United Nations health officials are concerned about the outbreak of disease from poor water and sanitation conditions in Iraq if the war drags on. But so far, they say, conditions are stable.
The World Health Organization's Ghulam Popal has run the WHO operation inside Iraq since 1999. He says the health situation so far appears to be under control in the north of the country.
But he is concerned about the situation in Baghdad and areas farther south. He says hospitals in the Iraqi capital are overburdened. "There is no acute shortage of items but hospitals are overcrowded, overloaded, overstretched," he said. "And we are afraid that if the situation continues as such they will not be able to cope with the treatment of the high number of cases."
Mr. Popal and international WHO staff had to leave Baghdad just before the war started. He says 330 Iraqi national employees continue to provide technical and logistical support to local health facilities. They are in daily contact by phone, radio and e-mail.
Before the war, the World Health Organization and other U.N. relief agencies managed to stockpile medical supplies inside Iraq to meet the basic health needs of one million people for three months. There are also emergency stocks in neighboring countries for several hundred thousand more. But Mr. Popal says it is not that much, considering Iraq's population surpasses 24 million.
Mr. Popal warns of a health crisis in the southern city of Basra even though medical supplies were stockpiled there too. He cites the power cuts and insufficient supply of clean drinking water, which could spark an outbreak of waterborn diseases.
WHO rapid assessment teams, he says, are still not able to reach the city because of fighting around the area.
Ghulam Popal also highlights what he calls the indirect health risks of war. "The mass media focus mainly on the direct consequences of this war, direct like wounded and deaths, which is not that high a number," he said. "But indirect impact of this war is very, very high. We have communication with our staff and they are telling us stories that most of the children cannot sleep until the morning. They are screaming. They are afraid. And they have many nightmares. Women as well, particularly pregnant women, are very much vulnerable to this situation. People are afraid to go to their health facilities because of the bombardments."
Mr. Popal says the Iraqi population is more vulnerable to a health crisis now than during the Gulf war in 1991.
He says that before 1990, Iraq's health care system was one of the best in the region. But destruction during the Gulf war and 12 years of sanctions have taken a toll. "So this is our fear," he continued. "The consequences will be much higher than 1991 because in 1990 when the war started they had a good health system. The people were strong with high resistance. Now the people are very weak. The economy is weak. The nutrition status is very bad. The diseases are very common. The water situation is not good. Sanitation is not good. So the consequences will be very, very high."
The WHO official says the U.N.-sponsored oil-for-food program set up in 1996 has helped to stabilize the situation, but it was suspended when war erupted. Mr. Popal says it is critical to get it running again and points out the program distributes both food and basic medicines.
On a personal note, he remembers how hard it was when U.N. orders were issued to leave Iraq on March 18. "I was the last to be evacuated," said Ghulam Popal. "I was in the last convoy in the last car. It was a very emotional time to leave our national staff, hundreds of them, and also to leave behind the people who at this very difficult time need our help."
Mr. Popal is not sure when he will be able to return to Baghdad. That decision, he says, will depend on a U.N. assessment of the security situation once the fighting ends.