HEALTH CONDITIONS IN IRAQ AND PROSPECTS FOR THE FUTURE

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Subject:       HEALTH CONDITIONS IN IRAQ AND PROSPECTS FOR THE FUTURE

     The increased disease incidence in Iraq should stabilize over
the next six months. Overall improvement in the medical.conditions
in the civilian population will be determined by how quickly
essential supporting services (water, sanitation, and electricity)
are restored. Iraq's healthcare infrastructure essentially 
remained
intact during DESERT STORM and during the civil unrest, improving
the future outlook.


     Iraqi healthcare capabilities prior to August 1990, while on
the ascent,  suffered significant deficiencies, particularly in
quality and quantity of healthcare staffing, and the availability
and distribution of medical material. Modern medical treatment
protocols, equipment, and medicines were limited to only a- few
premier hospitals, primarily because of financial constraints,
military priorities, and to a general lack of governmental concern
and support. Current restoration efforts are likely to be limited
by the same factors.

           The  extent  of  direct  damage  to  Iraq's  healthcare
infrastructure during DESERT STORM cannot be fully assessed at 
this
time.  However  significantly more  damage  occurred  during  the
subsequent civil war. A number of hospitals located in cities that
were sites of the heaviest fighting were reportedly shelled and 
the
interiors looted and healthcare workers routed. Overall, most of
the country's medical treatment facilities are believed intact and
operational. These include an estimated 18 new, potentially full
service hospitals (15 civilian and thr,e military) constructed in
major cities since the early l9SOs. Tfle loss of electrical power
and water significantly reduces hospital treatment capabilities 
and
increases the potential for hospital acquired infection.  While
these services are being restored to Baghdad hospitals; hospitals
outside Baghdad are likely to remain without power and water for
quite some time to come.

    During the 198Os, communicable disease incidence in Iraq was
lowered primarily through improved sanitation and health care
delivery. The breakdown of public services (water purification and
distribution,  waste disposal,  electricity,  communication,  and
transportation)  has been the primary cause for degradation of
health conditions in post-war Iraq. As a result, the incidence of
communicable diseases (primarily diarrleal and acute respiratory
diseases) in civilian populations has increased.

    However, the disease situation cannot be precisely determined.
There is no reliable baseline for determining the magnitude of
increased disease occurrence in Iraq, as pre-crisis Iraqi disease
surveillance  reports were insufficient  for determining normal





disease levels. Post-crisis reports will remain incomplete and
probably will be politically biased. For example, although cholera
is known to be endemic in Iraq, no cases were reported between 
1978
and the end of DESERT STORM. Therefore, initiation of cholera
reporting in May 1991 may be an attempt by the Iraqi Government to
gain international sympathy.

      Current and forecasted morbidity and mortality estimates
provided by international and private medical Organizations are
based  on  incomplete  data  and  may  be  misleading.  Based  on
information obtained during late March to early May 1991, 
estimates
on the amount of increased diarrheal cases' have range from two to
tenfold  above normal  levels.  However,  the  Iraqi  government
continually has restricted foreign observers' access to locations,
facilities, and medical records, thereby limiting the quantity and
quality of collected data. Even if accurate, the recent 
projections
by a Harvard medical team of an increased 170,000 child deaths in
1991 only represent an increase of the 5 percent pre-crisis child
mortality rate to 10 percent. Additionally, the projections may be
an over-estimate because their data only covered a two week period
and they assumed that health and living conditions would not
improve during the summer.

      Health conditions can be expected to improve as public 
services are restored and the population learns to cope with the 
current situation. Moreover, Iraq has received massive amounts of 
aid in the form of power generators, water, water purificatio
sewage equipment, food, and medicines from international 
assistance agencies. The bulk of initial Iraqi government and 
international public service and medical reconstruction efforts, 
however, appears to have been primarily limited to Baghdad and the 
capital region.

      Over the next six months,  AFMIC analysts expect disease
incidence in Iraq to stabilize above pre-crisis levels, but below
the  levels  projected  by  the Harvard  team.  Although disease
outbreaks are expected, actual morbidity and mortality rates will
not be known. Communicable diseases with the highest potential
public health impact (in descending order) include acute 
diarrheas,
acute respiratory infections,  typhoid and paratyphoid fevers,
childhood diseases, hepatitis A, and cholera; children and the
elderly are at increased risk.  Populations most likely to be
severely  affected  are  the  Shiites  in  southern  Iraq,  lower
socioeconomic groups in major urban areas, and the Kurds in the
north.

                             (Epidemiology Branch)


ARMED FORCES MEDICAL INTELLIGENCE CENTER