Four years into the occupation: No health for Iraq

Bert De Belder

26 March 2007
Iraq’s health status, four years into the occupation, is nothing short of disastrous.

Iraq’s health index has deteriorated to a level not seen since
the 1950s, says Joseph Chamie, former director of the United Nation’s
Population Division and an Iraq specialist.[1]
People’s
health status is determined by social, economic and environmental factors
much more than by the availability of healthcare. Not surprisingly, all
these factors have deteriorated in the course of the occupation.

A recent UNDP-backed study reveals that
one-third of Iraqis live in poverty, with more than 5 per cent living
in abject poverty. The UN agency observes that this contrasts starkly with
the country’s thriving middle-income economy of the 1970s and 1980s.[2]
But these figures may well be a grave underestimation, as other reports
speak of eight million out of 28 million Iraqis living in extreme poverty on
incomes of less than 1 dollar per day.[3]
More than 500,000 Baghdad residents get water only for a few hours a
day. Most
Iraqis get
three hours of electricity a day, in contrast to pre-war levels of about 20
hours.[4]

The
devastated health of Iraqi children
The
combination of sanctions, war and occupation has resulted in Iraq showing
the world’s worst evolution in child mortality rate: from an under-five
mortality rate of 50 per 1000 live births in 1990, to 125 in 2005. That
means an annual deterioration of 6.1 per cent — a world record, well behind
very poor and AIDS-affected Botswana.[5]
At the outset of the 2003 war, the US administration pledged to cut Iraq’s
child mortality rate in half by 2005. But the rate has continued to worsen,
to 130 in 2006, according to Iraqi Health Ministry figures.[6]

Nutrition is, of course, vital to health. According to the United
Nations Children’s Agency (UNICEF), about one in 10 Iraqi children under
five are underweight (acutely malnourished) and one in five are short for
their age
(chronically malnourished).
But this is only the tip of the iceberg, according to Claire Hajaj,
communications officer at the UNICEF Iraq Support Centre in Amman (ISCA).
“Many Iraqi children may also be suffering from ‘hidden hunger’ —
deficiencies in critical vitamins and minerals that are the building blocks
for children’s physical and intellectual development,” Hajaj says. “These
deficiencies are hard to measure, but they make children much more
vulnerable to illness and less likely to thrive at school.”[7]
Hayder
Hussainy, a senior official at the Iraqi Ministry of Health, states that
approximately 50 per cent of Iraqi children suffer from some form of
malnourishment.[8]
Also
important is the psychological impact of war and occupation.

In a study
entitled “Psychological effects of war on Iraqis”, the Association of Iraqi
Psychologists (AIP) reports that out of 2,000 people interviewed in all 18
Iraqi provinces, 92 per cent said they feared being killed in an explosion.
Some 60 per cent of those interviewed said the level of violence had caused
them to have panic attacks, which prevented them from going out because they
feared they would be the next victims.[9]
The API also
surveyed over 1,000 children across Iraq and found that 92 per cent of
children examined had learning impediments, largely attributable to the
current climate of fear and insecurity.
“The only thing they have on their minds are guns, bullets, death and a fear
of the US occupation,” says API’s Marwan Abdullah.[10]

Hospitals
and clinics faced with a critical lack of resources
On 19
January 2007, a group of some 100 eminent UK doctors signed a letter to
British Prime Minister Tony Blair to voice their grave concern over the fate
of Iraq’s children. The statement read: “We are concerned that children are
dying in Iraq for want of medical treatment. Sick or injured children, who
could otherwise be treated by simple means, are left to die in their
hundreds because they do not have access to basic medicines or other
resources. Children who have lost hands, feet, and limbs are left without
prostheses. Children with grave psychological distress are left untreated.”[11]
The
Iraq Medical Association reports that 90 per cent of the almost 180
hospitals in Iraq lack essential equipment.[12]
At Yarmouk Hospital, one of the busiest hospitals in Baghdad, five people
die on average every day because medics and nurses don’t have the equipment
to treat common ills and accidents, according to Yarmouk doctor Husam Abud.
That translates to more than 1,800 preventable deaths in a year in that
hospital alone.[13]
Hassan Abdullah, a senior health official in the Basra governorate, says
that information suggests that from January to July 2006, about 90 children
died in Basra as result of the lack of medicine, a worse figure than for the
same period last year, when some 40 children died for similar reasons. Marie
Fernandez, a spokeswoman for the Vienna-based aid agency Saving Children
from War, deplores the lack of essential supplies, especially intravenous
infusions and blood bags. “Children are dying because there are no blood
bags available,” says Fernandez.[14]

Hospitals
subject to military attacks and occupation

“The Geneva
Conventions state that hospital are and should remain neutral and accessible
to everybody, particularly civilians. Yet, when it’s occupied by armed
groups or official forces, people don’t have this free and humanitarian
access,” says Cedric Turlan, information officer for the Coordinating
Committee in Iraq (NCCI) NGO. His observation is corroborated by numerous
reports and sources.

In the first
week of November 2006, in Ramadi, some 115 kilometres west of Baghdad, 13
civilians entering the hospital to get treatment were killed by snipers.
Less than 10 per cent of the hospital’s staff was still working there when
US-led forces burst into the hospital many times day and night, looking for
snipers on the hospital’s roof. “The multinational forces were outside,
surrounding the hospital, but they intruded into the hospital on a daily
basis,” Turlan said. “Now people rarely go to the hospital because they fear
being shot or arrested.” For several months now, patients have refrained
from using the hospital for fear of being shot by snipers or by US-led
forces. According to other reports received by NCCI, military forces have
also occupied Mosul Hospital, and ambulances have been attacked regularly in
Najaf, Fallujah and other parts of Anbar.[15]
On 7
December 2006, there was yet another US military raid at the Fallujah
General Hospital that had suffered similar attacks during various US siege
operations in the city in April and November 2004. Eyewitnesses said US
soldiers raided the hospital “as if it were a military target”. Doctors and
medical staff were arrested, insulted and called terrorists. A hospital
employee said that it was already the third time he was handcuffed by US
soldiers, and alleged that “they have been more vicious with medical staff
than with others because they consider us the first supporters of those they
call terrorists.” US Lt Col Bryan Salas, spokesperson of the multinational
forces in Iraq, had a quite different explanation: “Coalition forces
searched the hospital to ensure that it continues to be a safe place for the
citizens of Fallujah to receive the medical treatment they deserve.” After
the US military raid, the hospital remained closed for several days.[16]
With
current Minister of Health Ali Al-Shimari belonging to the political
movement of Moqtada Al-Sadr, the latter’s military arm, the Mahdi Army, is
acting inside hospitals with impunity. Sick and wounded patients have been
abducted from public hospitals and later killed. As a consequence, more and
more Iraqis are avoiding hospitals. “We would prefer to die instead of going
to the hospital,” says Abu Nasr, a resident of a Baghdad suburb. “The
hospitals have become killing fields.”[17]

The
ministry also appears to discriminate in the provision of supplies. Tariq
Hiali, a health official in Baqouba (60 kilometres northeast of Baghdad),
laments that “the Ministry of Health is not providing us with medications
and medical equipment — they consider us to be terrorists.” An employee at
Baqouba’s blood bank, Jamal Qadoori, says: “Ambulances we send to Baghdad
are being intercepted by the Mahdi Army.”[18]
The
emergency unit in the Basra Teaching Hospital was closed for five months
after unidentified assailants killed a number of doctors working there. Now
many doctors and nurses refuse to go to work, fearing for their lives.[19]
Likewise, clinics have shut down in Ramadi, Hit, Haditha and Fallujah. The
Institute for War and Peace reports that in Baghdad, those doctors still
practicing have moved their clinics into residential areas or inside medical
compounds for safety reasons. They only open in the morning, because of
curfews and poor security.[20]

Health
workers harassed, arrested, kidnapped and assassinated
Under
the Fourth Geneva Convention, Article 18 reads: “Civilian hospitals
organised to care for the wounded and sick, infirm and maternity cases, may
in no circumstances be the object of attack, but shall at all times be
respected and protected by the Parties to the conflict.” On-the-ground
reality in Iraq today is quite different.

“A major
problem affecting Iraq’s health sector is the country’s desperate security
situation,” says Nada Doumani, a spokeswoman for the International Committee
of the Red Cross (ICRC). “Armed men storm operating theatres forcing doctors
to treat their patients they bring as a priority. Some patients insist on
keeping their arms and masks while being treated. This creates a
traumatising situation for the doctors,” she says.[21]

Examples
abound. Dr Washdi
Mahmoud works in the Ibn Al-Nafees Hospital, the largest cardio-vascular
centre in Baghdad. Via telephone from Baghdad on 27 February 2006, he told
us: “Yesterday morning, we were threatened by the relatives of patients.
They even pointed a gun at one doctor’s head! The hospital’s security guards
didn’t bother to intervene, so we decided to go on strike.”[22]
Dr Salam Ismael of the Doctors for Iraq society explains: “We are harassed
by militias of certain political parties. The government is not acting on
them. They enter the patient’s rooms with their weapons, they shout at the
doctors, they threaten to kill them.”[23]
Doctors
for Iraq received reports that armed gunmen had entered Tel Afar Hospital in
the northwest of Iraq on 9 May 2006 and threatened and attacked staff and
patients waiting to be treated. A doctor described how one of the armed men
put a gun to his head demanding that he stop treating a wounded child and
instead attend to a man with a minor shell wound in his leg. The armed group
started vandalising and breaking hospital equipment and then attacked an
ambulance driver, breaking his arm with a rifle butt. Another ambulance
driver was punched in the face, and three armed men attacked the hospital
pharmacist, taking turns in hitting and kicking him. One of the armed men
fired bullets above a doctor’s head, missing him narrowly and causing fear
and hysteria in the hospital.[24]
On 28
September 2006, doctors at Baghdad’s Yarmouk Hospital went on strike after
Iraqi police burst into the facility and forced doctors to treat a wounded
colleague, while brandishing their guns. The doctors called on the Interior
Ministry to enforce a complete weapons ban in the hospital.[25]

Early
November 2006, Dr Ibrahim Abdel-Sattar, a cardiologist in Baghdad, reported:
“My colleague was killed while he was attending one of his patients two
weeks ago. The armed gang broke into his clinic, shot him dead and left
without explanation.”[26]

As if
the daily violence was not enough, in the chaos and disorder that reign in
occupied Iraq, health professionals are also prone to getting kidnapped for
ransom.
On 9
November, men reportedly wearing blue police uniforms kidnapped the head of
Iraqi Red Crescent Society (IRCS) administration, Dr Anas Al-Azawi, in front
of his house. The price for his freedom was set at $750,000, but he was
released after a lesser ransom was paid. On 17 December, armed men allegedly
wearing Iraqi Army uniforms stormed the office of the IRCS in Baghdad and
abducted 42 people. 26 employees IRCS employees, both Shia and Sunni, were
later released.[27]
Peter
Kandela, an Iraqi doctor working in the United Kingdom, interviewed Iraqi
medical staff that had fled to Jordan and Syria. He recounts the story of a
kidney surgeon seized by a group of armed men whose first act was to go
through his address book to look for other potential victims. “They had the
audacity to suggest that in return for receiving better treatment in
captivity, I should recommend others for kidnapping,” the surgeon said. He
was released after his wife paid a ransom of $250,000.[28]
Dr Kandela also explained that “in the new Iraq, there is a price tag linked
to your position and status. Those doctors who have stayed in the country
know what they are worth in kidnapping terms, and ensure their relatives
have easy access to the necessary funds to secure their speedy release if
they are taken.”[29]
Dr
Omer, a cardiovascular surgeon, left his job in Baghdad and is now working
as a general practitioner in a primary health care clinic in Syria. “What
could I do?” he asks, “I was threatened by armed militias inside the
hospital. Three surgeons had been killed already and there were only three
of us left. I couldn’t be the next target as I have a child to raise.” Dr
Omer was forced to flee Iraq. He added: “I am not happy with what I am doing
here in Syria. I was a specialist doctor and now I am working as a junior
doctor. It is as if you were asking an officer to work as a soldier.”[30]

A massive
flight of health professionals
In
March 2006, the British NGO Medact said that 18,000 out of Iraq’s 34,000
physicians had left the country since the onset of the war, according to
official figures from the Iraq Medical Association (IMA).

Farouk Najji,
a clinician and senior member of IMA, declares: “About 2,000 physicians have
been killed since 2003. The violence has increased and everyday we are
losing the best professionals in Iraq.” In some cases, ambulances picking up
the injured after explosions are without paramedics or nurses, Najji says.
“There are not enough professionals and the ones available are in hospitals,
trying to figure out how to treat patients in improvised operating
theatres,” he adds.[31]
A
shortage of doctors and nurses has also been reported in Basra. According to
health official Hassan Abdullah, there are no reliable statistics on how
many doctors, dentists, pharmacists and nurses have left the area, but
unofficial data suggests that at least 200 health professionals have left
since January alone.[32]
Some of them try to get more secure employment elsewhere in Iraq. Rezan
Sayda, a senior official in the Kurdistan Regional Government’s health
ministry, said last December that her ministry had employed 600 doctors who
had fled insecure parts of the country, and that another 320 were on the
waiting list for employment.[33]
The
lack of health personnel has disastrous consequences for the health of local
patients. Writing in the British Medical Journal, Dr Bassim Al-Sheibani and
two colleagues from the Diwaniyah College of Medicine in Iraq report that,
“medical staff admit that more than half of those who died could have been
saved if trained and experienced staff were available.”[34]

Reconstruction under occupation: A dismal failure

Four
years into the US-led war on Iraq, the country’s healthcare system is in a
shambles. Most hospitals lack basis supplies, dozens of clinics remain
incompletely constructed, and costly high-technology equipment lies idle in
warehouses. Since 2003, US agencies may have spent up to $1 billion of Iraqi
reconstruction funds on healthcare, but no new hospitals and only a few
local clinics have been built. Even the pet project of First Lady Laura Bush
— a $50 million state-of-the-art children’s hospital in Basra — is running
far behind schedule and over budget.[35]

According to Amar Al-Saffar, an official in charge of construction at the
Iraqi Health Ministry, not a single hospital has been built in Iraq since
Al-Khadimiyah Hospital opened in 1986 in Baghdad.[36]
A $200 million reconstruction project for building 142 primary healthcare
centres ran out of cash in early 2006, with just 20 centres on course to be
completed, an outcome the World Health Organisation described as “shocking”.[37]
In a
damaging report, CorpWatch harshly criticises the US-led reconstruction of
Iraq’s health infrastructure, demonstrating how US companies such as Parsons
Global, Abt Associates and Bechtel did little more than take the money and
run.[38]
Those companies were awarded huge reconstruction contracts — a $70 million
contract for Parsons, $43 million for Abt Associates and $50 million for
Bechtel — while effectively sidelining experienced UN agencies as UNICEF and
WHO.
In
April 2006, the US Army Corps of Engineers that was supposed to construct
150 primary healthcare centres decided to cancel the construction of 130 of
them. The construction had been contracted out to Parsons Global and by the
time the US Army Corps cancelled Parsons’ contract only six clinics had been
completed. Meanwhile, 150 sets of medical equipment had already been ordered
and warehoused at Abu Ghraib. Thus, 130 sets are intended for clinics that
will never see the light of day. Further, it was found that 46 per cent of
the stock contained missing or damaged crates, or boxes that were
mislabelled or not labelled at all.
Abt
Associates was contracted to repair existing Iraqi hospitals but nothing of
the sort happened, the company handing the job over to local sub-contractors
who were inexperienced or corrupt. When, in April 2004, the security
situation in Iraq turned from bad to worse, Abt Associates staff left the
country. $20.7 million of US taxpayers’ money had already been paid to Abt
Associates through USAID.
Laura
Bush’s showcase children’s hospital in Basra, a project awarded to Bechtel,
went much the same way. The hospital was slated to feature 94 beds, private
cancer suits, CATS scans and other high tech equipment necessary to treat
childhood cancer in a region highly affected by depleted uranium following
the first Gulf War. The price tag rose from $50 million to $170 million and
in July 2006 Bechtel was asked to withdraw from the project. It remains on
hold.
Four
years after its onset, it has become clearer than ever that the US-led war
and occupation of Iraq have resulted in a massive public health disaster for
Iraqis. Reversing the current trend of ever-deteriorating health conditions
requires first and foremost the end of the occupation.
(the
author: Dr. Bert De Belder is coordinator of
Intal and Medical Aid For The Third World
and member of the BRussells Tribunal
Advisory Committee)

[1]
The Los Angeles Times,
15 November 2006

[2]

18 February, 2007,

http://siteresources.worldbank.org/IRFFI/Resources/ExSumLivingStandardIraq3.pdf

[3]
The Los Angeles Times,
15 November 2006

[4]
IRIN, 28 January 2007

[5]
UNICEF, The State of the World’s Children 2007

[6]
The Los Angeles Times,
15 November 2006

[7]
IRIN, 5 March 2007

[8]
Medact, Iraq Health Update, March 2006

[9]
IRIN, 31 January 2007

[10]
David Wilson, The Collapse of Iraq’s Health Care System,

http://www.counterpunch.org/wilson10162006.html,
October 14-15, 2006

[11]
The Independent,
20 January 2007

[12]
IPS, 26 November 2006

[13]
The Los Angeles Times,
15 November 2006

[14]
IRIN, 9 July 2006

[15]
IRIN, 13 February 2007

[16]
IPS, 14 December 2006

[17]
The Washington Post,
30 August 2006

[18]
The Los Angeles Times,
15 November 2006

[19]
IRIN, 9 July 2006

[20]
IPS, 14 December 2006

[21]
IRIN, 28 January 2007

[22]
Telephone conversation, 27 February 2006

[23]
Telephone conversation, 27 February 2006

[24]

http://www.health-now.org/site/article.php?menuId=14&articleId=632

[25]
The San Francisco Chronicle,
30 September 2006

[26]
IRIN, 7 November 2006

[27]
UN Assistance Mission for Iraq (UNAMI), Human Rights Report, 1
November-31 December 2006

[28]
The Independent,
20 October 2006

[29]
The Times,
20 October 2006

[30]
Communication of Dr Salam Ismael, 26 February 2007

[31]
IRIN, 7 November 2006

[32]
IRIN, 9 July 2006

[33]
IPS, 6 December 2006

[34]
British Medical Journal, 20 October 2006

[35]
The Los Angeles Times,
15 November 2006

[36]
The Times,
21 October 2006

[37]
The Independent,
20 October 2006

[38]
High-Tech Healthcare in Iraq, Minus the Healthcare. Pratap
Chatterjee, CorpWatch, 8 January 2007
15 November 2006