This latest Iraq Health and Infrastructure Digest #12 is a compilation of 9 articles covering a wide range of issues facing people in Iraq. Summaries are given as well as the full, or relevant portion of the articles.

Digest by David Smith-Ferri, Voices in the Wilderness

Article Summaries

• Iraqi hospitals under strain: Iraq’s national psyche traumatized: More than two years of war, occupation and insurgency have turned Iraq into possibly the most psychologically damaged nation in the world, one of the country’s top psychiatrists said on Thursday. “Psychologically, it may be the worst affected country in the world. It’s something experts are worried about and that we need to look into … The long-term implications are profound. “What’s going on is really a catastrophe from a psychological and a societal point of view.” (Dr Harith Hassan) [read article]

• Mental health problems among returning US troops: US military medical officials say that 30% of troops returning from Iraq have developed stress-related mental health problems three to four months after coming home. For those who have seen combat, about one in 10 suffers from post-traumatic stress disorder, a serious mental illness. [read article]

• Housing problems increase as conflict hits hearth and home: More than 450,000 families are homeless countrywide. Most are living in “very deteriorated or miserable conditions” (Ahmed D’lemi, a senior official at the Ministry of Construction and Housing). The actual number, he said, is likely much higher.” [read article]

• Power shortage drives Iraqis to frustration, fury: It’s five o’clock in the morning, the temperature is 40 degrees (100 fahrenheit), and a five- month-old baby is crying. “We didn’t have electricity all last night,” says Abu Zainab, the father of the screaming child, exhausted and frustrated from another sleepless night. “The neighborhood generator is broken. My family and I couldn’t sleep at all.” [read article]

• Rationing Fuel/Energy shortfall: Samira al-Moussaui, a lawmaker with the conservative Shia majority, thinks the government needs to start holding someone accountable for energy shortcomings. “The government’s first duty is to improve the infrastructure in Baghdad,” said Moussaui. “We have not asked for anyone to be accountable for this over the last two years,” she said, referring to the period under the US-led administration and the interim government that followed, which ended in May. [read article]

• New reports show limited progress in Iraq rebuilding: According to the US General Accounting Office, both power output and oil production in Iraq are lower than before the March ’03 US invasion. [read article]

• GAO: US Contractors spent $766M on Iraq Security: Rising security costs are draining money away from rebuilding. The government is not keeping track of how many private security guards are working in Iraq or how much U.S. contractors are spending on security, a congressional report says. The Government Accountability Office (GAO) report released Thursday says investigators identified more than $766 million in government spending for private security companies in Iraq through the end of last year. Four contractors spent more than 25% of their budget on security, Congress’ non-partisan investigative arm found. [read article]

• Drug resistant bacteria infecting US military who have fought in Iraq: Military doctors are fighting to contain an outbreak of a potentially deadly drug-resistant bacteria that apparently originated in the Iraqi soil. So far at least 280 people, mostly soldiers returning from the battlefield, have been infected, a number of whom contracted the illness while in U.S. military hospitals. [read article]

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Articles

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Iraq’s national psyche traumatised — doctor

4 Aug 2005
By Luke Baker

BAGHDAD (Reuters) - More than two years of war, occupation and insurgency have turned Iraq into possibly the most psychologically damaged nation in the world, one of the country’s top psychiatrists said on Thursday. Dr Harith Hassan, the former head of Baghdad’s Psychological Research Center, estimated that more than 70 percent of the private clients he sees each week are suffering from post-traumatic stress disorder (PTSD), a severe anxiety condition.

“Iraq is one of the most stressed, oppressed countries in the world — you can see the suffering every day, every hour, even every minute,” Hassan told Reuters in an interview.

“Psychologically, it may be the worst affected country in the world. It’s something experts are worried about and that we need to look into … The long-term implications are profound.

“What’s going on is really a catastrophe from a psychological and a societal point of view,” he said.

Aside from the initial impact of the war, with its “shock and awe” U.S. bombing, Iraqis have had to deal with occupation by foreign forces, the random, widespread death brought about by insurgents, and the growing effects of sectarian tensions.

Hassan said sectarian division was one of his biggest concerns, with Iraqis increasingly being defined, and defining themselves, by classifications that were not common before.

“The sectarianism — that goes straight into the heart of a family and can be very damaging,” he said.

DAMAGED PSYCHE

“You may have a Shi’ite father and a Sunni mother, and the children don’t really know how they are defined, but they are being forced to define themselves as one or the other,” he said.

“Iraq hasn’t experienced these sorts of divisions before and it is creating terrible psychological trauma.”

Iraq’s population is made up of Sunni and Shi’ite Muslim Arabs, Kurds, who are also mostly Sunni Muslims, and several smaller groups including Turkmen, Christians and Yazidis.

Insurgents, who draw the bulk of their support from the Sunni Arab community, have increasingly engaged in tit-for-tat killings of Shi’ites in recent months, raising the fear of civil war. Kurds and Christians have also been attacked.

“It’s what’s going on between us now that worries me most,” said Hassan, who studied in Britain and the United States.

With the help of a research center in the United Arab Emirates, Hassan has begun a preliminary study into the extent of post-traumatic stress disorder in Iraq. He is particularly concerned about the prevalence among women and children.

“It’s very widespread, the situation is really very bad,” he said. “I see 15-20 people a day just at my private clinic and I would say that not less than 70 percent of them are suffering from PTSD. The stories I hear are shocking.”

If he can secure assistance from the World Health Organization, the U.S. National Institute of Mental Health and other groups, Hassan hopes to conduct a nationwide study of the problem over the next 18 months.

“The country needs it. Things are getting worse and worse,” he said. “We need to understand what is happening to our national psyche and try to resolve it.”

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Mind games over Iraq

3 Aug 2005
By David Isenberg

Asia Times It increasingly appears that when GI Joe and Jane come marching home from their tours in Baghdad they will, among other things, be scheduling appointments with psychiatrists.

US military medical officials say that 30% of troops returning from Iraq have developed stress-related mental health problems three to four months after coming home. A survey of 1,000 troops found problems such as anxiety, depression, nightmares, anger and an inability to concentrate.

The 30% figure is in contrast to the 3% to 5% diagnosed with a significant mental health issue immediately after they leave the war theater, where the US has about 150,000 troops.

A smaller number of troops, often with more severe symptoms, were diagnosed with post-traumatic stress disorder or PTSD, which is a serious mental illness. For those who have seen combat, about one in 10 suffers from PTSD.

As a diagnostic term, PTSD came into existence in the aftermath of the Vietnam War to describe the various mental ailments experience by returning American servicemen.

Mental and emotional health issues have become a serious enough concern that the Pentagon has put into place post-deployment assessments to monitor troops for PTSD and related illnesses.

These assessments and other mental health initiatives at both federal and state levels are part of an effort to avoid the long-term mental health problems that afflicted many Vietnam veterans, whose disorder was initially not even recognized upon their return from combat.

Unlike then, the Pentagon and the Veterans Administration are trying to be proactive, rather then reactive. To that end they have published the Iraq War Clinician Guide; developed by members of the National Center for PTSD and the Department of Defense. It was developed specifically for clinicians and addresses the unique needs of veterans of the Iraq war. The executive summary states:

A variety of factors including personal and cultural characteristics, orientation toward coping with stressors and painful emotions, pre-deployment training, military-related experiences, and post-deployment environment will shape responses to Operation Iraqi Freedom. Furthermore, psychological responses to deployment experiences can be expected to change over time. The absence of immediate symptoms following exposure to a traumatic event is not necessarily predictive of a long-term positive adjustment. Depending on a variety of factors, veterans may appear to be functioning at a reasonable level immediately upon their return home particularly given their relief at having survived the war-zone and returned to family and friends. However, as life circumstances change, symptoms of distress may increase to a level worthy of clinical intervention.

Even among those veterans who will need psychological services post-deployment, acute stress disorder and PTSD represent only two of myriad psychological presentations that are likely. Veterans of Operation Iraqi Freedom are likely to have been exposed to a wide variety of war-zone related stressors that can impact psychological functioning in a number of ways.

Soldiers departing a war zone are typically given a health evaluation as they leave combat, but the army is only now instituting a program for follow-up screenings.

In fact the military plans to screen all troops who serve in Iraq and Afghanistan for post-traumatic stress disorder and other combat-related health problems within three to six months after they return home, William Winkenwerder Jr, the assistant secretary of defense for health affairs, said recently.

The Pentagon plans to spend nearly $100 million to make sure all returning troops take part in the program and get help if they need it, Winkenwerder said.

An army study made public last week found that at least 10% of service members surveyed in Iraq last year reported experiencing post-traumatic stress disorder or other acute mental problems. A study reported last year in the New England Journal of Medicine found 17% of all troops who served in Iraq and Afghanistan experienced post-traumatic stress disorder, severe depression or anxiety, but most didn’t seek medical care for fear of being stigmatized.

Another study published in the Journal in March found that as many as one in four veterans of Afghanistan and Iraq treated at Veterans Affairs (VA) hospitals in the past 16 months were diagnosed with mental disorders, a number that has been steadily rising.

Dr Michael Kussman, the deputy under secretary for health at the Department of Veterans Affairs, said 24,000 veterans from Iraq and Afghanistan had been diagnosed with mental health problems due to their combat experiences. More than 14,000 have sought treatment at VA medical centers for mental disorders or drug and alcohol problems related to combat experiences, he said.

But care for the troop’s mental health is not just something that starts when a soldier returns home from the war. The military has about 200 mental health experts in Iraq, grouped in what the army calls “combat stress control teams”. Such teams are required per Army Field Manual No 22-51, which notes, “Combat stress control is now recognized as an Army Medical Department functional area for doctrinal and planning purposes.”

These teams are deployed at six US bases across Iraq and talk with troops after battles to try to prevent suicides and diagnose troops who should be evacuated from of the country because of mental health problems.

To help soldiers cope, the army has revamped its routine for returning warriors, easing them back into domestic life after the prolonged pressures of a war zone. Unlike the past, where soldiers were more or less left to fend for themselves with regard to their mental health, now they are encouraged to ask for help.

Outreach starts before soldiers reach home soil and continues with two weeks of mandatory classes and a month of voluntary counseling for issues ranging from stress and anger management to marriage enrichment. Three to four months after their deployment, the army formally surveys how troops are doing.

The first version of the program began in May 2003; it has been evolving since then.

It remains problematic whether the government will actually be able to pay for the mental health service being put into place. Earlier this year, until Republican leaders in Congress finally managed to make it clear to the White House that veterans health services were no place for deficit reduction, the administration was pushing to restrain spending on military benefits and the Veterans Administration’s budget.

Due to the surge in demand of new veterans, the wait for VA medical services can be more than six months. Democrats proposed expanding mental healthcare to all VA hospitals by 2006 but it is not clear if that will make it into the final budget.

And the VA itself is sharply divided about how to care for returning service men and women. In the last decade, VA hospitals across the country have sharply reduced the number of inpatient psychiatric beds, replacing them with outpatient programs and homeless services, which, officials say, cost less and are just as effective.

But veterans’ advocates and even some VA psychiatrists say the hospitals are ill-equipped to deal with veterans who need the most extensive help for psychosis, substance abuse, suicidal impulses and PTSD.

On March 29 the Los Angeles Times published a letter by Bruce L Kagan, staff psychiatrist at the Greater Los Angeles VA Healthcare System. He wrote:

The Times account of decreased funding for veterans’ mental healthcare (March 20) leaves the impression that the state of this care is a matter of “debate”. But the Government Accountability Office and the Veterans Administration’s own special committee on post-traumatic stress disorder in October 2004 warned that the “VA does not have sufficient capacity to do this.

Approximately 15% of Iraq veterans will experience this disorder and another 15% will experience major depression, both conditions associated with severe morbidity, prolonged disability and significant mortality (suicide).

Despite the existence of highly effective treatment for these disorders, most veterans will not receive effective treatments because of fear, stigma and lack of treatment facilities and providers. The VA has repeatedly cut funding for mental health and post-traumatic stress disorder. There has been no significant spending to accommodate the 300,000-plus soldiers who will suffer from severe mental health disorders on their return from Iraq.

David Isenberg, a senior analyst with the Washington-based British American Security Information Council (BASIC), has a wide background in arms control and national security issues. The views expressed are his own.

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Housing problems increase as conflict hits hearth and home

3 Aug 2005

BAGHDAD, 4 Aug 2005 (IRIN) - Adel Abdel Sada is not proud of his home. Cobbled together from the wreckage of old buildings, cartons and bits of scrap, the ramshackle, jerry-built dwelling is all the 39-year-old unemployed security guard can afford.

“I’ve lived here for four years since I lost my job,” he said. “I built two rooms, a bath, a kitchen and a fence. I know no-one would like to live in a house like this, but what can I do? I need a home for my family.”

Sada is not alone, and many of Iraq’s low-income or unemployed families are struggling to find adequate housing countrywide.

The main reason for terrible living conditions for thousands of Iraqis is that many houses have been destroyed over years of conflict in the country.

The number, officials say, has been increasing daily and very little investment has gone into the sector.

Ahmed D’lemi, a senior official at the Ministry of Construction and Housing, said that according to its records, more than 450,000 families were homeless countrywide. Most were living in what he described as “very deteriorated or miserable conditions”.

“This number may shock the international humanitarian organisations but it’s the reality of Iraq now,” D’lemi said. “Our government is working hard to reverse this statistic, but we need very large investment.”

He added that the number could be much higher than their records suggest, since many homeless people have not been registered due to the prevailing insecurity in Iraq.

At a conference held in Jordan in November 2004 by the United Nations Human Settlements Programme, known as UN-Habitat, and Iraqi government officials it was stated that Iraq needed 1.5 million new homes to cover needs, confirming the vast scale of the problem, but lack of funds has delayed the process.

In Baghdad alone, more than 54,000 people have been identified as homeless, according to local government officials.

Recent conflict in the country, especially in the western province of Anbar, where US forces are flushing out insurgents, has caused thousands of residents to flee and become homeless, according to the Ministry of Construction and Housing.

US forces say their operations are needed to ensure security in the long term.

“The Coalition forces are assisting the Iraqi Security Forces and the government of Iraq in securing their future as they move forward in the democratic process.” Lt-Col Steven Boylan, spokesperson for the US forces in the country told IRIN on Wednesday.

“We take all precautions available to preclude any unnecessary actions that would cause harm to the Iraqi people and their property. However, it is the terrorists that continue to cause the most harm and damage by their use of car bombs, rockets, mortars and IEDs [improvised explosive devices].”

It is ordinary Iraqi families that suffer the destruction of their homes, and homelessness in many cases, according to one local.

“My house was totally destroyed in Fallujah in the last conflict and, until now, I’m living with my family in an abandoned school just outside the city, awaiting a solution from the government,” said Muhammad Kubaissy, a father of five in Baghdad.

“They are fighting insurgents and the result is more homeless people every day in the country.”

The country’s housing problem dates back to previous conflicts, but has been exacerbated by the war, insurgency and instability in the recent past.

After the Iraq-Iran war, in the 1980s, the government of former Iraqi leader, Saddam Hussein, announced the need for more than three million new homes in Baghdad and surrounding districts.

“A plan was established at that time to solve the housing crisis but, with Iraq’s entry into the [first] Gulf War in 1991, this plan was completely halted,” said Bassim al-Ansary, general director of planning at the ministry.

“The private sector declined as well because of weak funding, which made matters worse - as did the sanctions imposed by the United Nations in Iraq.”

The only project that was developed in Iraq between then 2003 was by UN-Habitat, official said. Since 1997, it has helped to provide over 20,000 houses, 475 primary schools, 220 secondary schools, 130 health centres between other projects.

UN-Habitat stopped its work in the country after the terrorist attack on the UN headquarters in Baghdad in August 2003, having to scale back staff temporarily, but is working from the Jordanian capital, Amman.

According to al-Ansary, more than 1,000 houses have been built since 2003, mainly for teachers at universities and government workers in central Iraq who were in drastically living situation conditions.

In order to address the problem, the ministry has proposed five projects in different places around the country, including several new lower-income housing tracts to cover emergency needs.

However, only three, at a cost of US $40 million, have been undertaken due to funding shortages.

“We have already started three new housing projects, one in [the northern city of] Kirkuk with 600 homes, in Baghdad with 284, and in [the southern city of] Karbala with 483 housing units,” al-Ansary said. They should be completed in 2006, he added.

The two projects pending, costed at US $12 million, are for housing needs in the northern city of Mosul and for Missan in the south.

But locals claim that progress is slow and that they continue to suffer.

“For two years we had no home and I lived with my family in abandoned buildings without water or electricity,” said Suad Mohammed from Sadr City, a vast low-income neighbourhood in Baghdad dominated by Shi’ites.

“Then, together with some other families, we moved into a small house with two rooms and a kitchen. There are around 11 people living with us waiting for a solution through the government housing project.”

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Power shortage drives Iraqis to frustration, fury

2 Aug 2005
By Hiba Moussa

BAGHDAD, Aug 2 (Reuters) - It’s five o’clock in the morning, the temperature is 40 degrees (100 fahrenheit), and a five- month-old baby is crying. Her parents try in vain to calm her down by fanning her face with a palm leaf.

Almost every night in summer it’s the same. Iraq’s rickety electricity grid, damaged in the war and only partly rebuilt, is unable to meet soaring demand for power — especially for air conditioners. In the sweltering heat, Iraqis’ frustration rises by the day.

Rather than rely on the grid, those that can afford it buy power from neighbourhood generators, but they often break down or run out of fuel, an irony in oil-rich Iraq. It’s a domino- effect that leaves overheated residents close to despair.

“We didn’t have electricity all last night,” says Abu Zainab, the father of the screaming child, exhausted and frustrated from another sleepless night. “The neighborhood generator is broken. My family and I couldn’t sleep at all.”

Some families have taken to moving everyone — parents, grandparents, children — into one room that is kept cool. The grid is either too weak to cool the whole house or they can’t afford to buy the extra power needed.

And those are the lucky ones. Most Iraqis have to rely solely on national power, which runs for only a few hours a day.

“We only get 15 minutes on and then its mostly six hours off,” says Nadia Murad, a 35-year-old woman, dismissing U.S. officials who say Baghdad power is now on for up to eight hours a day — two hours on followed by four hours off.

Some Iraqis in the south say they get only one hour a day.

SOARING DEMAND

For many, the hardship of living without reliable electricity wouldn’t be quite so bad if the Americans hadn’t been promising for more than two years to fix the problem.

Under Saddam Hussein, the power system was decrepit but functioned, producing around 4,200 megawatts — enough to meet national demand most of the time, although some areas suffered.

After his overthrow in 2003, output fell, partly because the creaking system was damaged in the fighting, but also, U.S. engineers say, because they needed to shut down parts of it in order to improve the whole. Sabotage also took its toll.

Only recently — nearly 2-1/2 years after Saddam’s fall — did output finally outstrip pre-war levels. The national grid now produces about 4,700 MW, according to U.S. engineers.

That’s still hugely short of demand, which has soared as Iraqis have snapped up airconditioners and other appliances.

Insurgents still sabotage the electricity infrastructure and their attacks have delayed the building of new power stations, meaning that it could take years for output to match current demand, estimated at 8,500 MW.

Meanwhile, Iraqis sweat.

SLEEPING ON THE ROOF

To beat the heat, Abu Omar, a 50-year-old college professor, and his wife sleep on the flat roof of their Baghdad home.

“It’s become a summer tradition,” says Abu Omar. “We figure it’s a better alternative to waiting for power.”

But it is not without danger. Iraqis sleeping on roofs have been killed by stray bullets and mortars in previous summers.

“I say a little prayer before I go to sleep,” says Omar.

Amid the hardships, some Iraqis have made a fast buck. Generator sales have been strong for two years, and some merchants who used to run other businesses have switched: Amir Hameed used to sell groceries but now stocks generators and does a roaring trade in Baghdad’s Karrada area.

He also owns a huge imported generator that is run by his brother and supplies power to homes in his neighbourhood, at 6,000 dinars ($4) per ampere per month. Most mid-sized homes require five to 10 amperes to run appliances and lights.

It’s a good business, but has its own hazards in the form of the fury of nearby consumers if the generator breaks down or runs out of fuel.

“Once I was beaten up by neighbours,” says Hameed.

In spite of the power crisis, some remain hopeful, like Bilal Mahmood, a 30-year-old who recently married.

“Every night, my wife and I have a romantic candle-lit dinner,” he says, unperturbed by the lack of electricity.

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Iraqi officials consider rationing fuel

31 Jul 2005
AFP

Iraq may have the world’s second-largest oil reserves, but top government officials are looking into creating a coupon programme to ration fuel for winter.

Rationing aims to put a dent into the black market sale of oil products “and lead to more equitable distribution for all Iraqis,” Petroleum Ministry spokesman Assem Jihad said.

Since the April 2003 fall of Saddam Hussein’s government, the supply of oil products, especially gasoline, has been effectively, if not officially, rationed.

Iraqis have been forced to stand in lines of up to two hours at the pump to get fuel.

The alternative: Buy gas on the black market, with prices 25 times higher.

While a litre of gas at the pump is 20 dinars (one US cent), on the black market it sells at 500 dinars (33 US cents).

Petroleum Ministry officials have formed a committee aimed at creating a system of coupons to ration petroleum products, especially kerosene used for heating and running power generators. “We expect that system to be ready before next October,” Jihad said.

He added that a coupon system had been used successfully in the Kurdish semi-autonomous region.

More cars

The demand for fuel, especially gasoline, has been aggravated by the import of more than one million cars after the fall of Saddam, Jihad said.

Aside from difficulties like getting fuel and water, Iraqis have also to put up with long periods without electricity, which becomes linked to the fuel shortage.

In Baghdad, power blackouts last up to 20 hours a day, at the height of summer with temperatures around 38 degrees Celsius even after sunset.

Legislators have raised the issue in parliament, but often their complaints run so long that Speaker Hajem al-Hassani has to interrupt and demand that they adhere to their allotted three-minute limit.

Accountability

Samira al-Moussaui, a lawmaker with the conservative Shia majority, thinks the government needs to start holding someone accountable for energy shortcomings.

“The government’s first duty is to improve the infrastructure in Baghdad,” said Moussaui.

“We have not asked for anyone to be accountable for this over the last two years,” she said, referring to the period under the US-led administration and the interim government that followed, which ended in May. Another legislator, Faridun Abdel Kader, said action was needed now, because “anyone who studies the projects at the Ministry of Electricity will realize that 10 years from now Iraq’s situation will not change”.

“That doesn’t surprise me, because the ministry has been unable even to re-establish the same level of energy supply that existed before the fall of the (Saddam) regime. What does surprise me is our silence in parliament on this important issue,” he added.

Blackouts

According to a recent UN study, three-quarters of Iraqi homes suffer from electrical blackouts.

The blackouts hit the capital especially hard, where they affect 92% of Baghdad’s 1.1 million households.

In a display of rising frustrations, residents of the poor neighborhood of Sadr City recently attacked a government worker who came to demand that they pay overdue electrical bills.

Twenty-nine percent of Baghdad households have bought generators to make do.

But the generators need fuel to operate, and the vicious circle continues.

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New reports show limited progress in Iraq rebuilding

31 Jul 2005
By Sue Pleming

WASHINGTON, July 31 (Reuters) - Despite pouring more than $9 billion into rebuilding Iraq over the past two years, the United States has made only limited progress in key areas such as oil and power, according to new reports on U.S.-funded projects there.

Rebuilding Iraq is seen by the Bush administration as a major foreign policy priority but three U.S. government reports released this week — the latest on Sunday — indicate ambitious reconstruction goals are falling short.

Soaring security costs are a major stumbling block in what is billed as the biggest U.S. foreign aid operation since the post-World War II reconstruction of Europe.

Congress’s investigative arm, the Government Accountability Office, said in its latest report that as of May 2005, power generation in Iraq was at a lower level than before the U.S. invasion of Iraq in March 2003.

Iraq’s oil output, which U.S. officials initially said would help pay for rebuilding projects, has also dropped in the past two years, said the GAO’s report on Iraq reconstruction.

In March 2003, Iraq produced 2.6 million barrels of oil per day and exported 2.1 million barrels daily. By May 2005, Iraq was producing just 2.1 million barrels of oil a day and exporting only 1.4 to 1.6 million barrels a day, said the GAO.

In a report to Congress released on Sunday, the U.S. Special Inspector General for Iraq Reconstruction said two key concerns were whether the U.S. government could accurately predict how much it would cost to complete projects and whether Iraq’s government could sustain U.S.-funded work after it was handed over.

“A failure on either of these points puts at risk the important legacy of success that the U.S. intends to leave,” said Stuart Bowen, the inspector general.

As of June 30, 2005, about $32.62 billion of U.S. and international donor funds had been pledged for Iraq reconstruction and about $32.75 billion of Iraqi funds arising largely from oil sales were available for rebuilding.

Of this, the United States has set aside $24 billion in total for Iraq’s reconstruction since 2003, and so far some $9 billion has been paid out for work done.

FUNDS DIVERTED TO SECURITY

Security costs are chewing up funds originally earmarked for power, water and health care, and key projects have been canceled as more funds are shifted to security.

“When it’s analyzed overall, it will turn out as being an expensive program in terms of what we actually got for our money,” said one senior U.S. official, who asked not to be named because such a statement might be viewed as too negative by Bush administration officials.

“It will be high cost but that does not mean that we should not have continued,” the official said of the rebuilding plan.

Rising security costs also make it difficult to estimate how much it will cost to complete projects. For example, as of March 31, 2005, security costs for work done by the Project and Contracting Office in charge of most Iraq deals rose from an original baseline of $1.2 billion to more than $2 billion.

The Pentagon estimates there are about 60 private security firms in Iraq, employing up to 25,000 employees. The GAO said in a report on these security firms on Thursday that some elite staff were earning up to $33,000 a month.

But security is essential to getting work done and risks to contractors have increased in recent months, with at least 330 contractors killed in Iraq as of June 30, said Bowen.

“The threat to life and property from continuing insurgent attacks remains a major impediment to the reconstruction and rehabilitation of Iraq,” Bowen said in his quarterly report.

Jim Crum, a senior U.S. official involved in Iraq reconstruction, said despite security problems he believed there had been great progress in rebuilding Iraq and he pointed to the more than 600 schools rebuilt using U.S. funds.

“I think it has been done in a wartime environment with a very intelligent enemy that is continually adjusting to attack our progress and that of the Iraqis,” said Crum, head of the Washington branch of the Project and Contracting Office, which is in charge of many U.S.-funded rebuilding projects.

“But given that environment, the progress on the construction program has been nothing short of astounding,” he added in a recent interview with Reuters.

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GAO: U.S. contractors spent $766M on Iraq security

29 Jul 2005
By Matt Kelley
USA TODAY

WASHINGTON - The government is not keeping track of how many private security guards are working in Iraq or how much U.S. contractors are spending on security, a congressional report says. The Government Accountability Office (GAO) report released Thursday says investigators identified more than $766 million in government spending for private security companies in Iraq through the end of last year. Four contractors spent more than 25% of their budget on security, Congress’ non-partisan investigative arm found.

The prevalence of private security companies in Iraq has been controversial almost since the end of major combat there in spring 2003. Some contractors have been accused of taking part in abuses at the Abu Ghraib prison. Others have been accused by military officials or in lawsuits of mistreating civilians or shooting at U.S. troops.

The Pentagon estimates as many as 60 private security companies are working in Iraq with up to 25,000 employees, the report says.

Retired general Barry McCaffrey calls the security contractors “an expensive substitute for military power.” He spent a week in Iraq last month at the invitation of regional commander Gen. John Abizaid to assess the situation there.

Companies hired to help rebuild Iraq had to scramble to find security guards as the insurgency grew during the summer of 2003, the GAO report says.

Part of the problem, the report says, was that top Bush administration officials expected a “relatively benign” security environment in postwar Iraq. Contracting officials didn’t require provisions for security in early reconstruction contracts because they were “bound to reflect that expectation,” it says.

U.S. authorities set up a Reconstruction Operations Center to help contractors and the military share information and coordinate their movements. The report says the new system has helped reduce conflicts between contractors and troops but hasn’t eliminated them.

In the first five months of this year, 20 clashes between contractors and troops were reported to the operations center, the report says. Most of the clashes involved incidents between military and contractor convoys or at military checkpoints.

Marines arrested 16 private security workers in May, saying they fired on Americans and Iraqi civilians. The contractors said they only fired three warning shots into the ground to warn an Iraqi vehicle.

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The Iraq Infection

02 Aug 2005
By Matthew Herper
Forbes

Military doctors are fighting to contain an outbreak of a potentially deadly drug-resistant bacteria that apparently originated in the Iraqi soil. So far at least 280 people, mostly soldiers returning from the battlefield, have been infected, a number of whom contracted the illness while in U.S. military hospitals.

Most of the victims are relatively young troops who were injured by the land mines, mortars and suicide bombs that have permeated the Iraq conflict. No active-duty soldiers have died from the infections, but five extremely sick patients who were in the same hospitals as the injured soldiers have died after being infected with the bacteria, Acinetobacter baumannii.

“This a very large outbreak,” says Arjun Srinivasan, a lieutenant commander in the U.S. public health service and a medical epidemiologist at the Centers for Disease Control.

Breaking This Threat Down To Numbers. Acinetobacter was the second most prevalent infection for soldiers in Vietnam, but the military did not expect to see it as part of Operation Iraqi Freedom. Researchers are still working to understand where it came from and how patients were infected. (See: “Military Chases Mystery Infection.”)

Doctors worry not only about soldiers who are already infected but also those who are carrying Acinetobacter on their skin even though they themselves are not infected. Lt. Cmdr. Kyle Petersen, an infectious disease specialist at National Naval Medical Center (NNMC) in Bethesda, Md.,says his hospital treated 396 patients who had been wounded in Iraq between May 2003 and February 2005. About 10% were infected and another 20% were found to have Acinetobacter bacteria on their skin but were not infected. The rate of appearance of the bacteria has “been flat-out steady,” says Petersen.

The same has been true at Army hospitals that include Walter Reed Medical Center in Washington, D.C., Tripler Medical Center inHawaii and Brooke Army Medical Center in San Antonio, where there has been a total of about 240 cases of patients infected, while another 500 have carried the bacteria, according to Col. Bruno Petrucelli, director of epidemiology and disease surveillance for the U.S. Army Center for Health Promotion and Preventive Medicine.

Petrucelli says the five patients who died were at Army hospitals-most of them at Walter Reed. They were already suffering from serious health problems before they contracted the bacteria. “These were the sickest of the sick,” says Petrucelli. The infections are split evenly among wound infections, respiratory infections and a mix of bloodstream and other infections.

Preventing the bacteria’s spread has required doctors to take extreme care, putting all patients who are returning from the theater of war into isolation. “It’s one of those pathogens that once it gets into a population and a chain of care, it can set up shop. Trying to contain the spread of this infection to other people is very difficult,” says Andrew Shorr, a doctor who recently left Walter Reed for Washington Hospital Center. “What has happened over the past 18 months is every patient who shows up, we assume they’re positive until they are demonstrated negative.”

One of those infected in Iraq was Marine Cpl. Sean Locker. On July 10, he was attacked by a suicide bomber in a car while guarding a convoy. Shrapnel hit him in his nose, his right index finger and his right eye, blinding him. His left lung collapsed. But the worst damage was done to his left arm. It was amputated, and Locker says he knew it would be as soon as he looked down at it. “I tried to stay level-headed,” he says.

Locker, 25, was flown to an army base in Landstuhl, Germany, and then to NNMC in Bethesda. There, doctors found that what was left of his arm after the amputation had been infected with Acinetobacter. For Locker, the prognosis was good, as two years of hard experience treating patients who had returned from war had taught doctors how to deal with the infection-and to prevent it from spreading to sicker patients. Using imipenem, one of three intravenous antibiotics effective against Acinetobacter, doctors are treating Locker’s infection. He hopes to go home soon and buy a new truck.

But other patients have been less fortunate, as they have suffered from infections of the bone, the bloodstream or of internal organs, which have complicated their care. Lt. Cmdr. Petersen says that NNMC’s annual bill for the kind of antibiotics Locker received has increased tenfold to $200,000.

Besides imipenem, which carries a risk of seizure, two other drugs have worked. Another is amikacin, which does not work for bone infections and has not been effective against some strains of the bacteria. A third is colistin, an antibiotic doctors had stopped using because of its toxic effects on the kidneys.

“It is a scary thing about any drug-resistant bacteria, when you grow it for the very first time out of a patient and you’ve only got three antibiotics, one so old that we had to bring it back from the archives,” says Col. Joel Fishbain, chairman of the infection-control committee at Walter Reed.

The methods used by the military in dealing with Acinetobacter represent a model for preventing drug-resistant infections, which kill some 100,000 patients per year in the U.S.

Patients arriving are swabbed in the armpit and the groin. Until the cultures show they are negative, the soldiers are kept in isolation. Doctors and nurses make sure to wear gloves and gowns when coming into contact with them. At NNMC, the cost of gowns and gloves to help prevent infection has jumped 80% to $12,000, according to Petersen. Soldiers and their family members are not confined to the room, however-the main point is to keep doctors and nurses from spreading bacteria from one patient to another.

At NNMC, an added step has been taken by making sure infected and contaminated patients are kept in clusters of rooms separate from those who don’t test positive for Acinetobacter.

A patient such as Locker might not even think much about Acinetobacter if the infection can be treated quickly and doesn’t cause other problems. But some others feel they weren’t given enough information about the bug-perhaps because military researchers themselves were still putting together answers.

Merlin Clark, a civilian contractor who was in Iraq doing humanitarian de-mining, was also infected with Acinetobacter and treated at Walter Reed, according to his wife, Marcie Hascall Clark. “My biggest problem,” she says, “isn’t so much that my husband had it, but why didn’t they tell me about it?”