Psychiatric News November 5, 2004
Volume 39 Number 21
© 2004 American Psychiatric Association
p. 1
Iraq Desperate To Rebuild Shattered Health System
Christine Lehmann
Iraq's new health minister faces enormous challenges in modernizing the
system. Meanwhile, hospitals in Baghdad face inadequate security, power, and
supplies, a prominent Iraqi doctor tells a medical coalition for Iraq.
A two-day conference on Iraqi health care at APA headquarters in late
September drew more than 40 physicians from U.S. medical specialty societies
including several Iraqi-American physicians and representatives of the Iraqi
Society of Physicians, Iraqi Medical Sciences Association, AMA, British
Medical Association, and World Medical Association.
APA member Col. E. Cameron Ritchie, M.C., the psychiatric consultant to the
Army surgeon general, was a co-organizer of the conference at APA. "We
wanted to show our support for our Iraqi colleagues and get an update on the
health care situation there including government and nongovernment sponsored
health care initiatives."
Ritchie added, "I am pleased that APA leadership continues to support
professional exchanges with Iraqi physicians. In addition to hosting this
conference, the president's [Marcia Goin, M.D.] symposium in May was devoted
to rebuilding health care systems emerging from conflict such as Iraq, and
Marcia Goin, Jay Scully, Darrel Regier, and I participated in a July 2003
conference devoted to rehabilitating Iraq's psychiatric services sponsored by
the World Health Organization and the World Psychiatric Association in
Cairo."
Michael Brennan, M.D., of the American Academy of Ophthalmology, moderated
the September conference and coordinated the agenda with Ritchie and the
organizing committee.
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Abdul Hadi Al-Khalili, M.D., a member of the Iraqi Society of Physicians
and chair of the department of neurosurgery at the University of Baghdad,
addresses the Medical Coalition for Iraq meeting at APA headquarters in
September. "Security is our most urgent problem," he said.
Photo: David Hathcox
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Brennan and Timothy Gibbons, M.D., of the American Academy of Orthopedic
Surgeons and an Army reservist, spent two months last year developing the
foundation for democratizing Iraqi medical societies based on mutual interest
between Iraqi and U.S. representatives (Psychiatric News, April
2).
High-ranking U.S. government officials participated in the conference,
including Senate Majority Leader Bill Frist (R-Tenn.), Surgeon General Richard
Carmona, M.D., Joint Staff Surgeon Maj. Gen. Darrel Porr, M.D., and Department
of State Under Secretary for Global Affairs Paula Dobriansky, Ph.D.
Abdul Hadi Al-Khalili, M.D., chair of the department of neurosurgery at the
University of Baghdad, described grim public health conditions in Iraq and
security conditions in Baghdad. Al-Khalili represented the Iraqi Society of
Physicians.
Inadequate sanitation, purification of water, nutrition, and health care
have taken their toll on the health of Iraqis. The rates of liver diseases,
including hepatitis B and diphtheria, increased under Saddam Hussein, and the
cancer rate tripled between 1984 and 2004, said Al-Khalili.
The mortality rate for infants and children more than doubled from 1990 to
1998. The United Nations (U.N.) had imposed sanctions on Iraq for its invasion
of Kuwait in 1990, and the impact on Iraq's people and economy was
devastating. Half a million children under age 5 were reported to have died
between 1991 and 1998. To provide some humanitarian relief, in 1997 the U.N.
established the Oil for Food program in Iraq. This allowed Hussein's
government to sell some of its oil in exchange for U.N.-approved food and
medical supplies. However, the benefits were limited because, experts claim,
only a third of the oil revenue was used for the intended purpose. The
sanctions were finally lifted after Hussein was ousted in May 2003.
Iraq's new minister of health, Ala'adin Alwan, M.D., faces enormous
challenges. He has a budget of nearly $1 billion this year from Iraqi oil
revenue; $578 million of it will go for pharmaceuticals and medical supplies,
and the rest for operations and maintenance, said James Haveman, a former
senior advisor to the interim Ministry of Health in Iraq. He also was the
health advisor to former Ambassador Paul Bremer, the administrator of the
Coalition Provisional Authority until the interim government was installed in
May.
The United States contributed nearly $900 million for health care in 2004,
"including $498 million for the construction of new primary care centers
and the renovation of 18 maternal and pediatric hospitals to reduce the number
of infant and maternal deaths," said Haveman. "About $17 million
will be used for training health care staff, $300 million for new equipment,
and $50 million for the new hospital in Basra," added Haveman.
He observed that when he arrived in Iraq in 2002, "the ministry's
budget was $16 million for 26 million people under Saddam Hussein. This was a
90 percent reduction from a decade earlier."
A priority of the health minister is overcoming shortages of medical
supplies and equipment allegedly stolen "under the corrupt
U.N.-administered Oil for Food program, which was shut down," said
Haveman.
Corruption was widespread under Hussein's regime, and "medical
supplies and equipment often disappeared out the back door," said
Haveman. To combat corruption, independent inspector generals have been
installed in each of the ministries.
The Ministry of Health has been immunizing the country's 4.2 million
children under age 5 against preventable diseases such as polio, diphtheria,
and tuberculosis, according to the ministry's official Web
site.
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Coalition meeting organizers Col. Cameron Ritchie, M.C. (left), Maha
Alattar, M.D., and Michael Brennan, M.D. (far right), pause for a photograph
with guest speaker Abdul Hade Al-Khalili, M.D.
Photo: David Hathcox
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Al-Khalili complained that frequent power outages in Baghdad disrupt the
hospitals' security and ability to refrigerate storage of vaccines.
Kidnapping Iraqi residents for ransom took place under Hussein, but the
number of middle-class residents of Baghdad—including
children—being kidnapped has risen sharply since Hussein was ousted,
according to Al-Khalili.
"People are afraid to leave their homes and send their children to
schools. A friend of mine hired three bodyguards, and he was still
kidnapped," he said at the conference.
Al-Khalili was kidnapped in August at gunpoint. The four-day ordeal ended
when his family paid the ransom to his kidnappers.
Health minister Alwan has asked the Ministry of Interior for help in
protecting medical staff at hospitals. Guards have been posted at hospitals,
including outside operating rooms, Al-Khalili told Psychiatric
News.
The kidnappings have exacerbated the already dangerous situation in
Baghdad. Bomb explosions by insurgents are killing more Iraqi civilians than
American soldiers. When American soldiers return fire, civilians have been
killed in the crossfire, said Al-Khalili.
"Security is our most urgent problem. When the insurgents are
fighting in the districts where guards live and it's unsafe for them to leave
their homes, we have to postpone patient operations scheduled that day,"
Al-Khalili said during the interview.
The health ministry allocated $3 million for mental health care this year,
a fraction of the overall health care budget. "That was all we could
afford, given so many primary health care needs," Haveman told
Psychiatric News
About $500,000 of the 2004 mental health budget is for Iraqi-run programs
for victims of torture, said Haveman.
Scores of Iraqis including children were imprisoned and subjected to
sadistic torture by Hussein's government.
In response to concerns about security in Baghdad, Frist said at the APA
conference that about 15,000 more coalition troops would be deployed soon to
Iraq to provide more security for the nation's January elections. He did not
specify the date of deployment. The total U.S. troop count in Iraq on October
20 was approximately 130,000 soldiers.
Al-Khalili said he would prefer the U.S. military to train Iraqi troops and
police in how to handle kidnappings and hostage-taking incidents.
Frist is a volunteer on apolitical, short-term medical missions in Africa.
He said that such voluntary efforts to assist developing countries are
"the currency of peace."
John Howe III, M.D., is the president and CEO of Project Hope, an
international health foundation with offices and programs in 24 countries
including Iraq. Howe described the program in Iraq as a public/private
partnership between U.S. Agency for International Development (USAID), the
U.S. National Cancer Institute, the King Hussein Cancer Center in Jordan, and
Project Hope. The goal is to help Iraqi children with cancer obtain
state-of-the art treatment and to train health professionals in Iraq to
provide appropriate care for them. Howe mentioned that a new children's
hospital will be built in Basra with a $50 million grant from
USAID.
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Sen. Majority Leader Bill Frist, M.D. (R-Tenn., left) responds to a
question, while John Howe III, M.D., president and CEO of Project Hope, looks
on.
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Baha Alak, Ph.D., an Iraqi-American board member of Life for Relief and
Development, said the organization received a $12 million grant from USAID to
build a small community hospital in Baghdad and a women's health center in
Mosul,"which we ran for six months and left it with the local
people," Alak said. Life for Relief and Development is now a global
organization dedicated to alleviating human suffering.
Life for Relief and Development also partnered with the Coalition
Provisional Authority, Iraqi Ministry of Health, Elsevier Foundation, AMA, and
the Noor Foundation to distribute more than 30,000 medical textbooks and
reference materials to hospitals, clinics, and universities in Iraq, according
to a news release.
Security concerns surfaced again when conference participants discussed
meeting in Baghdad for the second international medical specialty forum for
Iraq next year. When the discussion turned to meeting in neighboring countries
such as Jordan, Iraqi physicians were concerned about the impact on
participation of Iraqi colleagues. Other Iraqi locations were suggested,
including Kurdistan in the north, which is relatively calm.
Information on the Iraqi Ministry of Health and its accomplishments
are posted online at
<www.mohiraq.org/overview.htm>.
Information on Project Hope in Iraq is posted online at
<www.projhope.org/where/iraq.html>.
Information about Life Relief and Development is posted online at
<www.lifeusa.org>.
Related Article:
-
Americans Help Iraqis Build Community Mental Health System
- Christine Lehmann
Psychiatr News 2004 39: 19-47.
[Full Text]
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