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Experts Assess Iraq's Humanitarian, Public Health Priorities - 2003-04-22

In the wake of the U.S.-led war that toppled the dictatorship in Iraq, looting and lawlessness have complicated efforts to restore essential medical services and to treat soldiers and civilians injured in the war.

The World Health Organization and the International Red Cross have begun an assessment of the health care system in Iraq. They report severe problems in many parts of the country where hospitals have been looted and records destroyed. Some medical professionals reportedly have armed themselves and are living in hospitals in an effort to defend the facilities.

WHO spokeswoman Melanie Zipperer says the most important immediate goal is to halt the looting, vandalism and arson. She explains that beyond the security concerns, the most urgent needs are drinking water, electricity and access to basic medical care. "The medical staff will not be able to continue working unless a system is put into place to recompense them. Maintenance and cleaning," she said. "Many hospitals have been damaged by conflict or looting and they need repairs and must be kept clean."

The United Nations Security Council has identified $395 million in priority humanitarian needs, including food, agriculture goods, medicine and health supplies to be shipped to Iraq.

Most of the goods were already in transit when the war began under the United Nations administered Oil-for-Food Program, which has had an established distribution network in Iraq since 1997. The program was interrupted when the U.N. evacuated personnel from Iraq on March 17, although the Security Council has authorized extending the program for 45 days.

Michael Van Rooyen directs the Johns Hopkins Center for International Emergency, Disaster and Refugee Studies in Baltimore, Maryland, visited Iraq before the war. He reviewed humanitarian contingency plans and found a public health care system weakened by the economic sanctions the U.N. imposed after the Gulf War in 1991. He says what he hadn't expected in the aftermath of the current conflict was widespread looting and lawlessness directed at hospitals.

MICHAEL VAN ROOYEN: "I didn't expect that at all. Iraq is not like Afghanistan. It was not as if people were deprived of resources forever. Yes, they had to sell assets to make ends meet, but people were not starving. There was trade going on. People were still employed. And so the economy, while weakened, was still functional. So I did not expect or predict the widespread looting at all. And that being the case, I think that it is just going to increase the need for rehabilitation, such that we didn't expect structural rehabilitation. We thought that hospitals would be intact, and there would be lack of basic equipment and we could get it there, but now [they are missing] light fixtures, wires and sinks, and everything else, as well as hospital equipment, is gone. And, if that is really the case, the rehabilitative needs are substantial."

ROSANNE SKIRBLE: "You had gone to Iraq, you were looking at contingency plans. What were those plans, and did the hospital looting change the equation?"

MICHAEL VAN ROOYEN: "Yes, the contingency planning that was going on was on behalf of the non-governmental organizations who were in the country, of which there were very few. There were only, I think, nine organizations that were allowed to operate in the country. So, as the emergency continued to build, as the military forces built in the region, organizations were amassing to the borders of Amman and Kuwait getting ready to come in. But those organizations are still not functional, not able to work in the country. Those organizations that had a foothold in the country already were the only ones trying to plan, although I don't think anyone planned for this. I think people really planned for greater amounts of population displacement, in which it turned out to be not much at all. I think they were worried about food emergencies, but we wouldn't see food emergencies for the next couple of months because people have had access to advanced rations."

ROSANNE SKIRBLE: "What is it going to take to get the health care system up and running again."

MICHAEL VAN ROOYEN: "I think first and foremost is security, the reestablishment of civil society, the reestablishment of authority, of a secure environment is job one. If that can be accomplished that can set the stage for a more concerted rehabilitative effort. And, then there are levels of need. The first is going to be re-equipping hospitals and clinics and the health care system, which will need to happen relatively urgently. And then it is actually re-equipping the personnel, and that is through education. Again, the health manpower was excellent in Iraq, but people have suffered from lack of educational opportunities and lack of outside contact. So there is going to be a significant need to bolster the health manpower issues."

ROSANNE SKIRBLE: "How do you go about accomplishing those goals?"

MICHAEL VAN ROOYEN: "I think that non-government organizations, and the U.N. agencies and the World Health Organization need to have a concerted and coordinated effort. That's not always easy with non-government organizations because people are always doing their own thing. To really coordinate adequate and appropriate hospital services we're not talking about trying to fly in MRIs and CTs and dropping them off we're talking about re-equipping operating rooms with basic supplies and re-equipping clinics with scales and basic things like that. So, a coordinated national assessment of what really is gone and needs to be replaced is going to be necessary, and delivery and accountability for those deliveries, and eventually to find out where people are at in terms of health education."

ROSANNE SKIRBLE: "What do you think the greatest challenges to get these jobs done?

MICHAEL VAN ROOYEN: "I think as in any humanitarian emergency the two major challenges are coordination, meaning that people talk and agree with each other so they are on the same page because it is a mammoth task to reestablish this food distribution system, to reestablish and revitalize the health care industry and to transition it over to a semi-private system that it had been and worked pretty well, and to coordinate the non-governmental organizations there are probably 50, 60, 70 lining up in Amman and elsewhere, anywhere from very big organizations like CARE, for example, to very small organizations. Coordinating all those activities is really very difficult. And, the second thing is logistics, getting things where they need to go. Just because you are a physician from Dayton, Ohio and you show up in a hospital in southern Iraq means nothing if you don't have equipment or supplies. I think that is a great misunderstanding that by throwing doctors and professionals into a situation, it is not going to help so much. What those people need is equipment and supplies and to reinvigorate their health finance system and all of it. It is a complicated job that needs a lot of coordination."

ROSANNE SKIRBLE: "And what does Iraq have going for it to make it not such an arduous task?"

MICHAEL VAN ROOYEN: "Iraq has much going in its favor in terms of rehabilitation. It is a country that has well-established professionals. It is country that is very well developed. It has an excellent education system. It has an excellent health care system at baseline. It has a lot of resources and it is very capable of rising to this challenge especially if there is the establishment of security in civil society. If that happens, if security is maintained and reprisals are minimal and ethnic instability is minimal. Then there is no reason why Iraq should be able to do very well."

Michael Van Rooyen heads the Johns Hopkins Center for International Emergency, Disaster and Refugee Studies.