Four Years into the Occupation: No Health for Iraq

by Dr. Bert De Belder*, Belgium

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] […]

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.”[9]

The Iraq Medical Association reports that 90 per cent of the almost 180 hospitals in Iraq lack essential equipment.[10] 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.[11] 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.[12]

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. […]

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.” […]

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.[13] 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.[14]

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. […]

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.[15] […]

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.”[16]

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.[17] […]

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. […]

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.

[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] The Independent, 20 January 2007

[10] IPS, 26 November 2006

[11] The Los Angeles Times, 15 November 2006

[12] IRIN, 9 July 2006