|
One
year after the fall of Baghdad: how healthy is
Iraq?
REPORT
of Medical Aid for the Third
World, Belgium
by Dr. Geert Van Moorter,
M.D.
28 April 2004
based on a fact-finding mission
to Iraq, March 2004
Contact: Medical Aid for the
Third World, Belgium, info@g3w.be, tel. +32/2 209.23.60
geert.van.moorter@skynet.be, tel. +32/486
79.37.98
May 18, 2004
Dr. Geert Van Moorter was already in Iraq on various
missions for the Belgian non-governmental organization
Medical Aid for the Third World, in April 2002; before,
during and after the war in March/April 2003; in
July/August 2003; and in March 2004. He made, together
with Iraqi doctors and health workers, a random survey on
the health situation and the health care infrastructure
in Iraq, after one year of occupation. He visited
hospitals and clinics in Baghdad and Basra. On a health
conference in Basra, he was able to talk to colleagues
from all over the country. He had contacts with Unicef,
the World Health Organization, the new Ministry of Health
and with several war victims of last year.
Dr. Van Moorter is specialized in emergency medicine
and tropical diseases. He made a study and published on
child mortality and has experience in public health and
post traumatic stress disorder.
Summary:
Evidence that child mortality is
on the rise
The purchasing power, the food
situation and the living conditions of the majority of
the population have all deteriorated. Half of the active
population has no job and no income. The prices of basic
necessities, food and transportation have doubled or
tripled. The quality of the drinking water is not being
controlled, the sewage system of Baghdad has been damaged
by the bombings, there is no regular garbage collection.
Iraq has become one big garbage belt. All these
indicators put together point towards a rising child
mortality, a fact being acknowledged by the WHO
representative for Iraq. It also brings Unicef to the
conclusion that child mortality will probably increase
further.
Medical infrastructure and
medicines: no improvement
The medical infrastructure and
the medical material were already outdated and
malfunctioning as a result of the twelve years' embargo.
One year after the onset of the war, these have not yet
been renewed. War victims and other patients do not
receive optimal treatment. Complicated operations cannot
be performed. Everything is lacking, including medicines
for acute as well as chronic ailments. This results in
deteriorating conditions or even the death of patients,
and in extra handicaps for the wounded. On March 17,
right after the explosion at the Mount Lebanon Hotel in
Baghdad, we helped care for victims in the Ibn Al Nafis
hospital. We observed there that there were no disposable
gloves, no appropriate intravenous fluid to treat shock,
to ultrasound, no well-functioning monitors,…
Findings:
1. Testifying about the
situation in the hospitals is made difficult.
2. The purchasing power, the
food situation and the living conditions have
deteriorated. An increase in child mortality is to be
expected.
3. Insecurity creates
psychological traumas.
4. Access to health care is
severely limited.
5. The hospital infrastructure
has not improved over the past year.
6. Medicines and medical
material are lacking.
7. Depleted Uranium (DU): the
population is not informed nor protected.
8. The plans of the CPA and the
Ministry of Health are no solution.
9. Appendix: April 2004: US-led
troops in Iraq are targeting hospitals, ambulances and
civilians.
1. Testifying about the
situation in the hospitals is made difficult.
Access to hospitals is very
limited, the press is hardly allowed to enter. It was
only with difficulty and through personal contacts with
medical doctors that we could enter several hospitals.
Doctors who dare to testify before the camera are
intimidated and put under pressure. We talked to two
doctors who had given an interview. Afterwards, someone
from the Ministry of Health visited them. They were
forced to sign a letter stating that they wouldn't give
any interviews anymore, or else that they would lose
their job in the hospital.
2. The purchasing power, the
food situation and the living conditions have
deteriorated. An increase in child mortality is to be
expected.
According to the CPA (Coalition
Provisional Authority, the US administration led by Paul
Bremer), 35% of the active population is jobless. Other
sources speak of 60 to 70%.
During the embargo, several
foodstuffs were distributed for free among the
population; it concerns dry goods such as rice, tea,
beans, sugar, wheat, milk powder, oil, salt and things
such as washing powder and soap. This distribution is
being continued, but regularly some goods are lacking.
E.g. in March, there was no rice. As a consequence,
everybody was forced to buy rice on the free market,
which pushed prices up. And anyhow, the food that is not
contained in the food basket - vegetables, fruits, meat,
fish, cheese, eggs,… - has to be bought on the
market. Their prices have increased two- or threefold
over the past year.
The majority of the population
has less cash available, while the cost of living has
increased. The purchasing power has diminished, access to
food is less assured. Many families depend entirely on
the food basket. Unicef notes that malnutrition today is
higher than after the first Gulf War of 1991, and the
number of children with acute malnutrition rose sharply
in the first months after the onset of the 2003
war.
The provision of electricity in
Baghdad has deteriorated. Water services are still in
worse condition than before the war, and nobody knows the
quality of the drinking water. In some places there is
still no water coming out of the faucet.
The sewage system was already in
precarious condition before the war. It has been hit by
the bombings and hasn't been repaired ever since. In many
poor quarters of Baghdad, dirty water is standing in the
streets. Garbage collection is not yet well organized.
Garbage is all around the place.
The three main factors that
influence child mortality (under five mortality) at the
level of the family are the purchasing power, the food
situation and the living conditions. All three of them
have deteriorated over the past year in Iraq. The local
Unicef representative confirmed that child mortality will
probably increase further.
3. Insecurity creates
psychological traumas.
According to the director of the
psychiatric centre in Baghdad, lots of children are faced
with serious emotional and behavioural problems as a
direct result of the war, the fear, the hate, the
occupation. This is what is called Post Traumatic Stress
Disorder. Symptoms of this are bedwetting, aggressive
behaviour (verbal and physical), sleeping and eating
disorders, depression, fear, nightmares, concentration
and memory disorders, auto-mutilation, developmental
disorders and phobias.
Repeated exposure to war dead
and wounded has resulted in widespread emotional and
psychological traumas among medical emergency teams of
doctors and nurses.
Together with the bad economic
situation, the insecurity is today's major problem,
causing quite some psychosomatic disorders. There is
insecurity because of the presence of the occupation
troops. And there is the problem of the inefficiency of
the police, which has led to an increase in
criminality.
4. Access to health care is
severely limited.
The problems with the telephone
networks make it difficult to impossible to call an
ambulance. Because of the insecurity, patients as well as
doctors don't dare go to the hospital at night. We
experienced ourselves how, after a major car accident, an
unconscious patient could not be brought to the hospital
in an ambulance. He had to be brought with a
taxi.
High transportation costs are
another factor that renders going to the hospital
difficult. Same thing with the road blockades. A recent
Unicef report states that less than 50% of the Iraqi
population has access to the health care they need,
because of the insecurity.
5. The hospital infrastructure
has not improved over the past year.
We visited some 25 hospitals,
clinics and pharmacies. Nowhere had any new medical
material arrived since the end of the war. The medical
material, already outdated, broken down or malfunctioning
after twelve years of embargo, had further deteriorated
over the past year. In places where looting had taken
place, there is now less material than before, as in
Baghdad's rehabilitation centre, which is supposed to
provide the entire country of prostheses. Or as in the
burns section of the Al Nour Hospital, where there is no
possibility of sterile treatment, as a result of which
all patients with major burns are doomed to die. Or as in
the intensive care unit of the Kadhemya Hospital - which
has 8 of the 16 high intensive care beds for Baghdad -,
where only three respiration machines are
functioning.
6. Medicines and medical
material are lacking.
In the hospitals, some specific
medicines are lacking, e.g. for burns. In several
emergency units, live-saving drugs are not
available.
In the 'popular clinics', for
outpatients, there is a constant lack of medication. The
Ministry of Health itself is distributing lists of
medication, where for every drug the amount of products
delivered is mentioned. We saw one such list containing
32 products. For 10 of them… 0% had been delivered!
Many patients don't get their medicines, or they get only
half of the dose they need. Results: life quality
diminishes, while the risk at early death increases. This
is the case for e.g. epilepsy, hypertension, angina
pectoris, diabetes, chronic asthma,…
Doctors may prescribe, but
patients, who used to get their medicines for free, have
to buy them now on the private market. For most of them,
this is beyond reach. And many needed drugs are not
always available on the market. There are also doubts as
to the quality of these medicines, as they are not being
stored in optimal conditions.
There is also a lack of
disposable material, such as gauze, cotton, syringes,
gloves, sutures,… In one 'popular clinic' we
visited, three doctors had to share one single
stethoscope, while one and the same iron tongue depressor
was being used for all patients.
7. Depleted Uranium (DU): the
population is not informed nor protected.
In August 2003, we were only
able to obtain unofficial, 'off the record' information
from the World Health Organization (WHO) concerning
Depleted Uranium. The WHO had asked the US Armed Forces
leadership information about the use of DU. They
requested to be given a map indicating the places where
the US Armed Forces had used ammunition with DU, in order
to be able to undertake precautionary measures and
prevent the contamination with and the spread of DU
particles. The US Armed Forces leadership refused to
provide this information. In March 2004, according to WHO
sources, the attitude of the US Armed Forces and of the
CPA (Coalition Provisional Authority) concerning this
topic remained unchanged.
In 2003 and in March 2004, we
could personally see that there were no fences nor
warning signs around or near the destroyed Iraqi tanks
and APC's (armoured personnel carrier). Children were
playing nearby. Most of this Iraqi army material has been
destroyed by ammunition with DU. The areas where these
tanks and other materials were hit, have not been
decontaminated since. The earth around has not been
removed. In the neighbourhood of the Baghdad Gate, we saw
people cultivating vegetables, unaware of the danger, on
fields where in April 2003 many destroyed Iraqi tanks
stood. There were no protective measures to be seen.
Along the road between Baghdad and Basra still a lot of
destroyed tanks can be found. We saw people recycling
metal from these tanks. This sometimes happens in an
organised way: we saw open trucks, without canvass, fully
loaded with pieces of those Iraqi tanks. In the south of
Baghdad there is an area where this recycled metal is
collected. Again without any protective measure.
DU-contaminated dust is spread by the trucks and with the
wind.
Medical doctors in Basra told us
that they expect a rise in cancers and congenital
malformations in a few years, particularly in Baghdad,
because that is where DU has been used most. The CPA and
the occupying forces have the duty to protect the health
of the population. In the matter of DU they are
neglecting their responsibility.
8. The plans of the CPA and the
Ministry of Health are no solution.
Until last year, a number of
contracts for medical material that had been signed by
the previous regime were blocked by the UN Sanctions
Committee 661. 90 % of them because of a US veto, 10 %
because of a British veto. It concerned contracts for a
total value of more than 500 million dollar. This money,
which came from the sale of Iraqi oil in the framework of
the oil-for-food program, was available on a UN account
in New York. After the lifting of the sanctions, this
money has been turned over to the CPA, and yet those
contracts have not yet been executed.
The CPA and the interim
government are now talking about new plans to invest in
medicines and medical equipment. This can at most be part
of the solution, but even then it is a case of 'too
little, too late'. There are plans for a new paediatric
hospital of more than 50 million dollar. This money would
be put to better use by upgrading the existing hospitals.
Much of the money will go to expensive US firms, and it
can be feared that these investments will have a high PR
value. This is a case of combating the symptoms in order
to divert attention from the real prevention of illness
and disease, by attacking the root causes such as
purchasing power, the food situation, the living
conditions, the insecurity.
In any case, these investments
will not free the occupying power of its duty to
guarantee all necessary services to the Iraqi population,
as it is stated in the Fourth Geneva Convention.
Security, jobs, an income, food and decent living
conditions are all part of this. All these factors have a
major impact on public health.
9. Appendix: April 2004: US-led
troops in Iraq are targeting hospitals, ambulances and
civilians.
We received information from
first hand field testimonies from health workers in Iraq
and eye-witness accounts from Fallujah. According to that
information, the US-led occupying forces have:
1. targeted unarmed civilians
and used cluster bombs in populated areas of the city.
This is indiscriminate use of force, not discriminating
combatants from non-combatants. There are several reports
of eyewitnesses stating that cluster bombs are used in
Fallujah. These reports are confirmed by medical
doctors.
2. severely hampered relief work
to the wounded.
3. blocked access to Fallujah's
hospital thus forcing doctors and health personnel to set
up field hospitals in private homes.
4. targeted ambulances that went
about the city to collect the injured.
All of these constitute
violations of the Geneva Conventions. They have resulted
in the death of hundreds of civilians and extreme misery
for thousands of people in Fallujah and many more in the
rest of Iraq.
This is comparable to what
happened during the US-led invasion of Baghdad last year.
We were personally witness of the use of cluster bombs
and of US troops shooting at random at civilians, civil
cars and ambulances. Then, as now, it was difficult and
even impossible for the health personnel to reach the
hospitals, because US troops were shooting at everything
that came on their way.
Dr. Geert Van Moorter,
M.D.
28 April 2004.
©
TFF and the author
2004
Tell a friend about this article
Send to:
From:
Message and your name
|