Digest by David Smith-Ferri, Voices in the Wilderness

Several articles follow a brief summary of urgent health care conditions in Iraq.

Summary

While conditions for most Iraqis continue to deteriorate, as the country slips even more deeply into an environmental and health crisis, George Bush and his supporters danced to country music on the evening of election day, celebrating the War President’s reelection. If not exactly dancing on Iraqi graves, it is close enough to create the same revolting effect.

Consider this: in October, the Iraqi Ministry of Health in Baghdad produced the first detailed report of the health of Iraqis since the escalation of war in March, 2003. The report is alarming. Iraq’s network of health centers, already crippled by neglect, poorly provisioned, and understaffed 19 months, is worse now. Looting in the aftermath of the March invasion, increased violence, insecurity, and a chronic lack of medicines are contributing to the current crisis: a system that is clearly overwhelmed by the health needs of the population.

Because critical infrastructure repairs, especially those to the electrical grid and to water and sewer treatment facilities, have not been completed (in most cases, not even commenced), raw sewage continues to pour into drinking water supplies and deadly infectious diseases are rampant throughout the country. Almost 20% of urban households and 60% of rural households lack access to safe drinking water, leading to a surge in typhoid and hepatitis cases in 2004.

The report also chronicles increasing poverty: in 2003, an estimated 27 per cent of the population lived on less than $2 a day. Children have always borne the brunt of the health crisis in Iraq. Today, one third of children are chronically malnourished, putting their lives at serious risk from outbreaks of measles, mumps, and jaundice, which are infecting thousands. And there is a growing problem among children of post-traumatic stress disorder.

Articles

Hepatitis spreads in 2 Iraqi districts
James Glanz/NYT
Friday, September 24, 2004

Collapse of water and sewage systems is believed to be at root of the illness

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Iraq faces soaring toll of deadly disease
By Jeremy Laurance, Health Editor
13 October 2004

Soaring rates of disease and a crippled health system are posing a new crisis for the people of Iraq, threatening to kill more than have died in the aftermath of the war. Deadly infections including typhoid and tuberculosis are rampaging through the country, according to the first official report into the state of health in the country.

The alarming evidence is the legacy of years of neglect, crippling sanctions and two bloody conflicts. Iraq’s network of hospitals and health centres, once admired throughout the Middle East, has been severely damaged by war and looting, leaving staff struggling to cope and adding to the crisis.

The report, compiled by the Ministry of Health in Baghdad, provides the first detailed portrait of the health of the Iraqi population and the state of its health services since the 2003 war. It is being launched today by Dr Ala’din Alwan, the Iraqi interim government’s Minister of Health, at a conference of international donors in Tokyo.

It charts the drastic decline in the health of the population and the catastrophic deterioration in health services during Saddam Hussein’s era, one which has accelerated since the war. One third of the health centres and one in eight of the hospitals was looted of furniture, fridges and air conditioners or had equipment destroyed in the immediate aftermath of the war.

Damage to water supplies and sanitation has led to a surge in typhoid, with 5,460 cases recorded in the first quarter of 2004. Almost one in five urban households and three in five rural households do not have access to safe drinking water.

Poverty has risen sharply, 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.

One in three children are chronically malnourished, putting their lives at serious risk from outbreaks of measles, mumps and jaundice, which are sweeping the country and infecting thousands. The report, compiled from Ministry of Health data and international surveys, says mothers and children have been hardest hit by a combination of domestic policies and international sanctions stretching back over a decade. Infant and child mortality doubled during the 1990s at a time when health was improving in most other countries.

Between 1990 and 1998, the number of infants dying before their first birthday rose from 40 to 103 for every 1,000 live births. Maternal mortality rose almost threefold during the same period, with 279 deaths in childbirth for every 100,000 live births.

Adult death rates have risen and life expectancy has fallen to below 60 for men and women. Overall, Iraq’s state of health is now rated on a par with the impoverished countries of the Sudan, Yemen and Afghanistan, where once it was ranked alongside Jordan and Kuwait, the report says.

Dr Alwan said yesterday: “More Iraqis may have died as a result of inappropriate health policies, sanctions and neglect of the health sector over the past 15 years than from wars and violence. The main causes were poverty, poor nutrition, the deterioration of water and sanitation services and the collapse of health services …Iraq used to have one of the best health services in the region but Saddam did not consider it a priority.The budget was cut by 90 per cent.”

The report details the extensive looting and destruction of health facilities since the war, which combined with unreliable electricity and water supplies and the continuing threat of violence have added to the problems.

Dr Alwan said Iraq was now facing a “double burden of disease” from chronic conditions such as cancer, diabetes and heart disease, which were growing rapidly, alongside a resurgence of infectious diseases.

Cancer has been rising sharply for a decade, with most cases diagnosed only when advanced, 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.

‘The Americans cannot provide security we need’
By Kim Sengupta in Baghdad
13 October 2004

The children lie on their hospital beds. A few cry, others just stare ahead. Their parents huddle around, trying to provide comfort.

These are not victims of the war, but of an alarming rise in disease and a shattered health system.

The hospital used to be called Saddam Children’s. It has been renamed Central Children’s, but the new name cannot hide old problems. The shortage of some vital drugs and equipment is worse than in the days of UN sanctions.

“The problem of supply is particularly acute in areas like chemotherapy, IV fluids, even antibiotics. It is also worse than before the war when it comes to lab facilities,” said Dr Ali Hussein, the chief resident.

“We have seen a big rise in admissions. A lot of them are from an increase in the rate of infections, mainly of waterborne diseases … The big problem is that the Americans cannot provide security, and that affects medical supplies.”

Zeena Alla is seven weeks old and about the size of an A4 notebook. She is suffering from an acute gastro-enteritis related illness. Her mother Shirin, 25, says: “They have given her medicine, but she is so small, I just don’t know what will happen. I am sick with worry, all I can do is pray all the time”.

Abdurrahman Bassim, five, has leukaemia. Dr Hafiz Jaleel Hussein said that there were not enough chemotherapy drugs. “He will probably have to go on a deficient course, and that reduces his chances of living.”