The health of Iraqis continues to decline more than 18 months after the invasion, and this year has seen a dramatic increase in the toll of infectious disease, a report released last week by the Iraqi interim government's Ministry of Health says.
Ala'din Alwan, interim health minister, presented the report to a conference of the International Reconstruction Fund Facility for Iraq in Japan last week. “More Iraqis may have died as a result of inappropriate health policies, sanctions, and neglect of the health sector over the past 15 years than from wars and violence,” said Dr Alwan.
The greatest deficiencies are in primary care, public health infrastructure, and essential drugs. Fewer than a quarter of diabetic people in Iraq have access to insulin, and cancer drugs are almost non-existent despite an unexplained surge in cancer rates since the early 1990s. The report also notes a growing problem of post-traumatic stress disorder in children.
Figure 1.
Hidaya al-Kaabi, aged 3, of Baghdad has a middle ear tumour, and her family has been advised to take her abroad for treatment. Cancer drugs are almost non-existent in Iraq, a new report says
Credit: MARK SHERMAN/AP
But the most dramatic evidence of deteriorating health is the burden of infectious disease, driven by poor sanitation and growing malnutrition. One of the most serious threats is typhoid. The report estimates that there were 5460 cases of typhoid in the first quarter of 2004. In the first half of 2004, 8253 cases of measles were reported, up from 454 cases in the whole of 2003. The ministry reported 11 821 cases of mumps in the first four months of this year, nearly double the figure for the whole of last year.
Wartime damage to water treatment facilities has gone largely unrepaired. A fifth of urban households and more than half of rural households are without access to safe drinking water, says the report.
Security concerns have impeded work on water and sewerage facilities around Baghdad, but the most neglected area is the relatively peaceful British-run zone of Basra. Ross Mountain, UN acting special representative for Iraq, says that pre-war water levels are unlikely to be restored to Basra by the end of the year. Basra has seen some of the highest rates of diarrhoea and infectious disease.
Dr Alwan said that Iraq's population was one of the healthiest in the region in 1990, rivalling Jordan and Kuwait, but he compared Iraq's public health today with that of Sudan, Yemen, and Afghanistan. “Iraq used to have one of the best health services in the region, but Saddam did not consider it a priority. The budget was cut by 90% [during the sanctions period],” he said. The invasion itself destroyed much of what was left. One in three clinics and one in eight hospitals were looted or vandalised in the chaotic aftermath, said Dr Alwan.
Life expectancy has fallen to below 60 for both men and women, he added, and poverty has risen. One in three children are chronically malnourished, and 27% of the population now live on less than $2 (£1.11; €1.60) a day.