Gorilla’s Guides

GENEVA (AFP) The World Health Organisation said Thursday that cholera and typhoid pose the key risks to health in Iraq, with refugees and displaced people particularly vulnerable to any outbreak.

“The fear of cholera and typhoid is our immediate and urgent priority,” said Nae’ema al-Gasseer, the WHO’s country representative in Iraq.

Millions of Iraqis have been displaced within and without the country since the US-led invasion to topple Saddam Hussein in 2003, and these people are particularly vulnerable to disease risks due to their precarious circumstances.

The WHO opened a permanent office in the Iraqi capital Baghdad last month, after scaling down its operations in the wake of a devastating terrorist attack against the UN headquarters in the city in August 2003.

Gasseer, who works in the permanent office, said being based in the capital enabled her to be “much closer to decision making” and improve cooperation with the Iraqi authorities.

The WHO said earlier this year that an average of 120 Iraqi adults died a violent death every day in the three years following the 2003 invasion.

The WHO estimated the daily death toll by averaging the overall estimates out at 151,000 dead. The survey was based on interviews conducted in 9,345 households in nearly 1,000 neighbourhoods and villages across Iraq.

In 2006, another study by US doctors in the British medical journal The Lancet claimed that 655,000 Iraqis had died as a result of the invasion to topple Saddam Hussein.

WHO says cholera, typhoid main health risks in Iraq - Middle East Times

In 2003, allegedly to disarm Iraq of weapons of mass destruction, the US and Coalition forces launched a war to bomb Saddam Hussein into oblivion, topple the Ba’athist regime and instate a new era of “liberty and peace.” By late April, down plonked Saddam’s statues (the man himself remained underground) and tanks rolled into Baghdad flying the US victory flag. Five years, 3 980 US military deaths and in the calculation of Nobel laureate and former World Bank economist, Joseph Stilgitz, $3 trillion later, no WMD have been found, while Iraq overflows with blood and despair.

Even by Iraq Body Count’s conservative estimate, between 81,000 and 89,000 Iraqi civilians have been killed since the 2003 invasion. The World Health Organisation estimates that from 2003-2006, the US-led Multi-National Forces (MNF) and sectarian fighters have been responsible for the deaths of 151,000 Iraqi civilians. According to the UN Assistance Mission for Iraq (UNAMI), approximately 34,452 people were killed in 2006 alone, while the group Just Foreign Policy places the figure of civilian casualties in the last 5 years at a colossal 1 million.

The massive post-invasion death toll in Iraq has left tens of thousands of children orphaned and women widowed. In 2006, studies by the Ministry of Women’s Affairs concluded there were approximately 300,000 widows in Iraq’s capital city alone. In 2007, Iraq’s anti-corruption board estimated there were 5 million orphans in Iraq.

The widows, orphans and other survivors in Iraq’s enduring conflict are steeped in a miserable marinade of insecurity and displacement. According to the UN High Commissioner for Refugees, 4 million Iraqis are displaced, with approximately 2 million refugees in neighbouring Syria and Jordan.

In Baghdad, one of the world’s most dangerous cities, the International Committee of the Red Cross (ICRC) estimates a quarter of the city’s 6 million residents have been displaced from their homes. March figures indicate that in spite of the recent US troop surge in the Iraqi capital, Baghdad still suffers a reduced murder rate of 29 violent deaths a day.

With unemployment levels between 25 and 40 percent, and over 50% in some areas, food insecurity and deprivation is also rife.

Before the 2003 invasion, twelve crippling years of US-led economic sanctions, resulted in the death by malnourishment and lack of medical care of 1 million Iraqis. Last July, Oxfam revealed that 43 percent of Iraqis were earning less than 1 dollar a day while 4 million Iraqis depended on emergency assistance for survival.

Millions of Iraqis are also deprived of clean water and medical care. According to the ICRC, “the humanitarian situation in most of the country remains amongst the most critical in the world.” With water and sanitation systems in utter disrepair, 70 percent of Iraqis do not have access to safe drinking water.

While in the 1980s Iraq boasted one of the best healthcare systems in the Middle East, in the volatility of recent years, thousands of doctors have fled, hospitals are failing and children’s healthcare now ranks amongst the world’s bottom three. The ICRC declares that Iraq’s healthcare system is now “in worse shape than ever.”

The suffering of Iraq’s children is particularly harrowing. There are more starving children in Iraq now than during the black decade of West’s economic sanctions, during which half a million children died due to severe malnourishment and the breakdown of sanitation and healthcare (UNICEF). Child malnutrition rates, Oxfam reveals, have increased from 19 percent during the 1991-2003 embargo, to 28 percent currently.

The scars of child trauma associated with sustained violence and insecurity also run deep in Iraq. Many children pass dead bodies on their way to school, wake up to the sound of gunshots and have seen one or more relatives die in mortar or bomb attacks. Studies by Iraq’s Ministry of Health show 70 percent of children in Baghdad suffer trauma symptoms such as stress related bed-wetting or stuttering.

The millions of children ensnared by the gripping fear and distress of living in a war zone, cope with limited support – hospitals are too overstretched to deal with psychological trauma, many of the best psychologists have fled and international organisations such as Save the Children and the Iraqi Red Crescent Society have suspended work with child victims due to insecurity or limited funding.

Yet the incessant carnage fuelling terror and trauma, persists. While President George Bush claims that last year’s 30,000 US troop surge is allowing “normalcy” to return to Iraq, Iraq’s official March death toll, higher than any other month since August 2007, indicates otherwise. Heavy fighting in Baghdad and Basra and a scourge of deadly bomb attacks killed 1,082 Iraqis in March alone, including 952 civilians.

It seems that for Iraqis daily battling death and indigence in an imploding country, the devastating legacy of Iraq’s plunge into war 5 years ago, will be stoically suffered for years to come.

The Muslim News - Iraq wracked by death and despair 5 years after invasion

FALLUJAH, Mar 26 (IPS) - Iraqi doctors in al-Anbar province warn of a new disease they call “Blackwater” that threatens the lives of thousands. The disease is named after Blackwater Worldwide, the U.S. mercenary company operating in Iraq.

“This disease is a severe form of malarial infection caused by the parasite plasmodium falciparum, which is considered the worst type of malarial infection,” Dr. Ali Hakki from Fallujah told IPS. “It is one of the complications of that infection, and not the ordinary picture of the disease. Because of its frequent and severe complications, such as Blackwater fever, and its resistance to treatment, P. falciparum can cause death within 24 hours.”

What Iraqis now call Blackwater fever is really a well-known medical condition, and while it has nothing to do with Blackwater Worldwide, Iraqis in al-Anbar province have decided to make the connection between the disease and the lethal U.S.-based company which has been responsible for the death of countless Iraqis.

The disease is most prevalent in Africa and Asia. The patient suffers severe intravascular haemolysis — the destruction of red blood cells leading to kidney and liver failure. It also leads to black or red urination, and hence perhaps the new name ‘Blackwater’.

The deadly disease, never before seen in Iraq on at least this scale, seems to be spreading across the country. And Iraq lacks medicines, hospitals, and doctors to lead a campaign to fight the disease.

“We informed the ministry of the disease, but it seems that they are not in a mood to listen,” a doctor from the al-Anbar Health Office in Ramadi told IPS, speaking on condition of anonymity. “We are making personal contacts with NGOs in an attempt to get the necessary medicines.”

The three doctors who spoke to IPS in Fallujah and in Ramadi in al-Anbar province that lies west of Baghdad, seemed sure that the Iraqi government would do little to face the plague.

“They have not even made any announcement so that people can take precautions,” one of the doctors from Fallujah told IPS.

The doctor said a patient usually suffers three stages of malarial infection. “First is the cold stage where the patient will have chills and shaking, the second is the hot stage when fever takes over, and the third is the sweating stage.”

Doctors in Fallujah say the new complication of the disease that may develop from malarial infection can be treated in its early stages, but is difficult to control when complications develop. Drugs currently being used to treat the disease include Chloroquin, Mefloquin, Pyrimethamine, Suladox, Halfotrin and Primaquine.

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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.

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Disease currently contained, but experts say it will probably break out again in summer.

Health experts are warning that the country could be hit by new cases of cholera once temperatures start to rise.

The government said its last cholera case was recorded in late November and has credited a public-awareness campaign and the colder winter temperatures for halting the spread of the disease. However, doctors warn that cholera could recur as summer approaches because of poor sanitation.

Adil Abdul-Muhsin, general inspector at the ministry of health, said that Iraq suffered its worst bout of cholera for the forty years, with 4,691 cases, resulting in 24 fatalities.

Deputy Health Minister Amir al-Khuza’i said the ministry of health has “totally controlled the disease”.

“There aren’t any cholera cases in Baghdad or in any other provinces,” he said.

But doctors say it’s only a matter of time before the disease reappears.

“Nothing can prevent a cholera outbreak next summer,” said Ni’man Mohammad, a physician in Baghdad.
Mohammed expressed particular concern about new cases “in areas with dense populations and poor basic services, like eastern parts of Baghdad such as Sadr City and the surrounding neighbourhoods”.

Cholera is a potentially lethal diarrheal disease that is primarily spread through contaminated water or food. The disease often festers in overcrowded areas with poor infrastructure.

An outbreak last year began in the northern province of Kirkuk in August and spread to 11 other provinces, including Baghdad, where Iraq’s last case was recorded in early December, according to the World Health Organisation. The United Nations agency reported that 30,000 people fell ill with acute watery diarrhoea.

The last cholera outbreak prior to that was in the spring of 2003, when 187 cases were recorded, according to WHO. No one died at that time.

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