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MSF's Observations on Health Care in Iraq: US Failing to Address Urgent Medical Needs and Disorganization of Health Care System
May 5, 2003
Over the past couple of weeks, Doctors Without Borders/Médecins Sans Frontières (MSF) teams have continued to carry out assessments in cities and health centers throughout Iraq. MSF teams paid visits to more than 70 health structures in over 25 cities, assessing the most urgent needs and donating drugs and medical equipment where needed. In some hospitals confronted with a shortage of medical staff, MSF has also offered its assistance.
A mobile team in the North of Iraq performed numerous assessments in Mosul, Kirkuk, Dohuk, Erbil and Tikrit provinces, and donated 30 tons of essential medicines, surgical and medical equipment and emergency food rations to a dozen hospitals and health centers.
Another team travelling from Syria to Baghdad visited 10 hospitals along the Euphrates river from Al Qaem over Anah to Ramadi. In general, they found hard working hospital staff trying to cope without medication. Current supplies will only last two to four weeks. Another concern is the limited and substandard nursing care. In Ramadi, a pediatrician told the team that Kala Azar, or visceral leishmaniasis, is a major problem, since there is no treatment available for this severe and lethal disease. He reported at least 200 patients without treatment and many people at risk of contracting the disease. This is worrying, as the peak season for Kala Azar lies ahead.
This MSF team will donate basic medical supplies to each of the visited hospitals, as well as surgical items to four hospitals, two of which are performing trauma surgery without adequate material or medicines.
Mobile teams based in the South travelled to Basra, Karbala, Al Hilla, Al Najaf, Al Nasariya, Al Qut, Amarah, Diwaniya, Samawa, Al Hindiya, Nasariya, Al Qurna, Affack, and Al Mahdina. Conclusions are that the health system remains fragile, but is coping. No communicable diseases have been detected yet, but the potential remains high, since the plants for pumping and treating water are not functioning correctly due to power cuts.
Two major health concerns are drug distribution, which remains problematic, and chronic disease processes which are not being addressed. In many of the hospitals and primary health centers, life-threatening illnesses are not being treated due to lack of drugs. These diseases include tuberculosis, Kala Azar, and chronic illnesses such as asthma, kidney disease, epilepsy and diabetes. In Basra governate, over 1000 tuberculosis patients have had their treatment interrupted. Patients who require blood tranfusions are exposed to HIV and Hepatitis B infection as a result of lacking material to test blood. In Al Hilla hospital, 100 new suspected Kala Azar patients remain untreated. MSF will temporarily support health structures with donations of drugs and materials and continue its assessment with regards to Kala Azar.
In Baghdad, where MSF has been present since January, the team visited 16 hospitals and 11 primary health care centers, as well as the ambulance service a number of times. A surgical team worked in Al Kindi hospital during the war, and assisted the Al Zafarania hospital just after the end of the fighting. MSF also donated medical and surgical supplies to 10 hospitals and the ambulance service. None of these hospitals are fully functional, and many have to deal with security problems, shortage of staff, sporadic electricity, lack of medical equipment and some specific drugs. Painkillers, vaccines, lab tests, anaesthesia, sutures, dressing material are some of the items urgently required. Some hospitals are overcrowded and cannot treat patients and wounded in hygienic or sterile conditions. In many hospitals, salaries are no longer being payed.
Overall, the team classifies the problems as follows:
1) The US has given priority to efforts and concerns in building administration, forgetting to organize immediate assistance to the wounded. It also failed to provide timely security for hospitals and medical staff.
2) Emergencies were treated too late and patients discharged too early - There is no proper emergency transport, the phone service is disrupted so that people cannot call for emergency transport to hospitals. People wounded in the war were often discharged from hospitals during the anarchy of the first days of US occupation. Many of these people don't know where to go to receive follow-up treatment for their often serious injuries, including amputations. Since hospitals are still not fully functioning, patients continue to be discharged early.
3) Risks of epidemics - In some of the overcrowded neighbourhoods of Baghdad, the hygienic situation is significantly increasing the risk of epidemics. An early warning system is not in place.
4) Quality of health care is substandard - With limited nursing staff, disorganized hospitals, and far from ideal hygienic conditions, the treatment of patients remains problematic and the risk of infections is high.
5) No supply of drugs - Supply through the Ministry of Health remains disrupted. Many hospitals will have consumed their stocks within the coming days and weeks. Some medicines for chronic pathologies are missing altogether and sufferers of chronic conditions such as diabetes, kidney disease, and epilepsy have nowhere to refill their medication.
Although MSF has not yet detected signs of epidemics or acute malnutrition, it is clear from our assessments throughout the country that urgent medical needs are not being addressed. The disorganization in hospital administration is posing a threat to public health. The United States-led coalition has failed to take up its responsibility to ensure that the health and well-being of the Iraqi people was prioritised from the start. Although MSF has tried to fill gaps in medical assistance in Baghdad and elsewhere in the country by providing medicines, supplies, and assistance where necessary, a lack of clear lines of authority in Iraqi hospitals has so far made it impossible for MSF teams to do much more. Awaiting the outcome of power struggles and current negotiations regarding the set up of public services, it was extremely difficult to come to an agreement with the management of several hospitals where clear needs were observed. At present, MSF is intent on keeping a presence in Iraq until medical needs are being addressed adequately by the appropriate authorities and will continue to provide urgent medical assistance where possible. Currently MSF has 31 international aid workers in Iraq and surrounding countries.