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Iraq faces growing health crisis

October 13, 2004 By Mark Peplow This article courtesy of Nature News.

Crippled system struggles to cope with deadly diseases.

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The rising tide of disease in Iraq could kill more people than the military conflict has, according to the country's Ministry of Health.

In the first official government survey of Iraq's health since a number of countries, known as the coalition forces, invaded in March 2003, a detailed report reveals a crumbling health service unable to deal with an epidemic of typhoid, tuberculosis and other infectious diseases.

More Iraqis may have died as a result of ... neglect of the health sector over the past 15 years than from wars and violence.
Dr Ala'din Alwan
Minister of Health, Iraq
Disruption to water supplies during the conflict means that roughly 20% of urban households now have no access to safe drinking water. This has led to 5,460 cases of typhoid in the first quarter of 2004, the report estimates. In rural areas, more than half of households are without fresh water or adequate sanitation.

Measles and mumps are infecting thousands of children, partly because a third of them are chronically malnourished, it is reported. There were 8,253 cases of measles reported in the first half of 2004, with Basra particularly badly hit. In 2003, there were just 454 cases.

Likewise, the first four months of 2004 saw 11,821 cases of mumps, nearly 5,000 more cases than there were in the whole of the previous year.

Although Iraq has enormously valuable oil reserves, an estimated 27% of the population live now on less than $2 a day. Life expectancy has fallen to below 60 years of age for both men and women.

The report is presented today by Ala'din Alwan, minister of health for Iraq, at a meeting of donors to the Iraqi International Reconstruction Fund Facility in Tokyo, Japan.

Strained service

Alwan's report says that in the aftermath of the coalition invasion, a third of Iraq’s health centres were looted of vital equipment, with one in eight hospitals suffering the same fate. The health service is being strained further by staff shortages, an unreliable electricity supply and the ongoing violence in Iraq, leaving it unable to stem the growth in infections.

"I'm not surprised by this at all. The breakdown of sanitation and public health services is a huge problem in Iraq," says Gilbert Burnham, a public health researcher and co-director of the Center for International Emergency, Disaster, and Refugee Studies at Johns Hopkins University, Baltimore, Maryland. Burnham leads a team that is gathering its own evidence about the health impacts of the conflict. "Our research supports these conclusions," he says. The team plan to publish their research in the next few months.

The violence that still rocks Iraq is also an important factor, adds Burnham. "People are afraid to go out and get health care," he says.

"Currently, the emphasis in Iraq is on training clinicians in emergency care. Basic public health concerns - clean water, food and so on - are low on the priority list," Burnham says. "Whenever there are conflict situations, public health goes down."

"One of the major issues of reconstruction is to put a decent public health system in place," he adds.

Deadly decline

As well as addressing current health concerns, the report also details the Iraqi health service's 15-year decline under Saddam Hussein's rule. "More Iraqis may have died as a result of ... neglect of the health sector over the past 15 years than from wars and violence," says Alwan in the report.

Alwan adds that Iraq's health is now comparable with countries like Sudan and Afghanistan; 15 years ago it rivalled that of rich nations such as Jordan and Kuwait. "Iraq used to be the place to go in the middle East for clinical care," says Burnham.

Despite the rise in infectious diseases, cardiovascular disease still ranks as the number-one killer in Iraq. This is largely owing to poor diet and a very high prevalence of smoking, but it is exacerbated by a lack of public health initiatives to change the population's lifestyle.

Continuing problems

Declining health is just one of the problems now facing Iraq. Last month, scientists started assessing the environmental situation in the aftermath of the war (see " Iraq to tackle toxic 'hot spots'".

And on 11 October, additional concerns about security in Iraq were raised by the International Atomic Energy Agency. The agency said equipment and materials that could be used to build nuclear weapons had been lost from the country. It presented satellite photographs showing that sites relevant to Iraq's nuclear programme had been systematically dismantled, even though the Iraqi government had reported no such activity.

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