September 28, 2009

By Dr. Marie-Pierre Allié, President, Doctors Without Borders/Médecins Sans Frontières

On August 19, two attacks in Baghdad killed 95 people and wounded nearly 600. These two particularly deadly attacks were a startling reminder of the violence borne by the Iraqi people since the start of the war. Although the conflict's intensity has declined gradually in recent months, Iraq has been the stage of regular, bloody and indiscriminate attacks for more than six years, producing large numbers of victims. The media report them like clockwork, at the risk of turning the victims into abstractions through the sheer routine of the exercise.

The Iraqi health system, itself wounded by the war, has long struggled to respond to this influx of patients and to provide the proper sanitary conditions for treating them. For lack of resources and the necessary conditions, severely wounded and mutilated patients have been unable to obtain the care critical to their recovery.

In Jordan, a project managed and funded by Doctors Without Borders/Médecins Sans Frontières (MSF) reflects the impact of this kind of violence on the Iraqi population. This specialized surgery program has treated nearly 800 wounded patients, restoring the face of one, the mobility of another and the ability to carry out the simple acts of daily life, lost long ago for many others. The project was launched three years ago and has developed gradually with the help of a small group of doctors in Iraq, who identify patients and organize their transfer to Amman.

While more than 2,000 files have been reviewed to date, our teams have been able to treat only half of those patients, based on the specialist care we are able to provide (orthopedic, maxillo-facial and plastic). This surgical treatment is quite complex. It requires very long hospital stays, resources and an expensive, specialized environment. For example, half the patients treated in Amman are suffering from infected and, often, old wounds that are multidrug-resistant. In order to operate and avoid amputation, our doctors thus have no choice but to use antibiotics, at a cost that can total 2,600 euros for a single treatment.

In addition to the complexity and cost of these operations, and of the infrastructure and program required to support the wounded patients, this project tells us as much about those who do not receive treatment as those who do. In Iraq, no one knows how many mutilated and disabled patients have been waiting for years with infected wounds. However, the Amman project leads us to think about the social impacts of this violence, when disability goes hand-in-hand with the inability to resume work, social stigmatization and the human and financial burden that families must bear.

Currently, more than 200 patients have been identified and are still waiting to be treated in the Amman project. This is a considerable undertaking for a private organization like MSF, but it probably addresses only a marginal share of the needs in a country like Iraq, gripped by a violence that produces victims whose number and type of wounds far outstrip the capacity of a private medical organization.

While every war inevitably produces its share of deaths and tragedies that only time can ease, one thing is certain in Iraq today: the most gravely-wounded Iraqis will have to fight for a long time to overcome the difficulties of an existence now burdened by a host of serious handicaps.

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