Charity warns of “daunting challenges” for Iraq health system

Iraq's Ministry of Health faces “daunting challenges” in its effort to rebuild the country's shattered medical infrastructure, according to a report released this week by the health charity Medact. “Even if the circumstances were much more auspicious, the difficulty of reversing this downward spiral could not be underestimated,” suggests the report.

Figure 1.

Hala Madkoor, 24, injured by a roadside bomb in Iraq, is comforted by her brother at a Baghdad medical centre

Credit: KARIM KADIN/AP

The report mostly avoids allocating blame for the cumulative damage wreaked by dictatorship, three wars, and years of sanctions. It accepts, however, the findings of a recent study, published in the Lancet, which concluded that the invasion and its aftermath have led to an increase in civilian mortality of roughly 100 000 since March 2003. It adds that the 2003 war “not only created the conditions for further health decline, but also damaged the ability of Iraqi society to reverse it.”

Based partly on interviews with Iraqi and foreign health professionals, the report traces the decline of Iraq's health system not from 2003, but from 1990. After the Kuwait war, the Ba'athist government increasingly abandoned its healthcare responsibilities and allowed creeping privatisation. This year's national health service budget of $950m (£502m; €716m), which works out to $38 per capita, compares favourably with the $16m spent by Saddam Hussein in 2002.

From 1990, says the report, “the health system focused on curative, hospital-based care at the expense of already inadequate community services, health promotion and disease prevention. The net effect was that the health system failed to reorient itself to postwar needs and was poorly prepared to cope with the impact of the 2003 war.”

Among current positive signs are a recent national measles, mumps, and rubella immunisation campaign for school age children, which reports 97% coverage, and a dramatic rise in health workers' salaries. A doctor's monthly salary has risen from $20 to $120-$180, and a nurse earns from $60 a month.

Nevertheless, the doctor to population ratio is poor. Recent studies found 47 doctors per 100 000 population, less than half the ratio in neighbouring countries. The total of 16 700 civilian nurses for a population of 26 million represents an even more critical shortage, says the report.

In more prosperous days, Iraq depended heavily on foreign health workers. Most left long ago, and the security situation is now accelerating the brain drain among Iraqi nationals. Doctors are considered high value kidnap targets by criminal gangs, and Medact reports attacks on ambulances, staff, and hospitals by both insurgents and coalition troops.