Iraq: putting the health-care system back on its feet
29-07-2010 Operational Update
Despite some recent improvements, Iraq's health-care services are still struggling to cope. The ICRC is engaged in a wide range of initiatives aimed at helping them to respond to emergencies. This is an update on activities carried out in the country in May and June.
A lack of qualified medical personnel and, in some places, security problems continue to severely affect health-care services in Iraq, despite recent improvements in certain areas.
" The burden placed on medical staff and facilities by violence-related casualties has been enormous, " said Jean-Christophe Sandoz, the ICRC's deputy head of delegation in Iraq. " In addition, the insufficient numbers of medical personnel, the inadequate facilities, the difficulty obtaining access to certain places, the reduced availability of medical services in rural and remote areas, and other factors have made it very challenging to provide health care in Iraq. "
Security constraints are now restricted to specific areas. In general, people can move about and obtain health care more easily. However, better access does not necessarily mean that people receive better health services. ICRC-monitored health-care facilities report that the support they receive from the Ministry of Health has been stepped up. This is particularly true of hospitals in major urban centres. However, despite the ministry's efforts, much more needs to be done.
The available human resources fall short of needs. While 34,000 physicians were registered with the Iraqi Medical Association in the 1990s, by 2008 there were only around 16,000, a trend that has unfortunately not been reversed since the government's 2008 appeal for medical staff to return to the country. Furthermore, while in most countries the standard nurse-to-doctor ratio is around three to one, in Iraq, according to government estimates, there are only around 17,000 nurses. In other words, there are roughly as many nurses as doctors.
While health-care facilities have been rebuilt in most urban centres, facilities in rural and remote areas remain in dire condition. Facilities already coping with a poor supply of electricity or water frequently also have to deal with unreliable sewage or air-cooling systems and with inadequate solid-waste disposal. Equipment is often old and poorly maintained, and sometimes is not operated correctly.
Poor hygiene levels in many facilities have a severe impact on the quality of care delivered. Frequently, minimum standards of nursing, sterilization and waste management are not respected owing to a lack of resources. Substandard care is particularly worrisome when the patients are trauma victims, pregnant women or children, as it leads to high rates of infection and frequent ill-health. Medical and paramedical staff report that even minor accidents can sometimes be fatal because of inappropriate care. The number of beds in specialized services such as intensive care and dialysis units is insufficient, and shortages of trained nurses and paramedical staff oblige hospitals to rely on relatives to provide the patients with care.
The ICRC is carrying out a wide range of activities to support the health-care system, most of which are aimed at helping it to maintain a certain capacity to respond to emergencies. For instance, it is providing training in war surgery, trauma management, infection control and advanced first aid for Iraqi doctors and nurses.
This year the ICRC's support for health-care services is focusing on upper-level primary care in rural areas. The decision to provide support to a certain facility is taken on the basis of the likelihood of violence where it is situated, the difficulty of referring emergency cases, the presence of displaced people or returnees, the level of access to functioning health-care services and the level of support from central or region al health authorities and local or international non-governmental organizations.
A training project to strengthen emergency services in Iraq is being carried out by the ICRC in coordination with the Iraqi Ministry of Health and the Ministry of Health of the Kurdistan Regional Government in Sulaimaniya Emergency Hospital and Al Sadr Medical City in Najaf. Since the project began, over 350 doctors and nurses from seven governorates have been certified in trauma management, infection control and teamwork.
The ICRC also provides limb-fitting and physical rehabilitation services helping disabled people reintegrate into the community, through active support (equipment donation and sponsorship) and training. The ICRC supplies 11 physical rehabilitation centres with materials and tools, sponsors the training of prosthetists and orthotists through scholarships while actively supporting the development of national guidelines and standards.
Bringing aid to vulnerable people
The ICRC has maintained its support for people facing special difficulties earning a living and supporting their families, such as women heading households, people with disabilities and displaced people. During the months of May and June:
- About 4,500 people (756 households) newly displaced in five districts of northern Iraq were given individual food rations, hygiene kits and other essentials;
- Over 2,000 displaced families (12,000 people) headed by women in Baquba, Khanaqin, Tilkafi, Karkh, Rusafa, Tikrit and Baiji were given food and hygiene kits;
- 80 disabled people in Erbil, Dohuk, Sulaimaniya and Ninewa governorates were given grants enabling them to start small businesses and regain economic self-sufficiency. Some 600 disabled people have now received such aid in a programme that started in 2008.
ICRC delegates visit detainees in order to monitor the conditions in which they were being held and the treatment they receive. In all cases, the ICRC shares its findings and recommendations confidentially with the detaining authorities, with the aim of obtaining improvements where necessary. In May and June, the ICRC visited detainees held by the correctional service of the Ministry of Justice, the counter-terrorism office of the Ministry of the Interior, the juvenile correctional service and various Kurdish Regional Government authorities in places of detention in Diwaniye, Basra, Najaf, Baghdad, Babil, Kirkuk, Erbil, Dohuk and Sulaimaniya governorates. In some of these places, detainees were given mattresses and recreational items such as books, domino sets and chess boards to cover needs identified by the ICRC.
The ICRC makes a special effort to restore and maintain ties between detainees and their families. In May and June, over 2,400 Red Cross messages were exchanged between detainees and their families in Iraq and abroad. The ICRC also responded to around 1,700 enquiries from families seeking information on detained relatives. In addition, it issued 635 certificates to former detainees to make them eligible to receive social welfare benefits, and 106 travel documents to refugees to enable them to resettle abroad.
Clarifying what happened to missing people
Shedding light on what happened to people who went missing in connection with armed conflict in order to relieve the suffering their families endure is one of the ICRC's priorities. In June, the Ministry of Human Rights and the ICRC agreed to jointly provide support for Basra's Al Zubair Centre to boost its capacity to manage human skeletal remains.
On 17 May, the mortal remains of 55 Iraqi soldiers killed in 1991 were transferred under ICRC auspices from Kuwait to Iraq at the Abdaly/Safwan border crossing. The remains were taken to Al Zubair Centre, where eight of the dead Iraqis were identified. The operation took place within the framework of the Tripartite Commission and its Technical Sub-Committee, both chaired by the ICRC, which were set up in 1991 and 1994 respectively to clarify what happened to people missing in connection with the 1990-1991 Gulf War.
Providing clean water and sanitation
Access to clean water remains difficult in much of Iraq. ICRC engineers continue to repair and upgrade water, electrical and sanitary facilities, especially in places where violence remains a concern and in rural areas, to improve the quality of services provided in communities and health-care facilities. In May and June, their activities included:
- delivering water by truck (50 litres per person per day) to about 400 people displaced from the Sharkhan valley near Zharawa town, in the Pshdar district;
- replacing an elevated tank and upgrading a boosting station supplying water for around 22,000 people in the Talafar district of Ninewa governorate;
- drilling and equipping deep wells for each of three villages near Jalawla, and handing the wells over to the authorities. Some 5,000 villagers used to rely on shallow private wells or irrigation channels for their water supply;
- installing a pipeline in a neighbourhood of Al Fajir, in Thi-Qar governorate, to remove sewage, which will improve living conditions for about 12,000 people;
- carrying out extensive repairs on the Tamur public primary health-care centre in Kirkuk governorate, serving about 5,500 people south of Daquq;
- installing a compact unit in Al Nahrawan, in south-eastern Baghdad governorate, supplying water to a rural area inhabited by approximately 200,000 people;
- repairing the Najaf water treatment plant serving more than 1,000,000 Najafis and thousands of pilgrims.
Promoting international humanitarian law
Reminding parties to a conflict of their obligation to protect civilians is a fundamental part of the ICRC’s work. The organization also endeavours to promote international humanitarian law within civil society. In this framework, it organizes presentations for various audiences, which include military personnel, prison staff, students and professors.
In May, a presentation on international humanitarian law and humanitarian principles drawn from the Sharia was held in Dohuk. Participants included imams and preachers, members of the Directorate of Endowments in D ohuk, Islamic scholars and others from Mosul and Kirkuk. A separate presentation was given for law and sharia professors from Dohuk University and the Institute of Imams and Preachers of Dohuk.
Marçal Izard, ICRC Geneva, tel: +41 22 730 24 58 or +41 79 217 32 24
Layal Horanieh, ICRC Iraq, tel: +962 777 399 614