Gorilla’s Guides

Iraq: dire state of health system must take priority

Vulnerable groups:

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. 

On the shooting of pregnant women see for example Gorilla’s Guides (old site): What Was That We’re All Meant To Be “Pro” Again? and Gorilla’s Guides (old site) : What Was That We’re All Meant To Be “Pro” Again? Part 2 in particular see the notes numbered 4 and 5 on Solatia payments in part 2.

Note 4:

A particular point to note is no money is paid to Iraqi’s killed by insurgents. This was, to me at any rate one of the first indisputable indications that a cover up in Haditha had been attempted by the local commanders. The payments are made solely as a result of US actions and are made at the discretion of the local commander. In Haditha the US army first claimed that the 24 in Haditha had been killed by insurgents and then paid them. Clearly a HUGE discrepency between policy and what was done. The question immediately arose in my mind as to why the money was paid. The only reasonable explanation is as “hush money.”

Note 5:

Readers should also note that given that the payment for a death is US$2,500.00 payments in the order of US$19 million implies a massive number of civilian deaths many thousands of civilians deaths. Yet the admitted total of civilian deaths is considerably less than 1,000 - in the order of 600.

As Richard of This Old Brit remarked in his comments on Solatia payments on Mark’s personal blog (now defunct)

Those compensation figure mathematics have just floored me. I wonder if the enormous [and horrendous] implications of this revelation is sinking in as it should? 

The answer to that question was then and is now. “No”

Mass Casualties:

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.

With reference to mass casualties or indeed any casualties the situation is far worse than M. Olle’s comments would suggest. There is now considerable experience in Irak of treating bomb casualties. The problem is not stabilising a critically wounded patient. That can be and is often done with considerable success. The problems are:

• Coping with the volume of wounded:

  During the aftermath of a major incident a patient will at most get 2 hours in surgery due to the volume of cases needing urgent surgical treatment.

• Fatal post-surgical infections:

  Patients are of course sent home before they are recovered as there are not enough beds or staff and new patients need to be treated.

  Worse than that there are not the antibiotics needed to treat infections and staff lack such basic supplies as gloves and surgical spirit to disinfect their hands. A high level of cross-infection is the inevitable result.

  Additionally many post-operative patients wounds become infected at home due to the poor hygiene inevitable when the only water available is heavily contaminated. Again there are not the antibiotics to treat them without recourse to the black market and even if the patient’s family can afford these black market products there is no guarantee that the antibiotics they have bought are not useless as black market medicines are often re-labelled as current years after they have in fact expired. Add to that the fact that in a country where many cannot afford food disinfectants are prohibitively expensive and the results are clear.

  Post-operative deaths due to such complications are not included in the statistics of violence related deaths supplied by the health authorities or by the Americans. The consensus amongst my colleagues is that at a conservative estimate approximately half of the patients they treat for wounds following a bombing or any traumatic incident die within three weeks of release as a result of infections.

Maryam.

---

ICRC | Iraq: dire state of health system must take priority

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?

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.

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.

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 news release in sidebar editors.)

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.

Source ICRC: Iraq: dire state of health system must take priority

Indexed under: Al Kindi, Attacks on medical and humanitarian workers, Baghdad Teaching Hospital, Children, Haditha, Health, Imam Ali Hospital, Iraq, Red Crescent/Red Cross, Rescue Work, Sanctions, shock, trauma, Water, Water Crisis (Iraq), Women and Children, World Health Organisation