[casi-analysis] Iraqi Healthcare: "We are dealing with a crisis"

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Everyone,

Four damning and despairing stories have recently reported the state of Iraq's
hospitals.  Today's Washington Post carries the most powerful of the lot (below
in ts entirety), and others (from the NYTimes, Independent, and AFP) are cached
on OccupationWatch's website (links below).

It's almost one year after Baghdad fell, and it brings disbelief and shame to
hear that in in some respects, conditions are now worse than during the height
of sanctions.  Excerpts from the Post:

>> "... in recent months ... the health care system has been hit by a critical
shortage of basic medications and equipment. Babies die of simple infections
because they can't get the proper antibiotics. Surgeries are delayed because
there is no oxygen. And patients in critical condition are turned away because
there isn't enough equipment."

>> "'We are dealing with a crisis,' said Abdulwadood Talibi, director general of
the State Company for Drugs and Medical Supplies, which is in charge of ordering
all goods for the 240 public hospitals and 1,200 health centers in Iraq."

>> "There are shortages of basic items such as cough syrup and also of critical
items such as diabetes medications, anti-cancer drugs, intravenous lines,
tuberculosis test kits and ventilators ...  There also has been an oxygen
shortage. The two plants in Iraq that produce the gas and liquid have not been
keeping pace with demand. Twice, in November and in December, the children's
hospital ran out of oxygen for about 10 hours. The babies in the neonatal ward
went into cardiac arrest, said Munem, and some died ..."

Despite the insecurity, constitutional uncertainty, and threat of civil war,
"The U.S.-led occupation is preparing to hand over administration of the health
care sector to the Iraqi government, perhaps in a few weeks. The Health Ministry
will be among the first to have operational independence. ... Some Iraqis also
say the U.S.-led occupation authority's overhaul of the system for ordering and
distributing supplies might have been too ambitious for a country reeling from
war."

Regards,
Drew Hamre
Golden Valley, MN USA

===
http://www.washingtonpost.com/ac2/wp-dyn/A31728-2004Mar4?language=printer

Iraqi Hospitals on Life Support
Babies Dying Because of Shortages of Medicine and Supplies

By Ariana Eunjung Cha
Washington Post Staff Writer
Friday, March 5, 2004; Page A01


BAGHDAD -- The stout woman, covered from head to toe in a black abaya, shuffled
into the crowded hospital. She went straight to the emergency room and opened
her robe to reveal a tiny baby wrapped in fuzzy blankets. The boy had been born
prematurely, and the family was afraid he was going to die.

Uday Abdul Ridha took a quick look and shook his head. The physician put his
hands on the woman's shoulders in sympathy, but his words were blunt. "I'm
sorry," he said. "We cannot help you. We don't have an incubator, and even if we
did, we are short on oxygen. Please try another hospital."

Scenes like this one at the Pediatric Teaching Hospital in Baghdad's Iskan
neighborhood have become common in Iraq in recent months, as the health care
system has been hit by a critical shortage of basic medications and equipment.
Babies die of simple infections because they can't get the proper antibiotics.
Surgeries are delayed because there is no oxygen. And patients in critical
condition are turned away because there isn't enough equipment.

"We are dealing with a crisis," said Abdulwadood Talibi, director general of the
State Company for Drugs and Medical Supplies, which is in charge of ordering all
goods for the 240 public hospitals and 1,200 health centers in Iraq.

There are shortages of basic items such as cough syrup and also of critical
items such as diabetes medications, anti-cancer drugs, intravenous lines,
tuberculosis test kits and ventilators, say doctors and nurses at Iskan, the
Medical City Center, Yarmouk Hospital and other facilities.

The U.S.-led occupation is preparing to hand over administration of the health
care sector to the Iraqi government, perhaps in a few weeks. The Health Ministry
will be among the first to have operational independence. Health Minister
Khudair Fadhil Abbas said about 90 percent of the hospitals and clinics have
been brought back to the same poor conditions as before the war but that the
others will take more time to reach even that low level.

Occupation officials say they have made many improvements in the health sector
since the end of the war, and that much of the work is not obvious because it
involves training nurses and doctors and changing inefficient practices. The
U.S. Agency for International Development has financed vaccines for 4.2 million
children and is beginning to distribute supply kits to 600 clinics. The Iraqi
government and the U.S. military have financed reconstruction of nearly 40
hospitals and improvements to 130 more are in the works.

Jim Haveman, the Coalition Provisional Authority's senior adviser for health,
said he had heard "community concerns" about medical supplies and that the
occupation authority and the Health Ministry have dispatched quick-assessment
teams to identify and fill shortages. Among items being sought: incubators.

Iraq's hospitals were once the envy of the Middle East. Wealthy businessmen used
to fly their relatives in for everything from heart transplants to plastic
surgery, and Iraqi specialists traveled the world lecturing about their
research. But medical care deteriorated under the economic sanctions imposed
after the Persian Gulf War in 1991, and President Saddam Hussein banned the
importation of medications produced by U.S. companies and their affiliates, even
though those were often the best available.

Doctors, nurses and Iraqi officials said some things have improved since the war
-- especially the infrastructure of some hospitals and clinics that have been
rebuilt. But in other respects, conditions are worse.

Damaged records, attacks on convoys carrying supplies, looting at central
warehouses, inoperable factories and bureaucratic confusion have delayed repairs
and the restocking of medicine and equipment. Some Iraqis also say the U.S.-led
occupation authority's overhaul of the system for ordering and distributing
supplies might have been too ambitious for a country reeling from war.

The Health Ministry developed a new list of standard drugs to replace medication
that is outdated, but wrangling over the list put large purchases on hold. The
ministry also decided that all shipments of humanitarian aid should go through a
central depot and not directly to hospitals, so the government could ensure that
medicine and equipment were distributed fairly. But that extra layer of
bureaucracy delayed getting the supplies to the hospitals.

Some medical centers, such as the Iskan hospital, have had to bear the burden of
treating patients from other facilities that were damaged and had to be shut for
repairs.

The Iskan hospital was built for 170 patients, but it has been treating more
than 300. Two or sometimes three children have been crammed into single beds.
Sewage leaks onto the floors of the rooms where doctors perform surgery. And the
lines to get prescriptions filled stretch outside the doors. Flies hover around
beds that smell of wet bandages. And it is not uncommon for blood and other
spillage to remain on the floors for hours because antiseptic cleaning supplies
are not available.

Abbas, the health minister, said the Spanish government had pledged $10.5
million to help rehabilitate and restock the hospital. Contractors have arrived
in recent days to assess what needs to be done.

The situation is so precarious that twice in the past few months the fathers of
babies who died stormed the hospital and attacked doctors, said Saddam Hussein
Ali, 31, a security guard there.

Several witnesses recalled an incident in which a distraught father shouted,
"You are bastards all" at Walid Khalid, the doctor on duty at the time. The
doctor who had treated the man's baby had already left the hospital for the day,
so the father grabbed Khalid by the collar and shook him.

After the war, the children's hospital and others were overrun with people who
said they wanted to help. But the only follow-ups, according to nurses and
doctors, were visits from UNICEF and the U.S. Army. The occupation authority
said it has also visited the hospital to study its needs. The visitors brought
gifts for the children during the holidays. There were new clothes, candy and
milk, but that only made some parents more bitter, said Hadeel Jameel, a
doctor's assistant in the cancer ward.

"When organizations come and play with the children and take photos, the mothers
will cry because they think it means that this is all they can do and their
children will die," she said.

The shortages have angered many in the medical community. "The most important
thing for Americans is their interest: the Ministry of Oil. That is where all
the money is going. They don't give medical supplies or oxygen any thought,"
said Bahaa Abdul Munem, who until recently was chief resident at Iskan
children's hospital but transferred to Yarmouk.

Before Nov. 21, the United Nations, which managed Iraq's oil-for-food program,
had responsibility for ordering medicine and equipment. In conjunction with the
Health Ministry, it shipped in 25,000 tons of supplies. But because many records
were destroyed and there wasn't time for a proper survey, the supplies ordered
weren't necessarily the ones most needed.

Talibi, director general of the State Company for Drugs and Medical Supplies,
said he believes U.N. officials tried their best but that they did not have
enough information. "It's like you are visiting your neighbors and want to help.
You go to their kitchen, but you don't know where the cups and the tea are," he
said.

Abbas acknowledged that the Health Ministry should bear some of the
responsibility. "Our staff should have done something earlier, before the
supplies were depleted," he said.

On the third floor of the children's hospital, Habeeba Kadhim, a nurse who works
in the infectious diseases ward, said at one point there was only penicillin to
treat patients with diarrhea, and it didn't work, so babies got progressively
sicker and died. On the second floor, where cancer patients are, doctor's
assistant Hadeel Jameel said people only receive part of their leukemia
medications because there isn't enough for everyone to receive full doses.

But the biggest problem is in the neonatal ward.

Iraq has one of the highest infant mortality rates in the world -- one that
climbed from 40 out of 1,000 live births in 1989 to 108 per 1,000 live births
today. One of the main goals of the occupation authority and the Health Ministry
is to cut that rate in half by 2005. They have allocated nearly $1 billion of
the Health Ministry's budget for next year in addition to $793 million the U.S.
Congress has appropriated and more funds from other countries. Abbas said the
top priority for those funds will be maternal and child health.

There are 30 old-fashioned incubators at the children's hospital, and all
require the temperature to be adjusted manually. At any given time one or more
are out of order. There are usually more than 40 children who need incubators,
said Hayat Katia Sabeeh, a nurse in the ward.

There also has been an oxygen shortage. The two plants in Iraq that produce the
gas and liquid have not been keeping pace with demand. Twice, in November and in
December, the children's hospital ran out of oxygen for about 10 hours. The
babies in the neonatal ward went into cardiac arrest, said Munem, and some died
as doctors and nurses scrambled to bundle them up and transport them to a nearby
hospital.

"When we face moments of deficiency, it makes us feel very sad because the
difficulty is simply because we do not have a functioning machine -- not because
we don't have the skill," said Ahmed A. Muhammad, assistant manager of the
hospital who is in charge of supplies.

On one weekday morning last month, Ibtisam Ali, 35, brought her brother's baby
to Iskan. Her local hospital, where the baby was born that day, had turned her
away because it did not have medicine to treat the baby. The boy looked blue and
was bleeding from his nose and mouth.

A doctor told her that the child needed an incubator but that none was
available. Ali called a few hospitals and found that Medical City had a free
incubator. She raced over in a taxi, but when she arrived, she was told the
space had been given to another baby.

Ali argued: "Why did I come here? . . . I spent all my money on taxis and
reserved the place, and you say you are going to take [the incubator] away. I
have the priority."

The doctor replied: "This is not a hotel."

A nurse, Faihaa Muhsin, tried to console Ali by telling her that even if they
had an incubator, they didn't have a mechanical ventilator to keep the child
breathing. "He is a hopeless case. It is up to God," Muhsin said.

Sanaa Mehdi, 18, the mother's sister, was not ready to give up, so Muhsin handed
her a manual ventilator and told her to squeeze and let go, squeeze and let go,
as long as she could. Shortly before dawn, after standing by the baby and
working the respirator for eight hours, Mehdi's arms gave out.

Her nephew, Abdullah Hassan Ali, age 1 day, died at 4 a.m. The death certificate
listed "respiratory failure" as the cause.

Special correspondent Hoda Ahmed Lazim contributed to this report.

===
http://www.occupationwatch.org
$87 billion for occupation, but hardly a penny for Iraq’s hospitals

It is clear from conversations with Iraqis and reports from delegations recently
returned from Iraq that the daily lives of the Iraqi people have not improved in
the 10 months since Saddam Hussein was overthrown. In many cases, things are
even worse with no improvement in sight. A case in point is the dismal
conditions of Iraq's hospitals. Even at the “best” hospitals, like Baghdad’s
Central Teaching Hospital for Children, it is reported that 80 percent of the
patients leave with infections they did not have when they arrived. The wards
are filthy, the sanitaion shocking, the infections lethal, and sewage drips from
the roof above cots of premature babies. The following articles document the
current conditions in Iraq’s hospitals. Is this what hospitals in “liberated”
countries are supposed to look like?

===
http://www.occupationwatch.org/article.php?id=3206
Dying of neglect: the state of Iraq's children's hospitals

The wards are filthy, the sanitation shocking, the infections lethal. Sewage
drips from the roof above cots of premature babies. This is the state of
Baghdad's top children's hospital, 10 months after the fall of Saddam, reveals
Justin Huggler

by Justin Huggler, The Independent
February 21st, 2004

===
http://www.occupationwatch.org/article.php?id=3050
Chaos and War Leave Iraq's Hospitals in Ruins

by JEFFREY GETTLEMAN, New York Times
February 14th, 2004

===
http://www.occupationwatch.org/article.php?id=3041
Scenes of horror still plague an Iraqi hospital

by Agence France Press, AFP/Jordan Times
February 12th, 2004

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