. The incubators delivered so far represent the Ministry's focus on maternal and child health with the ambitious but attainable goal of reducing the infant mortality rate by one half by the end of 2005. Only a fraction of the more than 25,000 tons of pharmaceuticals and supplies that the Ministry of Health has been delivered since May 2003.

Meanwhile. Debt crisis grows and the Baker/Carlyle gang clean up

A week after the report came out, Iraq paid out another $195 million for war reparation debts, mostly to Kuwait. Meanwhile, the State Department announced that $3.5 billion for water, sanitation and electricity projects was being shifted to security in Iraq, claiming that, according to Deputy Secretary of State Richard Armitage, debt relief is on the way. Meanwhile development of 12 new military bases proceeds (14 if you believe the New York Times) of the world to add to the other 725 military bases the Us has scattered about the world.

Oh Yeah? The fact is, Iraq is plunging deeper into debt, (but then so is the US, although Congressional approval for raising federal loan limits have been put off until after the Presidential election) with $836 million in new loans and grants now flowing from the IMF and the World Bank. Meanwhile, Dubya's deal broker on the spot Jim Baker has not managed to get a single country to commit to eradicating Iraq's debts.

The Paris Club meets on November 12th to hash out a final deal on Iraq's debt. Iraqi's aren't holding their breath that mind boggling debts the West let Saddam run up will be cancelled – none have been so far.

It is a forlorn hope that their interminable discussions will make any effect on Iraqi poverty, with an estimated 27 per cent of the population living on less than $2 a day in 2003, in a nation with among the richest oil reserves in the world.

Edward Teague

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