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Filename:03-91a
                     Armed Forces Medical Intelligence Center
                                  Assessment


                  
Key Judgments

   Degraded medical conditions in Iraq are primarily attributable 
to the breakdown of public services (water purification and 
distribution, preventive medicine, waste disposal, health care 
services, electricity, and transportation).

   -Assessment of Iraq's public health needs has been hampered by 
the absence of reliable reporting. Disease reporting remains 
unverifiable and is considered biased. The prevalence of some 
diseases has increased, but major disease outbreaks have not been 
confirmed.

Conditions in major urban areas affected by bombing are favorable 
for communicable disease outbreaks.  Delayed restoration of public 
health services and approaching warmer temperatures increase the 
likelihood of significant disease outbreaks. Additionally, Iraqi 
health organations currently are incapable of adequately
responding to disease outbreaks.

   Collateral (blast overpressure) damage to hospitals due to 
coalition bombing has not been confirmed but can be expected in 
facilities located in proximity to structures targeted by 
coalition forces; it is believed that no hospitals were destroyed. 
There have been unconfirmed reports of hospitals being damaged or 
destroyed
as a result of the current civil war.

   Hospital care is degraded by lack of running water and 
electricity. Hospital-acquired (nosocomial) infections can be 
expected to increase significantly.

   Iraq hospitals are experiencing significant medical supply and 
staff shortages. The situation is believed to be worse in civilian 
facilities than in military facilities.

   Current health care conditions in Iraq should be assessed in 
context with the poor quality and administration of health care 
that extsted prior to August 1990


[      (b)(1) sec 1.3(a)(4)    ]









DISEASE OCCURRENCE

As accurate assessement of the public health situation in Iraq has 
been hampered by the absence of reliable reproting.  Iraqi-
controlled news, released to Western audienes from Baghdad, on  
sanitary conditions and disease incidene is considered biased. 
Epidemiologic surveillance and disease reporting by Iraqi agencies 
have been disrupted, and reported figures (such as numbers of 
cases and disease rates) enerally are only questionable estimates. 
 The Iraqi government has mandated the departure of news personnel 
and limited the acess of some relief agency observers, making 
evaluation of actual health conditions (disease, incidence levels, 
and groups affected) unclear.  Restrictions placed by the Baghdad 
government on the numbers, duration, and movements of 
international medical volunteers in Iraq significantly limit the 
scope and detail of observations.

The prevalence of some diseases has increased in Baghdad, but 
major disease outbreaks have not been confirmed.  Open source news 
releases, citing international and Iraqi health officials, 
indicate that communicable diseases in Baghdad are more wide-
spread than usually observed during this time of the year and are 
linked to poor sanitary conditions (contaminated water supplies 
and improper sewage disposal) resulting from the war.  According 
to a joint World Health Organization (WHO) and United Nations 
Children's Fund (UNICEF) report, the quantity of potable water in 
Baghdad was reduced to less than 5 percent of the original supply 
as a result of the war; the incidene of diarrhea was four times 
above normal levels.  Respiratory infections similarly increased. 
 Children particularly have been affected by these diseases.  
Increased incidene of tyhpoid and cholera has been reproted by 
Iraqi Red Crescent officials, buth the spread of these diseases 
has not been confirmed by other international nongovernmental 
agencies with representatives in Iraq.

Although urban areas have been affected by indirect consequences 
of bombing, there are conflicting indications about the 
population's ability to cope with the degraded consitions.  While 
the Cable News Network (CNN) has provided coverage of Baghdad 
residents scooping water out of the Tigris River, waterborne 
diseases can be minimized by boiling, filtering, and disinfecting 
(treating) the water prior to use.  Civil defense preparations 
prior to the onset of the wqr instructed inhabitants on how to 
protect food and water from contamination and to purify 
contaminated supplies.  Radio broadcasts continue to provide 
precautionalry measures for preventing diseases, but WHO/UNICEF 
reports that these measures commonly are unheeded; reportedly, 
residents are using scare fuel for purposes other than boiling 
water.  Moreover, government health agencies lack the capability 
to test water for potability.

Conditions in major urban areas, particularly 
Baghdad and Al Basrah, remain favorable for communicable disease 
outbreaks.  Additionally, Iraq health organizations currently are 
incapable of adequately responding to disease outbreaks.  The 
delayed restoration of public health services and approaching 
warmer temperatures will increase the likelihood of significant 
disease outbreaks; civil disturbances could further delay 
infrastructure repairs.

Food and waterborne diseases have the greatest potential for 
outbreaks in the population; these diseases include acute 
diarrhea, tyuphoid, cholera, hepatitis A, and brucellosis.  Other 
likely communicable diseases include childhood diseases 
(diptheira, pertussis, tetanus, measles, and polio), meningitis, 
acute respiratory infections, and tuberculosis.  The Expande 
Program of Immunization (EPI) has been interrupted.  Generally, 
increases of vectorborne diseases (leishmaniasis, schistosomiasis, 
and malaria) will be more of a long term problem; however, 
increased incidence can be expected with approaching warmer 
temperatures.

[      (b)(1) sec 1.3(a)(4)    ]







[   (b)(6)   ]




 



 

 

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