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Iraq Struggles to Rebuild Health Care System - 2004-08-11


As Iraq rebuilds after war, its devastated health care system is among the highest priorities. Iraqi health officials say good medical care is a prerequisite for a strong economy. The road ahead is long for a country where life expectancy has declined and basic medical supplies and trained health care workers are scarce.

Baghdad used to be a capital where the Middle East's more financially secure people went for medical care. Today, however, an Iraqi physician is lucky to have a stethoscope or a recent medical journal.

Health Minister Ala'adin Alwan says three wars, international economic sanctions, and years of neglect under Saddam Hussein degraded a once advanced health care system to the point of almost complete collapse. Health statistics took an equally precipitous drop since the 1991 Gulf War, with life expectancy, for example, declining from 67 years to 59.

"Mortality rates increased and almost tripled for infants, children, and mothers between 1990 and the year 2000," he said. "The physical infrastructure of primary health centers and hospitals has very seriously deteriorated to the degree that they are now incapable of delivering basic health services of acceptable standards."

Iraq's dysfunctional hospitals have few working toilets. An absence of generators leaves such facilities vulnerable to power outages. An advisor to the U.S.-led coalition that toppled Saddam, James Haveman, told a recent Washington meeting that the country's doctors are years out of date after long isolation from the world, and were often the target of Saddam's government.

"Physicians caught a lot of the wrath of Saddam Hussein," said Mr. Haveman. "I'll never forget standing in the hanging chamber of Abu Gharib prison, where tens of thousands of people were hanged, many of them professionals that ended up in mass graves."

Rebuilding Iraq's health care system is almost like starting from the beginning, and that is precisely where American government and Iraqi Health officials began when the U.S. led-coalition forces took control of the country in April, 2003.

The official in charge of U.S. military health issues, Dr. William Winkenwerder, says initial efforts have focused on basic matters such as improving water and sanitation supplies and reversing the decline in the health of children and mothers through better nutrition and immunization rates.

"A strategic plan was developed with attention to strengthening the area of preventive medicine, community health, and maternal and child care," he explained. "This coordinated effort leveraged the talents of countless organizations and people while providing Iraq with the management tools and other resources needed to start their reconstruction journey."

Iraq spent only $20 million on health care in 2002. Now, the Ministry of Health has a $1 billion budget. Most of the money comes from oil revenues, but the United States and other nations are supplementing this as the result of last year's donors conference in Madrid. This does not mean the Ministry is awash in money, but the increase has raised health care spending from 68 cents per Iraqi in 2002 to about $40 today.

As a result, Iraq's 240 hospitals are running despite severe shortages of medicines and other supplies and staff are being paid after going unsalaried for months leading to the 2003 war.

Health Minister Alwan says the most urgent needs continue to be overcoming the shortages and repairing medical facilities. In the longer term, he wants to focus on training more health care workers and people with skills to administer medical facilities. Decentralization from Baghdad's control is another government priority.

"There is a great deal of encouragement for the private sector to expand in Iraq and already we have policies to encourage the expansion of the private sector," he noted. "In the meantime, our focus as far as the public sector is concerned will be on strengthening primary health care and also rehabilitating the major Ministry of Health hospitals so that we could continue to provide better quality health services."

United Nations agencies such as the World Health Organization, UNICEF, the World Food Program, and the U.N. Industrial Development Organization are working with the World Bank to advise Iraq's Health Ministry as it moves forward on its ambitious overhaul.

U.S. military medical official William Winkenwerder calls it a new beginning for Iraqis, despite the formidable challenges ahead.

"The healing process to improving the health of Iraqis is under way and I'm confident that Iraq's leaders will use the opportunity to continue this healing process," Mr. Winkenwerder said.

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