Update no. 99/04 on ICRC activities in Iraq - ICRC survey of surgical hospitals
22-04-1999 Operational Update
The civilian population of Iraq continues to suffer a general deterioration of living conditions as the country enters its ninth year under UN embargo. The country's infrastructure, especially health services, water, electricity supplies and communications, is in a dire state, despite the implementation of UN Security Council resolution 986. One of the ICRC's main objectives for 1999, as outlined in its Emergency Appeals, is that the civilian population should, as far as possible, be spared the consequences of the embargo imposed on Iraq.
Since the US airstrikes of December 1998, the ICRC has stepped up support for medical facilities treating the war-wounded. In particular, it assisted with repairs to Basra hospital which suffered blast damage when three missiles fell nearby. This direct contact with hospitals brought home the fact that health centres and hospitals throughout the country are in an advanced state of disrepair and lack all kinds of basic equipment. The morale of health professionals is low and standards of care are appalling. This led to the decision to carry out a comprehensive survey of the Iraqi health system, comprising an evaluation of hospitals and of primary health care facilities, to identify the most pressing needs in the medical field.
The ICRC has so far carried out an in-depth survey of 14 state hospitals and one private hospital, focusing on an evaluation of surgical needs. This is to be complemented by an overall evaluation of eight of these hospitals. Another survey, assessing the state of primary health care facilities, is at present underway. The results of these surveys will provide a basis for the development of ICRC programmes to meet n eeds in this area, needs that are met only partially or not at all in spite of the oil-for-food programme.
Hospitals: first findings
From 13 February to 9 March, an ICRC surgeon visited 14 state hospitals and one private hospital from Mosul to Basra. The hospitals chosen had all been assisted in December 1998 by the ICRC with ad hoc donations after the airstrikes.
The findings from the mission included some positive aspects, such as the quality of the doctors and their great commitment to their work. However, the material needs were found to be overwhelming. They were very similar in all the hospitals visited.
Many buildings are in a deplorable condition. Cracked floors or missing tiles make proper cleaning impossible; the paint is falling off the walls and ceilings; sewage systems are not maintained; elevators rarely work; there are frequent power cuts.
Basic equipment is lacking or in bad condition, for instance rusty beds without wheels, dirty mattresses with holes; there is a lack of soap and disinfectants, a lack of bed linen, a shortage of paper and hence no proper patient files.
Consumables are scare or lacking: needles, syringes; gauze; i.v. lines and fluids; gloves. Diagnostic tools are also deficient. There are few laboratory tests because of the shortage of reagents and machines; there are few functioning gastroscopes, colonoscopes, cystoscopes; ECG machines are out of order; many drugs are scarce, such as antibiotics, cardiac drugs, chemotherapy; there is no radiotherapy.
Operation theatres are working on a very basic level. The problems are manifold: lack of detergents, disinfectants and water, broken and missing tiles; most bulbs in OT lamps are broken; the central supply of oxygen and nitrous oxide is out of order; few anaesthes ia machines are working; trolleys are broken.
Furthermore, no books or medical journals are available; there are no proper nursing schools, no computers. This all makes doctors'work extremely difficult. As a result, many young doctors and nurses have chosen to leave the country.
The result is that lifesaving procedures cannot always be performed due to a lack of drugs, monitoring equipment or specific treatment. Diagnosis is made more difficult due to the lack of modern equipment. Painkillers were missing in most places, especially those used for post-operative care. The number of planned, non-emergency operations has greatly decreased.
What ICRC will do: carry out repairs and provide equipment for operation theatres; set up a basic nursing training programme; repair and equip public health clinics; provide training for staff; supply medical literature.
Other ICRC activities in Iraq
For several years, the ICRC has been focusing its attention on two crucial areas of activity in the health sector: the provision of clean water, by rehabilitating water treatment plants, and the production and fitting of artificial limbs for war amputees and civilian victims of anti-personnel landmines.
The ICRC also visits detainees from countries that have no diplomatic relations with Iraq in order to monitor their treatment and conditions of detention, and assists the Iraqi Red Crescent in maintaining and restoring links between separated family members in the region. In northern Iraq, the ICRC provides emergency medical supplies and non-food assistance for the victims of the ongoing hostilities, and visits detainees held for security reasons or as a result of internal violence.
The ICRC continues to act as neutral intermediary between Iraq and the Coalition States in an effort to settle the humanitarian issues still unresolved after the Gulf war. It plays an active role in repatriating POWs still held as a result of the Iran-Iraq war. The ICRC has been present in Iraq since the outbreak of the Iran-Iraq war in 1980.