5 - 11 April 2007
Issue No. 839
Published in Cairo by AL-AHRAM established in 1875
http://weekly.ahram.org.eg/2007/839/re10.htm
Pity the sick of Iraq
After repeatedly topping the Arab health index, Iraq's health record is now
worse than ever because of the US-led occupation. The general effect on the
Iraqi population amounts to a massive war crime, writes Bert De Belder*
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Click to view caption
In March, the deadliest month witnessed by Iraqis recently, some 67 lives
on the average were lost daily, as a result of bombings and acts of violence.
An elderly man mourns his relative at the entrance of a local hospital in
Baghdad's impoverished district of Sadr City. Political violence has conspired
with the occupation to wreak havoc not only with lives, but, as well, the
infrastructure needed to safeguard the health of millions of Iraqis
Health standards in Iraq plummet because of the United States occupation
of the country: Iraqi medics treat a wounded child at a hospital in the oil
rich city of Kirkuk (left); and Iraqi women rush to the site where a car bomb
exploded in Baghdad's impoverished district of Sadr City
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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 Nations Population
Division and an Iraq specialist. 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 five 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. 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 per day. More than 500,000 Baghdad
residents get water for only a few hours a day. And the majority of Iraqis get
three hours of electricity a day, in contrast to pre-war levels of about 20
hours.
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: 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. 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.
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. "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." 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.
Also important is the psychological impact of war and occupation. In a study
entitled "The 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. The AIP 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 the AIP's Marwan Abdullah.
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."
The Iraq Medical Association reports that 90 per cent of the almost 180
hospitals in Iraq lack essential equipment. 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 Hussam Abboud. That translates to more than 1,800
preventable deaths in a year in that hospital alone.
Hassan Abdallah, 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.
HOSPITALS SUBJECT TO MILITARY ATTACKS AND OCCUPATION: "The Geneva Conventions
state that hospitals 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.
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 Multinational Forces-Iraq,
had quite a 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.
GOVERNMENT COMPLICITY IN ATTACKS AND FAILING HEALTH: 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."
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."
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.
Likewise, clinics have shut down in Ramadi, Hit, Haditha and Fallujah. The
Institute for War and Peace Reporting states 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.
HEALTH WORKERS HARASSED, ARRESTED 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 the patients they bring as a priority. Some patients insist on
keeping their weapons and masks while being treated. This creates a
traumatising situation for the doctors," she says.
Examples abound. Dr Washdi Mahmoud works in the Ibn Al-Nafees Hospital, the
largest cardiovascular centre in Baghdad. Via telephone from Baghdad on 27
February 2006, he said: "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."
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."
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.
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. 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."
HEALTH WORKERS KIDNAPPED AND HELD FOR RANSOM
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 IRCS employees, both Shia and Sunni, were later released.
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.
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."
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 Naji, 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, Naji 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.
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."
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. 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.
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."
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.
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. 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".
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.
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.
Abt Associates was contracted to repair existing Iraqi hospitals but handed 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, CAT scans and other high-tech equipment necessary to
treat childhood cancer in a region highly affected by depleted uranium
following the 1991 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.
CRIMINAL NEGLECT: THE OCCUPATION MUST END: 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 writer is coordinator for Medical Aid for the Third World, Belgium, and
member of the Brussels Tribunal (http://brusselstribunal.org
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