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Iraq: dire state of health system must take priority

25-02-2008 Interview

After years of sanctions and recurrent wars, and more significantly since 2003, the Iraqi health system has steadily deteriorated. Pascal Olle, the ICRC's health programme coordinator for Iraq, explains the state of the health system and what the current needs are.

 How would you describe the health system in Iraq?  

  In Iraq, the ICRC supports emergency services by rehabilitating health structures and supplying them with surgical equipment and medical material.

In 2007, the ICRC :  
  • provided essential equipment to 73 emergency rooms in 69 hospitals and medical facilities, and to operation theatres in 27 hospitals all over Iraq;
  • distributed emergency medical material that allowed for the treatment of more than 5,000 war wounded in 28 hospitals throughout Iraq;
  • provided medical material such as drugs, in 84 hospitals and 12 primary health care centres.;
  • organized three training sessions, for 80 doctors and nurses, on advanced first aid, emergency room trauma management and war surgery.
It is shocking to see how Iraqis today lack the most essential needs in terms of health services. In the 70's, the country offered one of the best health services in the region. Over the years of war turmoil the infrastructure has suffered a major stroke for several reasons.
Due to the precarious security situation, maintenance was no longer possible. Both facilities and equipment need regular care and upgrading. In any conflict zone, emergency medical response is crucial. Iraq continues to suffer through incidents that result in mass casualties. Most recently, on 1 February, explosions that tore through Baghdad's Al Ghazl marketplace and a second market in the south of the city, killed and injured dozens of people.
Many patients that reach hospitals could and should be saved. However, this is not always the case, as emergency rooms and operation theatres are often not able to cope with the number of casualties.
Another problem is the lack of qualified and experienced medical staff. Like many other Iraqis, medical doctors, surgeons and nurses are subjected to threats, security risks to themselves and their families, kidnappings and killings. This led many to leave the country – a considerable brain drain at a time when the country needed them the most.

 How does this situation affect the Iraqi people?

During one of my visits to Iraq, I met an Iraqi man who actually told me " medical care is not really a priority for me. What matters is security, shelter and employment. " This might also be the case for many Iraqis. I understand when people think in this way, especially when it comes to survival.

  ©Reuters /M. R. Mahmoud    
In Yarmouk hospital, Bagdad    
    I can understand that this goes beyond health to a need of stability and safety from any kind of violence. This also comes from a feeling among Iraqis of mistrust and despair in the services provided to them. However, this is a dangerous stance because people might get used to current health services that are far from the minimum standard. There are efforts being made by health authorities but resources and the security situation do not allow a faster pace.

It is extremely difficult for the population to get health care provisions in an environment that is short on supplies and limited when it comes to facilities because of buildings that are too old. The problem is even more acute for vulnerable groups such as children, pregnant women and injured persons. For a pregnant woman to pass a checkpoint on her way to deliver a baby is not obvious as there is a risk of being shot or kidnapped.


 In such a complex and dangerous situation, is the ICRC able to respond to the needs of the Iraqi people? What should be done today in order to improve access to health services?

It is by no means possible to say that the ICRC is able to meet all of the needs. Working in Iraq today is still dangerous as the context becomes more and more unstable and unpredictable. The only way for us to be efficient is to focus on emergency assistance.

  ©Reuters /F. Bensch    
  Residents queue for medical treatment inside a local hospital in Zafraniyah, Baghdad    
    news release  
The main focus for us today is to respond to mass casualties. We help the health system cope with the influx of wounded by distributing war wounded kits comprised of medical and surgical items necessary for the treatment and recovery of an injured person. Each kit allows hospitals to treat more than 100 injured persons, thus reducing the number of deaths during hospitalization.
Following the explosions of 1 February, the ICRC provided the Baghdad Teaching Hospital with sufficient emergency medical supplies to treat over 100 injured patients. Similar aid had been sent earlier to both Al Kindi Teaching Hospital and Al-Imam Ali Hospital in Baghdad as a precautionary measure. (See .)
One very important element that should always be kept in mind is that people working in the medical field and the facilities they work in must be protected, as they offer a service extremely important in today's Iraq. It is hard enough for the health system to stand on its feet with the current lack of experienced staff. Along with the rehabilitation of the health infrastructure, capacity building for medical staff should be a priority in Iraq.    

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