Medical situation in Iraq

NYTIMES story on a WHO report:

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There are the obvious risks of car bombs and other violence that now kill an average of 100 people a day, according to the report from the W.H.O.’s Health Action in Crises group. But beyond that, there are a host of other problems created by years of conflict: 70 percent of Iraqis lack regular access to clean water, and 80 percent lack toilets that do not contaminate water sources, according to the report.

As a result of these multiple public-health failings, diarrhea and respiratory infections now account for two-thirds of the deaths of children under five, the report said. Twenty-one percent of Iraqi children are now chronically malnourished, according to a 2006 national survey conducted by Unicef, which puts them at risk for both stunted growth and mental development.

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The report cites the Iraqi government as saying that almost 70 percent of critically injured patients die in the hospital because of lack of staff, drugs and equipment.

To make matters worse, pregnant women and the injured and ill in parts of Iraq, including Baghdad, are afraid to risk the trip to the hospital for security reasons, the report said. Dr. Shibib said the problem was complicated by divisions between Shiites and Sunnis that led Iraqis to fear that they would not be treated at certain facilities.

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Updated link is http://discovermagazine.com/2007/aug/iraq2019s

This is a repost to possibly a more appropriate community from the catch all OIF threadline and now I have the link above to the Article referenced.


2001 --Iraq had 34,000 physicians and no War
2006 -- 18,000 have fled or ceased practicing publicly
2007 --2,000 physicians dead by report --this number strains credibility but if accurate physicians are being killed in Iraq at a rate close to killings of Iraqi police officers 5.8% for physicians vs 6.3% for new Iraqi police

These figures and reports are in August 2007 issue of Discover Magazine article "Iraqi Medical Meltdown". The Medical system in Iraq has been attacked not on a bricks and mortar level but at a staff level which is more devastating.

Imagine an enemy getting the phone list of an Army Battalion from Private to Colonel or worse their families phone numbers, and subjecting them to personal and family death threats, add to that a few actual attacks and killings and you have a battalion that is at least impaired if it does not melt away in vain individual attempts to protect family. My assumption is similar sustained attacks have plagued much of the remaining infrastructure and new army personel in Iraq. Very ingeneous, they have leveraged technology to separate the soldier from his weapon and unit at least mentally if not physically.

If this report and others like it are credible refering to reports earlier this year of the New Iraqi government refusing to issue travel visa's and diplomas from medical school to prevent new graduate emigration in an attempt to stem the exodus of physicians.

In the end the Mercy and Comfort without a staff are converted bulk cargo ships. Charity hospital in New Orleans is a stack of bricks now.

With this hostile enviroment NGO's and other nonmilitary medical providers have a very hard time functioning similar to the indigenous health system. US AID and the US military medical assets do not seem to be able to step up to this problem.

My suggestion is control all the modern communication systems in the country. If you want to buy a cell phone that works then you must have a valid address and submit to biometric scans and family and associate relationship questions of census takers. Difficult --very. slow-- yes, but possibly easier and more sustainable than ploping the Comfort or Mercy staff in medical city hospital Baghdad to staff it on a rotating basis. Also The Iraqi government may want to give new medical graduates body armor and a side arm as a graduation gift while they hold their passports (I understand visa's to England may already be hard to get anyway)

Any thoughts for mitigating the humanitarian impact the problem has on the population and or stoping this avenue of attack?


Mason

2,000 dead Iraqi doctors - I can buy that quite easily. Iraqi doctors make for easy targets for both hostage-taking for profit and for murder, even easier than Iraqi police.

This article makes it clear that there was already a semi-organized campaign of assassination against Iraqi intellectuals three years ago.

This article indicates that upwards of 70% of critically injured patients in Iraq who enter hospitals die due to lack of medicine, staff, or equipment.

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Originally Posted by MASON

2001 --Iraq had 34,000 physicians and no War
2006 -- 18,000 have fled or ceased practicing publicly
2007 --2,000 physicians dead by report --this number strains credibility but if accurate physicians are being killed in Iraq at a rate close to killings of Iraqi police officers 5.8% for physicians vs 6.3% for new Iraqi police.

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Related discussion in the thread Professionals who have fled Iraq.

Interesting anecdote I came across in my daily Iraq reading:

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... I must wait until mid-afternoon to return to Sadr City, the stronghold of Moktada al-Sadr, the Shiite cleric who opposes the American presence in Iraq. I plan to meet a woman doctor who works in the emergency room of the Ali Ben Ali Talib Hospital, one of 14 public hospitals in Baghdad. Rana is only 26, but one doesn't need to have practiced medicine a long time in Iraq to lose one's illusions.

"In this district, the patients don't respect us. They don't even bother to disarm when they come here, despite all the notices at the entrance," she says.
"Sometimes doctors are directly threatened. You get used to it."

A non-practicing Shiite, Rana does not wear a veil. In blue jeans and a white blouse, her small, elegant silhouette is easily recognizable in the corridors of the hospital, where she spends four days a week.

It is not surprising that in this ultra-conservative district of Sadr City - an enclave entirely controlled by the Mahdi army, al-Sadr's militia - many of the patients, mostly illiterate, refuse to be treated by a female doctor.

Exasperated at repeatedly having to justify herself to the patients, Rana dared to go and complain to the representatives of Moktada, with the support of her veiled female colleagues.

To her own surprise, they took her side by not asking her to veil herself. That was probably because there is so great a shortage of doctors. Since 2003, more than 200 have fled the city, and the exodus continue ...

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I must say I had not considered the kidnapping aspect and ransom market.

As late as 2006 it was widely briefed in military medicine that the Iraqi medical community was robust and ready to take on civilian collateral damage to the point where you needed a reason over and above them just being being wounded to take a civilian into the military medical system there. The baby Noor's are the total exception.

I am picturing how this must look to Iraqi civilians -- Market or Convoy hit in a urban setting and 1-2 dead Coalition forces with a few 3-4 injured picked up by helecopter while the other 20+injured civilians lay bleeding in the street.
Awaiting local ambulance pick up. The temptation is to take the most seriously injured but what you have done there is set yourself up for a low success rate and the less seriously injured who will likely live will recover with a particularly bad taste in their mouth.

"Thats a hearts and Mind campaign with a future"

The air and other coalition ambulance crews typically offer care and transport for eval but sometimes people do not accept for multiple reasons scared of US , scared of New Iraqi Army or repercussions from insurgents.

My understanding is if we did not cause the injury or it is a regular health issue then we are not obligated to help (life or limb only etc). This unfortunately leaves the insurgent targeted civilians to seek care in as above is noted to be a onerously burdened system. In the end we must find ways to protect the population if possible in and out of hospitals and clinics or better yet to help them protect themselves.

The much bigger bang for support and impact on hearts and minds are in treating the not so badly injured too. That task would likely require a mixed medical team of Iraqi staff and American or other coalition staff. What we are attempting to do is honorable but given our own restraints as to who we will care for and how-- our personal risk is minimized but so is our effect on the greater situation.

USIP: Public Health and Conflict in Iraq: Rebuilding a Nation’s Health

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On March 22, 2007, the U.S. Institute of Peace (USIP) and Johns Hopkins Bloomberg School of Public Health (JHSPH) Task Force on Public Health and Conflict held its third symposium, Iraq: Rebuilding a Nation’s Health. The Task Force is committed to raising the profile of conflict analysis and resolution in the field of public health education. The speakers at this event included Dr. Robert Lawrence, professor of Environmental Sciences and professor of Health Policy and Management at JHPSH; Dr. Gilbert Burnham, professor and co-director of the Center for Refugee and Disaster Response at JHSPH; Jeff Helsing, deputy director of the Education Program at USIP; His Excellency Ambassador Feisal Al Istrabadi, Iraq’s deputy permanent representative to the United Nations; His Royal Highness Prince Zeid Ra’ad Zeid Al Hussein, Jordan’s ambassador to the United States; Dr. Sarmad S. Khunda, dean of the University of Baghdad School of Medicine; Commander David Tarantino, director of Medical Stability Operations and International Health Affairs at the Office of the Secretary of Defense; Dr. A. Hadi Khalili, Former head of the Iraqi Board of Neurosurgery; and Dr. Abdullah Salem, a current student at JHSPH who studied medicine in Baghdad. This USIPeace Briefing summarizes the symposium’s discussion on public health and conflict in Iraq.....

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Deadly cholera outbreak in northern Iraq - LATIMES, 1 Sep.

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A cholera outbreak in northern Iraq, where thousands of people have sought refuge from sectarian violence, is overwhelming hospitals and has killed as many as 10 people, health officials said Friday.

The outbreak in Sulaymaniya and Kirkuk is seen as the latest example of the displacement and deterioration of living conditions caused by the Iraqi conflict.

The water-borne disease has struck more than 80 people in the two cities, which are about 100 miles apart, said Claire Hajaj of the U.N. Children's Fund, or Unicef. She said cholera had been confirmed as the cause of five deaths and was suspected in five others.

Local officials said more than 2,000 people had been affected.

Aid agencies had warned of the possibility of a cholera outbreak as blazing summer heat settled in Iraq, where the infrastructure is shattered by war and neglect. The disease tends to appear in the summer because, as the temperature rises, Iraq's chronic electricity shortages make it difficult to operate pumps at sewage and drinking-water treatment plants, which leaves many people without clean water ...

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Its important to consider that "security" extends beyond the physical sense, and how that translates to how a populace perceives itself. I'd also suggest that we don't always consider the relationship between critical infrastructure and the people required to provide critical services - those professionals who make the medical, legal, political, and economic systems respond to the needs of the populace.

The AIF I think has understood it from the beginning. The reasons we might not have understood as well could be:

-where we perceived our focus to be
-where we preferred our focus to be
-the fact that our critical infrastructure was on the FOBs

I think during the last year or two we have made some great gains in understanding how the infrastructure problems bear on security and instability, but we still have a problem securing the means and ways to fix (and to help the Iraqis fix) these problems given the scope of the problems and the many other related problems brought on by instability.