Healthcare in Iraq

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Healthcare in Iraq - Update

Filename:0421pgf.91



Subject:  Healthcare in Iraq - Update

KEY JUDGMENT:      Current disease incidence in Iraq most likely  
 is higher than it was before the Gulf War but not at the 
catastrophic levels that some groups predicted.  Increased disease
incidence above prewar levels is more attributable to the regime's
inequitable restoration of public health services rather than 
effects of the war and sanctions.  Since Iraq's medical 
infrastructure is essentially intact, the primary health-related 
task is restoring supporting services, such as water treatment, 
sanitation, and electric power.

        Direct damage to Iraq's healthcare infrastructure during 
DESERT STORM was small because medical facilities were not targets 
of the campaign.  Indirectly, however, damage caused by DESERT  
STORM and ensuing Iraqi civil unrest did have a major impact:

        --  Iraq had to treat a large number of war casualties.

        --  Iraq's loss of electric  power reduced the ability of
   hospitals to treat patients, while the breakdown of water
   distribution increased the likelihood of hospital-acquired
   infections.

        --  Contaminated drinking water and improper waste 
disposal
   increased the incidence of communicable diseases, primarily    
    acute diarrheal diseases.

        --  During extensive internal fighting that followed 
DESERT
   STORM, a number of hospitals reportedly were shelled and 
looted,
   and healthcare workers were routed.

     On the positive side, most of the country's medical 
facilities  are believed to be operational.  In addition, 
international relief organizations have provided large amounts of 
aid to Iraq, including power generators, water purification 
systems, sewage equipment, and food, water, and medicine.  
Humanitarian assistance has played an important role in restoring 
public health services.

    However, the true medical situation in Iraq is difficult to  
gauge because the regime did not report adequate pre-war disease 
surveillance data and current disease reporting is used for its 
own political purposes.  Although there are no adequate prewar 
baseline figures for comparison, most of the current disease 
incidence
statistics reported through the Iraqi government are considered to 
reflect normal incidence levels.  Much of the current reporting, 
therefore, may be part of an attempt to gain international 
sympathy.

    Morbidity and mortality forecasts publicly provided by 
international and private medical organizations frequently have 
been based on incomplete information.  Baghdad continually 
restricts the access of foreign observers, limiting the quantity 
and quality of collected data.  Many of the original estimates 
assumed that health and living conditions would not improve, which
led to significant overestimates of projected forecasts.  UNICEF  
recently reduced its estimates of Iraqi children at-risk from 
170,000 to between 50,000 and 80,000, due to the restoration of 
essential services and international relief efforts.

     Even before it invaded Kuwait, Iraq had major deficiencies in 
 its medical facilities and staffs.  State of the art healthcare 
was  limited to only a few premier hospitals, primarily because of 
fiscal constraints, military priorities, and the government's 
general lack of concern.  Current restoration efforts are likely 
to be limited by the same factors.

                    Current Iraqi claims that disease incidence 
has increased above prewar levels is more attributable to the 
regime's inequitable restoration of public health services rather 
than effects of the war and sanctions.  [   (b)(1) sec 1.3(a)(4)  
 ]
                       indicated that life in Baghdad essentially 
has returned to normal, with no signs of poverty or food 
shortages.  Government reports linking increased disease mordibidy 
(particularly  cholera, typhoid fever, hepatitis A, amoebic 
dysentery, and brucellosis> and disease mortality (especially 
among children) to medicine and vaccine shortages created by the 
international embargo are particularly misleading.  The diseases 
commonly cited are fundamentally prevented through the provision 
of safe food and water, not curative medicine or public 
vaccinations.

    AFMIC expects that Iraq's incidence of disease will continue 
to stabilize in a range that is somewhat above pre-crisis levels, 
with discriminated groups (particularly Kurds, Shiites, other 
groups opposing the regime) having more severe medical problems.  
Further improvements in the health sector will depend on the 
regime's continued ability and willingness to restore services 
essential to public health (i.e. electricity and potable water) to 
adequately fund preventive medicine programs, pharmaceutical 
purchases, and hospital-based services; and to provide health 
services equitably to all regions of the country.


[   (b)(6)   ]
[   (b)(6)   ]
[   (b)(6)   ]
Armed Forces Medical Intelligence Center