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Iraq 10 years on: War leaves lasting impact on healthcare

Photo: Heba Aly/IRIN
This boys family is displaced and cannot afford to take him
to hospital
DUBAI, 2 May 2013 (IRIN) - Of all the areas of Iraqs
development that were affected by the US-led invasion 10
years ago, healthcare has probably taken the biggest hit.

The impact of the 2003 invasion and subsequent conflict on Iraqs healthcare system has been well-
documented. (Check out consistent coverage of the health consequences of Iraqs conflict by the Lancet
medical journal here.) The conflict shattered Iraq's primary healthcare delivery, disease control and
prevention services, and health research infrastructure. Attempts to resurrect Iraq's healthcare system
remain hindered by a number of factors, including fragile national security and lack of utilities like water
and electricity.

Much of the damage incurred in the first few years of the invasion continues to have an impact today.

Lasting legacy

Iraq had prioritized healthcare at least since the 1920s, when the Royal College of Medicine was formed to
train doctors locally. By the 1970s, Iraqs health care system was one of the most advanced in the region,
according to researcher Omar Al-Dewachi, a medical doctor who worked in Iraq during the 1990s before
emigrating to the US. Health indicators improved quickly and significantly in the 1970s and 1980s, only to
deteriorate again after the first Gulf War of 1991, which destroyed health infrastructure, and during a
decade of sanctions, which drastically reduced government spending on health and led to a brain drain in
the medical profession.

After the 2003 invasion, the healthcare situation deteriorated considerably, and Mac Skelton, a contributor
to the Costs of War project, fears it may never recover. Between 2003 and 2007, half of Iraqs remaining
18,000 doctors left the country, according to Medact, a British-based global health charity. Few intend to
return.

Getting back to that robust, excellent standard [of healthcare] is not going to happen anytime soon,
Skelton told IRIN. Unlike buildings that can be rebuilt, migration patterns arent reversed easily.

In 2011, according to the World Health Organization (WHO), Iraq had 7.8 doctors per 10,000 people - a
rate two, if not three or four times lower, than its neighbours Jordan, Lebanon, Syria and even the
Occupied Palestinian Territory. In the Muslim world, Iraqs doctor-patient ratio is higher only than
Afghanistan, Djibouti, Morocco, Somalia, South Sudan and Yemen.

In a recent article in the Lancet, the aid group Mdecins sans Frontires (MSF) said that until now, it is
extremely difficult to find Iraqi medical doctors willing to work in certain areas because they fear for their
security.

According to MSF, many remote areas were excluded from state reconstruction and development efforts,
leaving thousands of Iraqis without access to essential healthcare to this day.

Nearly all families - 96.4 percent - have no health insurance whatsoever and 40 percent of the population
deems the quality of healthcare services in their area to be bad or very bad, according to the Iraq
Knowledge Network (IKN) survey of 2011.

As a result of the poor quality of care in their country, many Iraqis now seek healthcare
abroad, increasingly selling homes, cars and other possessions to afford to do so, according to Skelton,
who interviewed Iraqis seeking healthcare in Lebanon.

And researchers are still questioning the degree to which white phosphorus and depleted uranium, the
armour-piercing, radio-active metal used in British and American ammunition, has increased cancer rates
and caused birth defects.

The environmental damage caused by the war - degradation of forests and wetlands, wildlife destruction,
greenhouse gases, air pollution - will also have a longer-term impacts on health, according to the Costs of
War project.

Mental health

A 2007 survey by the government and WHO found that more than one-third of respondents had
significant psychological distress and presented potential psychiatric cases. A 2009 government mental
health survey concluded that mass displacement and a climate of fear, torture, death and violence have
contributed to the high ratio of mental illness in the country.

In a new report released last month, MSF said mental health continues to be a major problem in the
country.

Many Iraqis have been pushed to their absolute limit as decades of conflict and instability has wreaked
devastation, Helen ONeill, MSFs head of mission in Iraq, said in a statement.

Mentally exhausted by their experiences, many struggle to understand what is happening to them. The
feelings of isolation and hopelessness are compounded by the taboo associated with mental health issues
and the lack of mental healthcare services that people can turn to for help.

Improvements?

The statistics, as always in Iraq, tell a story that is less clear-cut.

The number of fully immunized children, for example, dropped from 60.7 percent in 2000 to 38.5 percent
in 2006, then rose to 46.5 percent by 2011 - still less than pre-invasion levels, according to the Multiple
Indicator Cluster Surveys (MICS) conducted by the government and the UN Childrens Fund (UNICEF).
Acute and chronic malnutrition trends for children under five also showed a slight regression.

However, other indicators show some improvement over pre-2003 levels - unsurprising, some say, if you
consider the semi-starvation diet of many Iraqis during the sanctions.
According to the UNs Human Development Reports, life expectancy at birth rose from 58.7 before 2000 to
69.6 in 2012. (These figures are quite similar to those of WHO, but differ significantly from those of
the World Bank, which show a regression from 70 to 71 years during the mid-1990s and early 2000s, to 69
years in 2011)

The last decade undoubtedly saw a great reduction in infant mortality rates, not only over pre-invasion
levels, but even compared to the early 1980s, when about80 infants died per 1,000 live births. By the year
1990, this figure was down to 50, and decreased further to 31.9 in 2011, according to a 2012
government report monitoring progress towards the Millennium Development Goals (MDGs).

Still, this rate remains more than double the national target of 17 per 1,000 by 2015; and while Iraqs rate
in the early 1980s was among the best compared to other countries in the region, today, it is among the
worst.

The mortality rate of children under five also dropped from 42.8 per 1,000 births in 2000 to 37.2 in 2011,
well ahead of 1960s levels, but far off the national target of 21 by 2015, according to the government
report, which monitored MDG indicators at the governorate level. The percentage of births attended by
skilled personnel also rose from 72.1 percent in 2000 to 90.9 percent in 2011, according to the MICS.

(WHO shows a similar trend of decrease in mortality rates, but its statistics are quite different, showing a
much larger drop in infant mortality from 108 deaths per 1,000 in 1999 to 21 per 1,000 in 2011, and a
decrease in child mortality from 131 in 1999 to 25 in 2011.)

Government expenditures on health have increased in the last decade. From a high point in 1980s, they
dropped significantly due to the 1991 Gulf war and sanctions. But spending jumped from 2.7 percent of
GDP in 2003 to 8.4 percent in 2010, according to the World Bank. According to Yasseen Ahmed Abbas,
head of the Iraqi Red Crescent Society, government allocations for health spending have risen from $30
million a year under former president Saddam Hussein to $6 billion a year today.

http://www.irinnews.org/report/97964/war-leaves-lasting-impact-on-healthcare












Published on Alternet (http://www.alternet.org)
Home > Health Care in Iraq Was Better Under Saddam Hussein

CorpWatch [1] / By Pratap Chatterjee [2]
Health Care in Iraq Was Better Under Saddam Hussein
January 18, 2007 |
The convoy of flat-bed trucks picked up its cargo at Baghdad International Airport last spring and
sped north-west, stacked-high with crates of expensive medical equipment. From bilirubinmeters
and hematology analyzers to infant incubators and dental appliances, the equipment had been
ordered to help Iraq shore up a disintegrating health care system. But instead of being delivered to
150 brand-new Primary Health Care centers (PHCs) as originally planned, the Eagle Global
Logistics vehicles were directed to drop them off at a storage warehouse in Abu Ghraib.

Not only did some of the equipment arrive damaged at the warehouse owned by PWC of Kuwait,
one in 14 crates was missing, according to the delivery documents. The shipment was fairly
typical: Military auditors would later calculate that roughly 46 percent of some $70 million in
medical equipment deliveries made to the Abu Ghraib warehouse last spring had missing or
damaged crates or contained boxes that were mislabeled or not labeled at all.

Not that it really mattered. Just over three weeks before the April 27th delivery, the U.S. Army
Corps of Engineers had canceled the construction of 130 of the 150 PHCs for which the materiel
was intended. As a result, the equipment that could help diagnose and treat Iraqi illness (and
escalating bomb or gun injuries) now sits idle waiting for someone to figure out what to do with it.

Even if the equipment finally makes it through the bureaucratic logjam, lack of trained personnel to
operate it, especially outside major cities, will severely limit its utility. The Army Corps had written
a 15-day training plan into the contract, but over time, this had been whittled it down to ten and
then to just three days. Iraqi Ministry of Health officials have given up hope that any training at all
will accompany the sophisticated equipment.

But if Iraqis have failed to benefit from the idle PHCs, the $70 million contract to supply them has
been a shot in the arm for Parsons Global. The Pasadena, California-based engineering company
reaped a $3.3 million profit according to an audit report issued by the Special Inspector General
for Iraq Reconstruction (SIGIR), an independent U.S. government agency. And that is in addition
to the $186 million that U.S. taxpayers shelled out to Parsons to build dozens of clinics that have
yet to dispense a single aspirin.

While the new buildings remain uncompleted and millions of dollars worth of expensive equipment
are stored under lock and key, a dwindling number of doctors at existing hospitals perform
operations without basic supplies of disinfectant and anaesthesia. A severe shortage of nurses
further imperils patient care.

This failed planning and wasted money has been a hallmark of the last three years of healthcare in
Iraq. Today the country faces a medical crisis that many say exceeds conditions under sanctions.
Compounding this crisis is the violence that creates a steady flow of seriously injured victims.

What we asked for, we did not get

Days before the equipment arrived in Abu Ghraib, Dr Lezgin Ahmed, general director of planning
at the Kurdish health ministry offices, just below the ancient hilltop city of Erbil, northern Iraq,
proclaimed his frustration with the U.S. plan to fix the Iraqi healthcare system to this reporter.

"They told us that they had money for seven PHCs in Erbil, three in Dohuk. We were asked where
they should build them, that's all," said Dr Ahmed. "We didn't approve it but we accepted it without
interference because it was part of the plan for all of Iraq. They simply asked us for the numbers
and locations. What we asked for, we did not get," he said, noting that the ministry would have
preferred repair of existing facilities.

Six of the 150 PHCs were slated for the western Kurdish region of northern Iraq. In the Brayati
neighborhood of Erbil, just five miles from Ahmed's office, a partially constructed grey building
topped with red water tanks, appeared abandoned. The windows and doors were sealed with
cinder blocks to prevent intruders after work halted in late March. No construction workers or
security guards were to be found. In other cities across northern Iraq, such as Koya and
Sulamanya the story was the same: buildings, most lacking even paint, stood abandoned. In
Halabja Taza, close to the eastern border with Iran, a security guard at an empty Parsons PHC
agreed to talk. Nawshin Shakir Qasim explained that the contractors did a really bad job and the
roof was leaking. "The Americans soldiers fired the contractor. Now there is no more money so all
the work has stopped," he said.

Indeed, just two months before my visit, SIGIR inspectors traveled to five PHCs in Kirkuk, northern
Iraq, and came to similar conclusions about the quality of the work. The auditors snapped pictures
of poorly placed roof beams, honey-combed concrete, walls made of brick fragments held together
with plaster, and staircases crumbling into dust even before they were finished.

The SIGIR auditors also questioned Parsons' progress reports. One building, declared 56 percent
complete, was a shell of uneven bricks. Another floor that was balanced on wooden sticks was
listed as half complete, according to the SIGIR report.

If health care is in short supply, blame is plentiful. The SIGIR report concludes that a wide range of
factors contributed to the failures, ranging from disputes among Iraqi construction companies, poor
quality of local materials, and lax oversight by the Army Corps, which conducted "windshield
surveys" - hasty drive-by inspections.

The Army Corps blames Parsons. "They failed to adequately plan project schedules to include
known issues, resulting in unrealistic, risky construction and purchasing schedules," wrote the
division' commander, Brigadier General William H. McCoy Jr. "They failed to exercise adequate
due diligence to control costs."

And predictably, Parsons blames the Army Corps. In a written reply to the military, the company
says that it estimated the job would take two years, but the Army Corps. ordered it to finish the
clinics in one year. (The contract was canceled after Parsons failed to complete the job in 25
months.) The company also says that it informed the military that did not have enough supervisory
staff to oversee all 150 clinics simultaneously as the military demanded.

In a reply, included as an appendix to the SIGIR report, McCoy counters that Parsons "ignored, or
failed to respond adequately to, numerous expressions of concern by the government over these
issues, and in some cases failed or refused to provide the government with information that would
have allowed the government to make decisions to assist Parsons in regaining control over
subcontractor performance and cost," he added.

By the time the contract was canceled on April 3, 2006, Parsons had completed only six clinics.
Project managers estimated that another 14 could eventually be completed and equipped.

Meanwhile, some 130 sets of medical equipment, partially damaged, are warehoused at Abu
Ghraib, in the hope that someday the project might be completed.

The PHC program "was the most important program in the health sector," Stuart Bowen, the
director of SIGIR, told the Los Angeles Times. "It sought to fulfill a strategy to get health services
to rural and remote poor in Iraq."

In September 2006, four months after the contract was canceled, Congressman Chris Van Hollen
(D-MD) questioned Ernest Robbins, the manager of Parson's Iraq project: "What is the recourse
for the taxpayer under these circumstances? Don't you think that Parsons, given what has turned
out to be a very shoddy job, should return some of its profits to the taxpayer"?

Robbins told the Congressional hearing: "No, sir, I will not."

Iraq's health care system

While some critics focused on the failure to deliver the PHC system, others questioned the whole
U.S. approach. Iraq had developed a centralized free health care system in the 1970s using a
hospital based, capital-intensive model of curative care. The country depended on large-scale
imports of medicines, medical equipment and even nurses, paid for with oil export income,
according to a "Watching Brief" report issued jointly by the United Nations Children's Fund
(UNICEF) and the World Health Organization (WHO) in July 2003.

Unlike other poorer countries, which focused on mass health care using primary care practitioners,
Iraq developed a Westernized system of sophisticated hospitals with advanced medical
procedures, provided by specialist physicians. The UNICEF/WHO report noted that prior to 1990,
97 percent of the urban dwellers and 71 percent of the rural population had access to free primary
health care; just 2 percent of hospital beds were privately managed.

Infant mortality rates fell from 80 per 1,000 live births in 1974, to 60 in 1982 and 40 in 1989,
according to government statistics. A similar trend characterized under-five mortality rates which
halved from 120 per 1,000 live births in 1974 to 60 in 1989. (Later studies have questioned these
optimistic Iraqi government figures.)

With the 1991 Gulf War that followed Iraq's invasion of Kuwait, the situation changed dramatically.
The war damaged hospitals, power generation, and water treatment facilities; foreign nurses left
the country; and the health budget was slashed. From US$500 million in 1989, the import budget
plummeted to US$50 million in 1991 and then to $22 million in 1995. Spending per capita fell from
a minimum of US$86 to US$17 in 1996.

In the eight months following the 1991 war, mortality rates for children under five shot back up to
120 per 1,000 live births, the highest recorded increase for any country in the world in the 1990s,
according to the UNICEF/WHO report. (Only 14 countries had an overall mortality increase among
young children during the 1990s. Nine of them were in Africa, where HIV infection was the
predominant cause of elevated mortality.)

For over-50 year olds, the mortality rate rose from 1,685 per month in 1989 to 6,731 in 1994
according to the UNICEF/WHO report. Iraq's health care system was accelerating fast in the
wrong direction.

The war and the sanctions destroyed the capital-intensive model of free and sophisticated care.
Water was often contaminated and the electricity supply erratic, making it difficult to operate the
expensive medical equipment. Deaths from diarrhea rose fivefold and malnutrition-related
diseases such as respiratory infections became widespread.

From 1996 to 2002, the UN-administered Oil-for-Food program allocated US$4.8 billion for
medical supplies and related support. The program's emphasis on basic health care including
vaccination caused a drop in infant mortality. But because the UN program barred cash transfers,
Iraqi salaries stayed low and there was no money for training or recurring expenses.

In 1994, hoping to prevent doctors from emigrating, the Iraqi government encouraged private
medical practices. Four years later it allowed hospitals to charge some fees. The government also
encouraged organizations including the Red Cross and the Red Crescent to build PHCs and help
support hospitals.

After the invasion, sanctions were lifted, and the government finally started to earn cash on its oil
income, allowing it to raise medical salaries. But the damage to the health care system was hard
to reverse. For example, according to the UNICEF/WHO report, Iraq now has more doctors than
nurses -- an unusual predicament for a poor country -- and very few of them specialize in the
community or social medicine the country needs.

Today Iraq needs either to initiate a major renovation program to resurrect its old medical system
or it needs to switch to a preventative health care model based at primary health case clinics. In
the last three years, owing to lack of money and security, it has done neither.

Post-invasion planning

The failure by the occupation forces to revitalize healthcare tracks back to immediately after the
invasion, when U.S. Agency for International Development (USAID) dispatched Fred "Skip" Burkle
to run the Ministry of Health. A doctor with four post graduate degrees, the American had worked
in Kosovo, Somalia and northern Iraq after the Gulf War.

He faced a health sector that-like the oil and electricity sectors -- was devastated by post-war
looting and had lost much of its infrastructure to theft and violence. Some 12 percent of hospitals
were damaged and 7 percent looted. Central records were destroyed along with the country's two
major communicable disease laboratories and four out of seven of its central warehouses.

"I spent many months preparing for the invasion of Iraq, for what I expected to be a humanitarian
crisis," Burkle told CorpWatch. "In the decade before the invasion, we saw a decline in every
health indicator, which told me what to expect. I've been in a number of wars and humanitarian
crises where we've developed systems over years, and we know how to do this, and how to do
this on the run."

"So I spent my time planning a surveillance system and figuring out how to decentralize it, so that
it was not Baghdad-centric. Remember, there were no communication systems between Baghdad
and the provinces. I was also concerned about looting, as I had observed this first hand after the
first Gulf War, as the first civilian to enter the country."

Burkle's suggestions were never implemented. Two weeks after arriving in Iraq, the White House
informed him, he says, that it wanted a "loyalist" in the job and recalled him to the U.S.

More than two months passed before the new Republican appointee arrived. Unlike his
predecessor, Jim Haveman was not a doctor, had never lived outside the U.S. and had never
taken part in post-war or post-disaster reconstruction, He had a degree in social work, experience
as director of community health in the state of Michigan, and was a former director for International
Aid, a faith-based relief organization that promotes Christianity in the developing world. He also
previously headed up Bethany Christian Services, a large adoption agency that urges pregnant
women not to have abortions.

Haveman said that he arrived to find that the ministry was still a mess. "I walked into a situation
with two empty 11 story towers, 120,000 employees, 240 hospitals and 1,200 clinics (but the)
employees had not been paid for three months. The ministry had a $16 million dollar budget."

He says he is proud that he got the administrative staff back into the building within 45 days, get
the ministry up and running, draw up a budget, completed large-scale immunizations successfully,
and respond to disease outbreaks. He believes that he helped the ministry to switch from a
prescription-based healthcare system to prevention and primary health care, wrote up a mental
health code, implemented new training systems, supported professional groups and worked
closely with NGOs and international agencies. (see box for Haveman email to CorpWatch)

Critics acknowledge that Haveman got the ministry building and payroll up and running but say
that he focused on the wrong priorities such as rewriting the list of medicines that the state medical
company should import. Asked what medicines they were able to buy, Dr Nasser Jabar Sheyal, an
assistant to the health minister, told CorpWatch in spring 2004: "We make recommendations but
we don't decide anything. This is an occupied country, not a democracy, and the Americans make
all the decisions."

"The fact is that Kimadia, Saddam's medical supply bureaucracy created under the UN's failed oil-
for-food program, was so riddled with corruption and bribery that little medication was available,"
Haveman wrote later to defend his decision to rewrite the list. "Suppliers received kickbacks and
sent expired drugs that were exorbitantly overpriced. Half of the medications on hand were
unusable, and some were 30 years old."

Meanwhile, under orders from Paul Bremer, the U.S. administrator of Iraq, senior doctors and
health administrators with decades of experience, were fired because they were members of the
Ba'aath party. The ministry was handed over to the Da'wa party, a conservative Islamic group,
with little experience in this field.

The party appointed Dr Khudair Abbas, a respected breast cancer surgeon to head the ministry.
He started with a disadvantage: Abbas, who had studied in India and practiced in the UK, had not
worked in the Iraqi health system since 1979. A year later, after Haveman left, Abbas also quit the
ministry.

Some Da'wa officials struggled along bravely. Amar al-Saffar, the deputy minister in charge of
finance for the health ministry, candidly confessed that he too, was out of his depth. "I was not
planning to be a part of the crew at the ministry. I came to serve my party [Da'wa] and I don't know
how I found myself in this ocean, but I have to swim. Unfortunately the current is very strong," he
said. "My only experience is that for six years, I was the executive manager of an optical
instruments business in Dubai."

While many top bureaucrats quit, he stayed on until he was kidnapped in November 2006 from his
home in Adhamiya. His fate was unknown at the time of writing.

Meanwhile doctors in Iraq began to resent the expatriates who were given control of the system in
which they had labored for so long. Dr Koresh Al Qaseer, president of the Iraqi Surgeons
Association, explained that he had a lot of respect for Dr Abbas's medical expertise, but did not
believe that his team knew Iraq's needs.

"Who are these people who left for 20 years and now think they can run our country? They don't
know anything about it, and they don't care," he said angrily. "Believe me they did not leave
because of Saddam, they left to pursue their careers and to make money. We have 35,000
doctors in Iraq, we don't need outsiders to come and run our hospitals but we do need training."

Richard Garfield, a professor of nursing from Columbia University in New York who has visited
Iraq almost every year since 1996 as an advisor to UN health adviser, agreed that training was
necessary, but he believed that that was just the first step - a fundamental overhaul of the system
should have been conducted.

What Iraq needed, he said, was a focus on community health, health education, outreach for basic
health promotion programs, and the elaboration of financial management, systems planning, and
pharmaceutical administration systems appropriate to a middle-income developing country.

He summarizes the mistakes the CPA made:

investing in supplying medicines to a system where medicines were used poorly;
holding short training courses with no supervision or follow-up to teach techniques that
were not practiced in the country;
catering to professional organizations that represented few people; and
contracting U.S. firms to build hospitals and clinics, few of which were built and fewer still
well-utilized.


While the CPA fumbled the health care reform, Iraq's escalating lack of security halved the number
of patients willing to visiting hospitals. This crisis in care was especially problematic for people with
chronic diseases and pregnant women. The accompanying rise in harassment of and violence
against women has limited access of health services.

The violence was also directed at doctors, on the assumption that they were wealthy or a part of
the strategy of civil war. Since the invasion, 2,000 Iraqi doctors have been murdered and some
250 kidnapped, the Brookings Institute reported in December 2006. Altogether more than half of
Iraq's 34,000 doctors have fled the country, some fleeing to drive taxis in Lebanon.

Abt associates

The CPA prioritized certain health contractors over others: It awarded UNICEF an $8 million grant
and gave the WHO $10 million. But the CPA funneled the big money to private U.S. contractors
such as Abt Associates, a Massachusetts-based consultancy, which won a $43-million contract in
April 2003 to modernize the Iraqi Health Ministry and provide supplies.

No matter that UNICEF and WHO had been working in Iraq for years, had stockpiled medicines,
and had staff ready to go, they were effectively sidelined. The contracting process also completely
shut out non-profit groups such as the Red Cross and Red Crescent Society which had decades
of experience in Iraq.

But what Abt had was an inside track: Janet Ballantyne, vice president for international
development, had joined the company just six months after working as counselor and acting
deputy administrator at USAID. She was also USAID mission director for Russia from 1996 to
1999, a position she also held in Nicaragua from 1990 to 1994.

Abt claimed to have considerable experience, having administered nearly $908 million in U.S.
government contracts in the previous 12 years. The company website highlights work on programs
ranging from AIDS treatment in South Africa, child immunization in Asia, healthcare delivery
restructuring and financing in Central Asian republics, to managing clinical trials for AIDS/HIV
vaccines in the U.S.

But despite its history and high-level connections, Abt ran into considerable difficulties on the
ground in Iraq. Mary Paterson, who had previously worked in the Middle East, was chief of party
for the Abt Associates contract.

She quickly clashed with Haveman after criticizing the CPA's healthcare plan to invest the ministry
money in new clinics.

"The main emphasis at the CPA was on reconstruction projects, with the underlying assumption
that there was no health infrastructure in Iraq worth preserving and that understanding the existing
situation was not important since everything would be replaced," she told a Congressional hearing
in the summer of 2006.

"Mr. Haveman's response addressed to one of my team leaders," she told the committee: "'We are
done with the corrupt government of Saddam Hussein. Why do we need to study what they had in
the past?' This ideology had the effect of isolating Iraq health experts since they represented the
old, obsolete system that no one needed to understand."

Paterson told CorpWatch that a mere $16,000 a month could have restored normal operations at
25 primary health clinics in the Al Karkh district of Baghdad.

"Addressing pressing needs to support existing essential services in existing clinics was a clear
priority and could lead to quickly improved services more effectively than large-scale new
construction and renovation plans," she said. "Simple equipment such as stethoscopes, blood
pressure monitoring equipment, sterile supplies, essential drugs and vaccines, and basic
infrastructure such as generators were needed in most areas, and could have been supplied from
existing stocks or from willing donors."

Haveman asked Abt to withdraw her from Iraq. Paterson returned to the U.S. in August 2003, to
find out that she had been frozen out of new work at Abt, forcing her to resign her job. Three more
chiefs of party came and went in the next four months, making it impossible to effectively plan or
complete tasks.

Over the nine months of its contract, Abt lurched from one project to the next: it held a visioning
exercise for ministry staff, it handed out new uniforms for nurses at one hospital, it designed a
survey of Iraqi households to better understand "the nature of demand for health care and to
identify appropriate strategies for providing primary health care" and then canceled the survey.

Then Abt botched its most important project -- providing emergency supplies to existing clinics. It
missed its October 2003 deadline by eight months and even then, shipments arrived with items
such as cabinets and gynecological exam tables missing or damaged. For example, autoclaves
were ordered from a vendor in India that had never manufactured them before.

USAID auditors would later report that "almost every shipment received had some type of problem
with the paperwork (i.e., no commercial invoice, no packing list, improper consignment,
discrepancies between the quantity of units received and that specified on the packing list)." One
of the procurement officials, who worked on the contract, told USAID auditors later that in his
almost 20 years of experience with procurement for the agency, he had "never witnessed such a
debacle."

Another major Abt project was a centralized computer-based rapid-response disease surveillance
system for Basra and parts of Baghdad. The system relied on telephone reporting to track
selected communicable diseases and input real-time data entry and information availability.

This venture went nowhere because, apart from the lack of electricity, hospitals had no working
telephone system. Hospital directors were each issued MCI cell phones that allowed them to
summon the military, but that could not call ordinary Iraqi telephones. Indeed, the hospitals did not
have a working intercom system, let alone pagers. One doctor told CorpWatch that the only way
they could communicate --even during emergencies--was by walking, or running, between wards.

It became clear that Abt hadn't even delivered a working database to support the surveillance
system. The ministry of health computer on which the database was loaded had a virus that
blocked access. The backup computer disks that Abt provided were in a "read only" format that
prevented the ministry from inputting data and keeping them current. The database project was
quietly shelved.

Abt staff finally left Iraq in April 2004 when things turned increasingly violent. USAID canceled the
contract, after paying out $20.7 million. A USAID audit concluded that: Abt's "activities did not
provide the level of support envisioned under the contract and often offered little, if any, benefit to
the Ministry of Health."

Abt spokesperson Peter Broderick, emailed a response to the USAID audit: "Despite these
extremely difficult and dangerous conditions, we are proud of our accomplishments in Iraq. We
believe our work and that of USAID contributed significantly to the Iraqi health care system and the
development of meaningful reform strategies. We support the only recommendation of the audit in
question -- that the USAID Mission improve its process for reviewing and approving requests for
modification to future contracts."

USAID did initially decide to hire a follow-up contractor and issued an ambitious $100 million
request for proposals. Abt, among others, applied for the new contract. Then mysteriously, USAID
first cut the proposed grant to $15 million, and then canceled it altogether.

Asked what USAID was working on now, Harry Edwards, a USAID press officer, told CorpWatch
that USAID had completed all health-related projects in October 2006 and handed over
responsibilities for the sector to the U.S. Army Corps of Engineers. "The broader National Capacity
Development program currently underway provides capacity building activities to various Iraqi
ministries which will include the Ministry of Health. A vital component of the program is a "Train-
the-trainers" component expected to create an independent self-sustaining capacity building
activities within Iraqi ministries," he added in an email response.

New technology, old problems

Even the repair and expansion of existing health care facilities in safe parts of the country was
botched, leaving hospital administrators frustrated by the lack of basic supplies and simple
training.

In Sulamanya, a relatively peaceful and prosperous town in Northern Iraq where violence is
practically unknown, the engineer in charge of construction at the health ministry told CorpWatch
that Parsons promised $29 million to build five new primary health care centers, one new pediatric
hospital, and to repair a maternity hospital. The ministry was allowed to select sites but the
contractors and USAID determined the design and budget.

Not one of the PHCs in the province has been completed. Engineer Hewa, who was in charge of
construction for the ministry, traveled to Baghdad in 2004 to review plans for the new hospital but
that was the last time anybody talked about it. Nobody from the Army Corps or the company even
visited the proposed site, according to Hewa.

The only thing completed was a new elevator that the Al Monel company installed in the pediatric
hospital. During a site visit to the hospital in Sulamanya in April 2006, a security guard showed this
reporter the new elevator large enough to fit a hospital bed. It hadn't worked for a couple of days,
he said, because local mechanics didn't know how to fix it. The head technician promised to hire a
new mechanic who could.

Elevators appear to be Parsons Achilles heel. At the Najaf Maternity Hospital, a New York
Times reporter found that only one of the hospital's four elevators functioned while the others
awaited repairs.

The company was paid in full in June 2004 to install a new elevator bank at the Hilla General
Hospital. When SIGIR auditors visited the hospital three months later, the administrator reported
that just a couple days before, a renovated elevator crashed and killed three people.

Parsons did not return phone and email requests for comment.

Cancer hospital remains unfinished

Most prominent among the long list of failures is the Basra Children's Hospital, which was intended
as crown jewel of U.S. aid to Iraq. Instead, it has become a showcase for everything that went
wrong. In August 2004, USAID awarded the $50 million contract to build the hospital to Bechtel, a
San Francisco-based engineering company, one of the largest engineering companies in the
world, which has become synonymous with the building of nuclear power plants, gold mines and
large projects like the new Hong Kong airport.

The idea was to create a state-of-the-art facility to treat childhood cancer, a pressing need in a city
where cancer rates have skyrocketed following the first Gulf War. (Contested data link the rise in
cancer to extensive U.S. use of depleted uranium weaponry in the region.)

The facility, championed by the First Lady Laura Bush and Secretary of State Condoleezza Rice,
looked suspiciously like a political propaganda effort. And as with much U.S. aid, it was designed
with little local consultation: the city lacked clean water and already has a leukemia ward where
lack of funding means that each bed is shared by two or three children.

The hospital was planned by Project Hope, a charity headed by John P. Howe III, president of the
University of Texas, San Antonio, and a Bush family friend. Project Hope had built similar hospitals
in Poland and in China. Howe pushed the project after Rice and Bush invited him to visit Iraq to
assess the country's healthcare system.

Before construction began in August 2005, the project attracted skeptics, who were concerned
that it was a white elephant. Republican Congressman Jim Kolbe criticized the project: "Why build
a hospital for kids, when the kids have no clean water?" the Arizonan asked. But it went ahead: No
new technology would be spared in this showcase facility featuring with 94 beds, private cancer
suites, CAT scans, a linear particle accelerator for radiation therapy, no.

But like every so many U.S.-initiated projects, the money to build this fancy facility would
disappear when things went wrong. A year after the August 2005 groundbreaking, the project
became a target for attacks, according to the company. The price tag rose from $50 million to an
estimated $169.5 million. Cliff Mumm, president of the Bechtel infrastructure division, predicted
that the project would fail. "It is not a good use of the government's money" to try to finish the
project," Mumm told the New York Times. "And we do not think it can be finished."

In July 2006, Bechtel was asked to withdrew from the project, which is now on hold. USAID
spokesman David Snider's cheerful spin on the stall was that the contract did not actually require
the company to complete the hospital. "They are under a 'term contract,' which means their job is
over when their money ends ... (so) they did complete the contract."

Iraqi officials were angry. "The pretexts given by Bechtel to the Iraqi government to justify its
failure in finishing the project are untrue and unacceptable, especially the ones regarding the rise
in security expenses," Sheik Abu Salam al-Saedi, a member of the Basra provincial council told
the New York Times.

Asked about this comment, Bechtel spokesman Jonathan Marshall said that it was "irresponsible."

"Given the many tragic deaths suffered by our subcontractors on the project and the evacuation of
the area by many international aid workers " his claim [should not] stand unchallenged," Marshall
wrote in an email response.

Deputy Minister Amar Al-Saffar charges that part of the failure traces back to Bechtel's decision to
hire a Jordanian company to oversee work by local Iraqi construction companies, instead of
working directly with the Iraqis. "Our counterparts should have full faith in the Iraqi companies,"
Saffar told the New York Times, in July, less than four months before his kidnapping.

Marshall agreed that a Jordanian team (Mid Contracting, Universal Hospital Services, and Hospital
Design and Planning) had been awarded the sub-contract, but pointed out that the workers were
mostly Iraqi.

"We could not find Iraqi firms of equal caliber for this job, although Iraqi subcontractors were, of
course, employed extensively," Marshall told CorpWatch. "Bechtel's record of hiring Iraqi firms was
exemplary. We held major conferences in Baghdad and Basra to inform and recruit Iraq partners.
Over the life of the project, we hired Iraqi subcontractors to perform about 75 percent of the work.
At peak, our projects employed 40,000 Iraqi workers. Bechtel also trained and employed more
than 600 Iraqi nationals on its professional staff."

Looking back...

Almost four years after the invasion, some of the planners who worked at the ministry were asked
for this report about the situation today. All agreed that the health care system was in major crisis
and that the security situation was a key challenge. But they were at odds over why things had
turned sour.

Burkle, the first ministry director under the CPA, looks back in anger at the invasion itself.
"Decisions were made by inexperienced military planners, who were often more concerned about
how it would look politically," he said. "I was disgusted."

"The humanitarian planning team denied themselves access to valuable expertise by failing to
establish good working relations with UN agencies, the Red Cross organizations, and other relief
agencies, which had worked in Iraq for many years and were very familiar with the existing health
and public-health infrastructure," Burkle continued.

Haveman, who succeeded him, acknowledges that he made mistakes but remains optimistic.

"The lead for reconstruction should have been Iraqi contractors with funding from NGOs and
governmental sources and Iraqi run. I should have advocated early on for a Ministry of Health
training academy for refreshing Iraq skills in planning and financial management. ... and setting
benchmarks and measurable objectives," he wrote.

"Reconstruction in Iraq, including the health sector, has not progressed as rapidly as hoped but
there has been notable progress. It has been slowed by sectarian violence, but still continues
today. It's just a matter of time... ten years from now plus, they will again become the system they
desire to be," he added.

Garfield says that the plans failed for very basic reasons: "We designed beautiful systems, then
we had workshops to train them (the Iraqis). Isn't that great?" he said sarcastically. "And now, we
are out of there. That's not the same as making a system. It did not work because foreigners
designed it and the locals didn't adopt it. And the foreigners weren't around long enough to help
make it part of the regular system."

...And looking forward

Today, almost four years after the toppling of Saddam Hussein, the country's healthcare system is
still a shambles. While most hospitals lack basic supplies, dozens of incomplete clinics and
warehoused high-technology equipment remain as a testament to the U.S. experiment in Iraq.
Meanwhile the hospitals are grappling with an unexpected health crisis -- the daily toll of bombs
and sectarian clashes, which leaves over a hundred dead each day and more seriously injured.

While Abt, Bechtel and Parsons have long left the country, even local non-profit organizations are
now confronted by this escalating violence, In mid-December, dozens of workers of the Iraqi Red
Crescent, one of the few groups still operating in the country, were kidnapped in broad daylight
from its Baghdad offices, forcing the group to shut down operations in the capital city.

"There's no way to fix the healthcare system now, without security. You'd need half-a-million
troops and even then, I'm not sure it's enough," says Garfield. A parallel system of emergency
care from NGOs that would bypass the current ministry (which is controlled by the Mahdi army)
could help, he adds, until order is established, and then the whole system would have to be
overhauled.








War Crimes: Health Care in Iraq has Collapsed
By Bert De Belder
Global Research, April 06, 2007
Url of this article:
http://www.globalresearch.ca/war-crimes-health-care-in-iraq-has-collapsed/5289
After repeatedly topping the Arab health index, Iraqs health record is now worse than ever
because of the US-led occupation. The general effect on the Iraqi population amounts to a
massive war crime, writes Bert De Belder
Iraqs health status, four years into the occupation, is nothing short of disastrous. Iraqs health
index has deteriorated to a level not seen since the 1950s, says Joseph Chamie, former director of
the United Nations Population Division and an Iraq specialist. Peoples health status is determined
by social, economic and environmental factors much more than by the availability of healthcare.
Not surprisingly, all these factors have deteriorated in the course of the occupation.
A recent UNDP-backed study reveals that one-third of Iraqis live in poverty, with more than five
per cent living in abject poverty. The UN agency observes that this contrasts starkly with the
countrys thriving middle- income economy of the 1970s and 1980s. But these figures may well be
a grave underestimation, as other reports speak of eight million out of 28 million Iraqis living in
extreme poverty on incomes of less than $1 per day. More than 500,000 Baghdad residents get
water for only a few hours a day. And the majority of Iraqis get three hours of electricity a day, in
contrast to pre-war levels of about 20 hours.
THE DEVASTATED HEALTH OF IRAQI CHILDREN:
The combination of sanctions, war and occupation has resulted in Iraq showing the worlds worst
evolution in child mortality: from an under-five mortality rate of 50 per 1000 live births in 1990, to
125 in 2005. That means an annual deterioration of 6.1 per cent a world record, well behind
very poor and AIDS- affected Botswana. At the outset of the 2003 war, the US administration
pledged to cut Iraqs child mortality rate in half by 2005. But the rate has continued to worsen, to
130 in 2006, according to Iraqi Health Ministry figures.
Nutrition is, of course, vital to health. According to the United Nations Childrens Agency
(UNICEF), about one in 10 Iraqi children under five are underweight (acutely malnourished) and
one in five are short for their age (chronically malnourished). But this is only the tip of the iceberg,
according to Claire Hajaj, communications officer at the UNICEF Iraq Support Centre in Amman.
Many Iraqi children may also be suffering from hidden hunger deficiencies in critical vitamins
and minerals that are the building blocks for childrens physical and intellectual development,
Hajaj says. These deficiencies are hard to measure, but they make children much more
vulnerable to illness and less likely to thrive at school. Hayder Hussainy, a senior official at the
Iraqi Ministry of Health, states that approximately 50 per cent of Iraqi children suffer from some
form of malnourishment.
Also important is the psychological impact of war and occupation. In a study entitled The
Psychological Effects of War on Iraqis, the Association of Iraqi Psychologists (AIP) reports that
out of 2,000 people interviewed in all 18 Iraqi provinces, 92 per cent said they feared being killed
in an explosion. Some 60 per cent of those interviewed said the level of violence had caused them
to have panic attacks, which prevented them from going out because they feared they would be
the next victims. The AIP also surveyed over 1,000 children across Iraq and found that 92 per cent
of children examined had learning impediments, largely attributable to the current climate of fear
and insecurity. The only thing they have on their minds are guns, bullets, death and a fear of the
US occupation, says the AIPs Marwan Abdullah.
HOSPITALS AND CLINICS FACED WITH A CRITICAL LACK OF RESOURCES:
On 19 January 2007, a group of some 100 eminent UK doctors signed a letter to British Prime
Minister Tony Blair to voice their grave concern over the fate of Iraqs children. The statement
read: We are concerned that children are dying in Iraq for want of medical treatment. Sick or
injured children, who could otherwise be treated by simple means, are left to die in their hundreds
because they do not have access to basic medicines or other resources. Children who have lost
hands, feet, and limbs are left without prostheses. Children with grave psychological distress are
left untreated.
The Iraq Medical Association reports that 90 per cent of the almost 180 hospitals in Iraq lack
essential equipment. At Yarmouk Hospital, one of the busiest hospitals in Baghdad, five people die
on average every day because medics and nurses dont have the equipment to treat common ills
and accidents, according to Yarmouk doctor Hussam Abboud. That translates to more than 1,800
preventable deaths in a year in that hospital alone.
Hassan Abdallah, a senior health official in the Basra Governorate, says that information suggests
that from January to July 2006, about 90 children died in Basra as result of the lack of medicine, a
worse figure than for the same period last year, when some 40 children died for similar reasons.
Marie Fernandez, a spokeswoman for the Vienna-based aid agency Saving Children from War,
deplores the lack of essential supplies, especially intravenous infusions and blood bags. Children
are dying because there are no blood bags available, says Fernandez.
HOSPITALS SUBJECT TO MILITARY ATTACKS AND OCCUPATION:
The Geneva Conventions state that hospitals are and should remain neutral and accessible to
everybody, particularly civilians. Yet, when its occupied by armed groups or official forces, people
dont have this free and humanitarian access, says Cedric Turlan, information officer for the
Coordinating Committee in Iraq (NCCI) NGO. His observation is corroborated by numerous
reports and sources.
In the first week of November 2006, in Ramadi, some 115 kilometres west of Baghdad, 13 civilians
entering the hospital to get treatment were killed by snipers. Less than 10 per cent of the hospitals
staff was still working there when US-led forces burst into the hospital many times day and night,
looking for snipers on the hospitals roof. The multinational forces were outside, surrounding the
hospital, but they intruded into the hospital on a daily basis, Turlan said. Now people rarely go to
the hospital because they fear being shot or arrested.
For several months now, patients have refrained from using the hospital for fear of being shot by
snipers or by US-led forces. According to other reports received by NCCI, military forces have also
occupied Mosul Hospital, and ambulances have been attacked regularly in Najaf, Fallujah and
other parts of Anbar.
On 7 December 2006, there was yet another US military raid at the Fallujah General Hospital that
had suffered similar attacks during various US siege operations in the city in April and November
2004. Eyewitnesses said US soldiers raided the hospital as if it were a military target. Doctors
and medical staff were arrested, insulted and called terrorists. A hospital employee said that it was
already the third time he was handcuffed by US soldiers, and alleged that they have been more
vicious with medical staff than with others because they consider us the first supporters of those
they call terrorists. US Lt Col Bryan Salas, spokesperson of Multinational Forces-Iraq, had quite a
different explanation: Coalition forces searched the hospital to ensure that it continues to be a
safe place for the citizens of Fallujah to receive the medical treatment they deserve. After the US
military raid, the hospital remained closed for several days.
GOVERNMENT COMPLICITY IN ATTACKS AND FAILING HEALTH:
With current Minister of Health Ali Al-Shimari belonging to the political movement of Moqtada Al-
Sadr, the latters military arm, the Mahdi Army, is acting inside hospitals with impunity. Sick and
wounded patients have been abducted from public hospitals and later killed. As a consequence,
more and more Iraqis are avoiding hospitals. We would prefer to die instead of going to the
hospital, says Abu Nasr, a resident of a Baghdad suburb. The hospitals have become killing
fields.
The ministry also appears to discriminate in the provision of supplies. Tariq Hiali, a health official in
Baqouba (60 kilometres northeast of Baghdad), laments that the Ministry of Health is not
providing us with medications and medical equipment they consider us to be terrorists. An
employee at Baqoubas blood bank, Jamal Qadoori, says: Ambulances we send to Baghdad are
being intercepted by the Mahdi Army.
The emergency unit in the Basra Teaching Hospital was closed for five months after unidentified
assailants killed a number of doctors working there. Now many doctors and nurses refuse to go to
work, fearing for their lives. Likewise, clinics have shut down in Ramadi, Hit, Haditha and Fallujah.
The Institute for War and Peace Reporting states that in Baghdad, those doctors still practicing
have moved their clinics into residential areas or inside medical compounds for safety reasons.
They only open in the morning, because of curfews and poor security.
HEALTH WORKERS HARASSED, ARRESTED AND ASSASSINATED:
Under the Fourth Geneva Convention, Article 18 reads: Civilian hospitals organised to care for
the wounded and sick, infirm and maternity cases, may in no circumstances be the object of
attack, but shall at all times be respected and protected by the Parties to the conflict. On-the-
ground reality in Iraq today is quite different.
A major problem affecting Iraqs health sector is the countrys desperate security situation, says
Nada Doumani, a spokeswoman for the International Committee of the Red Cross (ICRC). Armed
men storm operating theatres forcing doctors to treat the patients they bring as a priority. Some
patients insist on keeping their weapons and masks while being treated. This creates a
traumatising situation for the doctors, she says.
Examples abound. Dr Washdi Mahmoud works in the Ibn Al-Nafees Hospital, the largest
cardiovascular centre in Baghdad. Via telephone from Baghdad on 27 February 2006, he said:
Yesterday morning, we were threatened by the relatives of patients. They even pointed a gun at
one doctors head! The hospitals security guards didnt bother to intervene, so we decided to go
on strike.
Dr Salam Ismael of the Doctors for Iraq society explains: We are harassed by militias of certain
political parties. The government is not acting on them. They enter the patients rooms with their
weapons, they shout at the doctors, they threaten to kill them.
Doctors for Iraq received reports that armed gunmen had entered Tel Afar Hospital in the
northwest of Iraq on 9 May 2006 and threatened and attacked staff and patients waiting to be
treated. A doctor described how one of the armed men put a gun to his head demanding that he
stop treating a wounded child and instead attend to a man with a minor shell wound in his leg. The
armed group started vandalising and breaking hospital equipment and then attacked an
ambulance driver, breaking his arm with a rifle butt. Another ambulance driver was punched in the
face, and three armed men attacked the hospital pharmacist, taking turns in hitting and kicking
him. One of the armed men fired bullets above a doctors head, missing him narrowly and causing
fear and hysteria in the hospital.
On 28 September 2006, doctors at Baghdads Yarmouk Hospital went on strike after Iraqi police
burst into the facility and forced doctors to treat a wounded colleague, while brandishing their
guns. The doctors called on the Interior Ministry to enforce a complete weapons ban in the
hospital. Early November 2006, Dr Ibrahim Abdel-Sattar, a cardiologist in Baghdad, reported: My
colleague was killed while he was attending one of his patients two weeks ago. The armed gang
broke into his clinic, shot him dead and left without explanation.
HEALTH WORKERS KIDNAPPED AND HELD FOR RANSOM
As if the daily violence was not enough, in the chaos and disorder that reign in occupied Iraq,
health professionals are also prone to getting kidnapped for ransom.
On 9 November, men reportedly wearing blue police uniforms kidnapped the head of Iraqi Red
Crescent Society (IRCS) administration, Dr Anas Al-Azawi, in front of his house. The price for his
freedom was set at $750,000, but he was released after a lesser ransom was paid. On 17
December, armed men allegedly wearing Iraqi Army uniforms stormed the office of the IRCS in
Baghdad and abducted 42 people. 26 IRCS employees, both Shia and Sunni, were later released.
Peter Kandela, an Iraqi doctor working in the United Kingdom, interviewed Iraqi medical staff that
had fled to Jordan and Syria. He recounts the story of a kidney surgeon seized by a group of
armed men whose first act was to go through his address book to look for other potential victims.
They had the audacity to suggest that in return for receiving better treatment in captivity, I should
recommend others for kidnapping, the surgeon said. He was released after his wife paid a
ransom of $250,000.
Dr Kandela also explained that in the new Iraq, there is a price tag linked to your position and
status. Those doctors who have stayed in the country know what they are worth in kidnapping
terms, and ensure their relatives have easy access to the necessary funds to secure their speedy
release if they are taken.
MASSIVE FLIGHT OF HEALTH PROFESSIONALS:
In March 2006, the British NGO Medact said that 18,000 out of Iraqs 34,000 physicians had left
the country since the onset of the war, according to official figures from the Iraq Medical
Association (IMA). Farouk Naji, a clinician and senior member of IMA, declares: About 2,000
physicians have been killed since 2003. The violence has increased and everyday we are losing
the best professionals in Iraq. In some cases, ambulances picking up the injured after explosions
are without paramedics or nurses, Naji says. There are not enough professionals and the ones
available are in hospitals, trying to figure out how to treat patients in improvised operating
theatres, he adds.
Dr Omer, a cardiovascular surgeon, left his job in Baghdad and is now working as a general
practitioner in a primary health care clinic in Syria. What could I do? he asks, I was threatened
by armed militias inside the hospital. Three surgeons had been killed already and there were only
three of us left. I couldnt be the next target as I have a child to raise. Dr Omer was forced to flee
Iraq. He added: I am not happy with what I am doing here in Syria. I was a specialist doctor and
now I am working as a junior doctor. It is as if you were asking an officer to work as a soldier.
A shortage of doctors and nurses has also been reported in Basra. According to health official
Hassan Abdullah, there are no reliable statistics on how many doctors, dentists, pharmacists and
nurses have left the area, but unofficial data suggests that at least 200 health professionals have
left since January alone. Some of them try to get more secure employment elsewhere in Iraq.
Rezan Sayda, a senior official in the Kurdistan Regional Governments Health Ministry, said last
December that her ministry had employed 600 doctors who had fled insecure parts of the country,
and that another 320 were on the waiting list for employment.
The lack of health personnel has disastrous consequences for the health of local patients. Writing
in The British Medical Journal, Dr Bassim Al-Sheibani and two colleagues from the Diwaniyah
College of Medicine in Iraq report that, medical staff admit that more than half of those who died
could have been saved if trained and experienced staff were available.
RECONSTRUCTION UNDER OCCUPATION: A DISMAL FAILURE:
Four years into the US- led war on Iraq, the countrys healthcare system is in a shambles. Most
hospitals lack basis supplies, dozens of clinics remain incompletely constructed, and costly high-
technology equipment lies idle in warehouses. Since 2003, US agencies may have spent up to $1
billion of Iraqi reconstruction funds on healthcare, but no new hospitals and only a few local clinics
have been built. Even the pet project of First Lady Laura Bush a $50 million state-of-the-art
childrens hospital in Basra is running far behind schedule and over budget.
According to Amar Al-Saffar, an official in charge of construction at the Iraqi Health Ministry, not a
single hospital has been built in Iraq since Al-Khadimiyah Hospital opened in 1986 in Baghdad. A
$200 million reconstruction project for building 142 primary healthcare centres ran out of cash in
early 2006, with just 20 centres on course to be completed, an outcome the World Health
Organisation described as shocking.
In a damaging report, CorpWatch harshly criticises the US-led reconstruction of Iraqs health
infrastructure, demonstrating how US companies such as Parsons Global, Abt Associates and
Bechtel did little more than take the money and run. Those companies were awarded huge
reconstruction contracts a $70 million contract for Parsons, $43 million for Abt Associates and
$50 million for Bechtel while effectively sidelining experienced UN agencies as UNICEF and
WHO.
In April 2006, the US Army Corps of Engineers that was supposed to construct 150 primary
healthcare centres decided to cancel the construction of 130 of them. The construction had been
contracted out to Parsons Global and by the time the US Army Corps cancelled Parsons contract
only six clinics had been completed. Meanwhile, 150 sets of medical equipment had already been
ordered and warehoused at Abu Ghraib. Thus, 130 sets are intended for clinics that will never see
the light of day.
Abt Associates was contracted to repair existing Iraqi hospitals but handed the job over to local
sub-contractors who were inexperienced or corrupt. When, in April 2004, the security situation in
Iraq turned from bad to worse, Abt Associates staff left the country. $20.7 million of US taxpayers
money had already been paid to Abt Associates through USAID.
Laura Bushs showcase childrens hospital in Basra, a project awarded to Bechtel, went much the
same way. The hospital was slated to feature 94 beds, private cancer suits, CAT scans and other
high-tech equipment necessary to treat childhood cancer in a region highly affected by depleted
uranium following the 1991 Gulf War. The price tag rose from $50 million to $170 million and in
July 2006 Bechtel was asked to withdraw from the project. It remains on hold.
CRIMINAL NEGLECT: THE OCCUPATION MUST END:
Four years after its onset, it has become clearer than ever that the US-led war and occupation of
Iraq have resulted in a massive public health disaster for Iraqis. Reversing the current trend of
ever-deteriorating health conditions requires first and foremost the end of the occupation.
The writer is coordinator for Medical Aid for the Third World, Belgium, and member of the Brussels
Tribunalhttp://brusselstribunal.org.

The following comment is from the father of a US Marine who participated in the military
operation directed against the Fallujah hospital referred to by Dr. de Belder.

Id like to respond to a paragraph in Dr. De Belders article of 4/6/07.
He mentioned the US Militarys military operation against the Fallujah Hospital on 12/7/06.
His article was practically word for word of others printed about this atrocity. I think he should
have tried to get the military involveds view point.
My son is a Marine currently serving in Iraq. During one of our conversations soon after the report
on the net, I asked him if he knew about it.
Not only, did he know about it, he was a participant. The Marines are not allowed to enter the
hospital without Battalion Commands permission. They were looking for an insurgent who had
been wounded by return fire after he had attacked my sons patrol.
They waited for the Iraqi Army who led the search of the hospital. No one was terrorized or
handcuffed or called terrorists.
Upon hearing who they were looking for, the head of the hospital talked to his staff and learned the
insurgent had been sent to another facility to be treated.
My sons patrol went to the other facility, obtained the records of the insurgent and picked him up
at his home.
As an American, I resent this type of reporting. Using this information as is, it blinds people to the
real enemy we are facing, Fanatical Islam.
Maybe the reports you read dont detail how the insurgents are using chlorine bombs against
women and children because they dont happen to agree with who should have taken over control
of the religion when Mohammed died 1500. years ago.
Have you not seen the reports about the insurgents who were run out of their stronghold by joint
Iraqi and American actions and killed women who were morally wrong by not wearing what these
patriots considered acceptable clothing?
Have you not heard of The Awakening, a tribal movement in the Anbar province to join with the
Americans to drive out Al Quaeda because they have come to realize the threat to the tribes
traditional way of life? I can go on, but these people you seem to feel sorry for are intent on
crushing Western civilization and making the whole world Muslim. Read their websites.
The globalization you are working to bring about will be on their terms, not yours. Thank you for
taking the time to al least read anothers view point.
Joseph M. Thompson
11 April 2007
www.globalresearch.ca/war-crimes-health-care-in-iraq-has-collapsed/5289" data-title="War Crimes: Health
Care in Iraq has Collapsed">
Copyright 2014 Global Research


Iraq health care 'in deep crisis'
Iraq's health system is in a far worse condition than before the war, a British medical charity says.
Doctors from the group Medact conducted surveys with international aid groups and Iraqi health workers in
September.
They exposed poor sanitation in many hospitals, shortages of drugs and qualified staff and huge gaps in services
for mothers and children.
Medact, which monitors healthcare in post-conflict areas, called for an inquiry into the situation.
It has also challenged the British government to set up a commission to establish the level of civilian casualties in
Iraq.
Damaged hospitals
"The war is a continuing public health disaster that was predictable - and should have been preventable," the
group says.
"Excess deaths and injuries and high levels of illness are the direct and indirect results of ongoing conflict."
Groups like the medical charity Merlin and the UN aid organisation Unicef were among those whose staff provided
information.
They paint a picture of a health service struggling to cope and, because of the continuing violence, a population
often afraid to leave their homes to seek medical help.
In those many areas of Iraq where there are no terrorists and no insurgents there is no problem
whatsoever with the delivery of healthcare
UK foreign secretary
Jack Straw
Twelve percent of Iraq's hospitals were damaged during the war and the country's two main public health
laboratories were also destroyed, the report says.
However, Iraq's deputy prime minister Barham Saleh told reporters in London that the health situation in Iraq was
"not good" but it was improving not deteriorating.
He said "the level of devastation that Saddam Hussein has left us with was unimaginable" and added that health
budgets were increasing.
UK foreign secretary Jack Straw pointed out that since the conflict 95% of children under five had been
immunised, some 150 primary health care centres were planned and a string of hospitals in the south of the
country had been renovated.
He said the great mistake the report made was blaming any problems with healthcare on the Iraqi government
and health ministry rather than terrorists and insurgents.
"In those many areas of Iraq where there are no terrorists and no insurgents there is no problem whatsoever with
the delivery of health care."
Medact accuses the UK and US governments and Iraqi authorities of denying "the true extent of harm" to Iraq's
civilians.
It also says health relief and reconstruction efforts have been bungled through mismanagement and corruption.
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/world/middle_east/4054105.stm

Published: 2004/11/30 16:08:12 GMT

BBC 2014
SANCTIONS ON IRAQ

Before the sanctions
Before 1990 and the imposition of sanctions, Iraq had one of
the highest standards of living in the Middle East. It was a
highly urbanized society, dependent on a large service
economy, with high standards of healthcare very widely
available, and a complex infrastructure typical of a modern
society. In 1990 about 71% of the 18.9 million population lived
in cities, 80% of the labour force worked in the service sector,
with only 12.5% in agriculture and 7.8% in industry. 97% of
urban-dwellers and 70% rural-dwellers had access to health
facilities, according to United Nations Development Programme criteria.
The World Health Organisation in Baghdad reports that before the Gulf War, 93% of the
population had access to a free, modern, high quality health care system. Today that system
is barely functioning.
More than 93.9% children were enrolled in primary school before the sanctions. Also pre-war,
over 90% of the population had access to safe distributed water. Extensive health
surveillance ensured a high quality of drinking water, and efforts to eradicate malaria,
leishmaniasis and other water-borne diseases had saved Iraq from the epidemics found in
many other developing countries. (source :Report on Humanitarian needs in Iraq prepared by
a mission led by Sadruddin Aga Khan, executive delegate of the Secretary-General, UN,
1991)
UN sanctions
"People are dying silently in their beds. If 6,000 children are dying each month, this
means 72,000 a year. Over eight years, we have half a million children. This is
equivalent to two or three Hiroshimas."
Ashraf Bayoumi, former head of the World Food Programme Observation Unit

The sanctions were adopted on August 6, 1990, forty-five years to the day after the United
States dropped an atomic bomb on Hiroshima, Japan, killing an estimated one hundred
thousand people and leaving a toxic legacy that still affects the population of the area. As
horrific as the use of nuclear weapons against Japan was, perhaps five to ten times as many
people have died in Iraq as a consequence of the war led by the United States and Britain,
under United Nations (UN) auspices, during the last decade.
The United Nations, acting under US pressure, imposed economic sanctions four days after
Iraq's invasion of Kuwait and reaffirmed them after the brutal 1991 Gulf War, which claimed
tens of thousands of lives, expelled Iraq from Kuwait, and in the process reduced the country
to a "pre-industrial" state, as a UN-led delegation observed just after the war. Sanctions were
allegedly extended to disarm Iraq of its biological, chemical, nuclear weapons, and all kind of
weapons of mass destruction. They imposed sanctions in 1991 under UN Resolution 687
which says they will only be lifted once Iraq meets the cease fire terms.
In May 1996, Iraq reached an accord with the United Nations allowing it to sell $1 billion
worth of oil every 90 days, with the money set aside for food and medicine, compensation to
Kuwaitis, and other purposes. In Oct 1997, the UN disarmament commission concluded that
Iraq was continuing to hide information on biological arms and was withholding data on
chemical weapons and missiles. U.S. weapons inspectors were expelled from Iraq in Nov
1997, and a U.S. military buildup in the Persian Gulf ensued. As Iraq ceased cooperating with
UN inspectors, the United States and Britain began a series of air raids against Iraqi military
targets and oil refineries in Dec 1998. In Jan 1999, the United States admitted that American
spies had worked undercover on the inspection teams while in Iraq, gathering intelligence on
Iraqi weapons programs. A new UN arms inspection plan that could have led to a suspension
of the sanctions in place since the end of the war was devised by the Security Council in Dec
1999, but Iraq rejected the plan.
Basically, Iraq is being collectively tortured for its defiance of American domination plans for
the region. Even official U.N. reports document that nearly 1 million Iraqis, mostly the young
and the elderly, have died in the past eight years as a direct result of American policies. The
Security Council consistently blocks vaccines, analgesics and chemotherapy drugs, claiming
they could be converted into chemical or biological weapons. Even the morphine, the most
effective painkiller has been banned by the Security Council.
One of the way the Iraqi government can win support from other nations is by promising
lucrative post-sanction oil contracts to potential allies. Most experts believe that Russia,
China, and France will be the main beneficiaries of these promises and expect that these
countries will support softening the sanctions. However, the sanctions are not likely to be
fully lifted as long as Hussein remains in power. Meanwhile, the Iraqi government is expected
to focus on circumventing the sanctions, primarily through oil smuggling.
Ten years on, despite evidence from top former UN arms inspectors and from other
international agencies that Iraq has been "qualitatively disarmed," the sanctions remain in
place. Sanctions will be maintained "until the end of time, or as long as he (Saddam Hussein)
is in power," ex-President Bill Clinton said.
The U.S. policy of economic destabilization and overthrow in Iraq will not lead to a democratic
government, but rather to a dictatorship compliant to U.S. bidding, as has been shown time
and again.

United Nations Security Council documents on Iraq
Security Council resolutions on Iraq
Consequences of the sanctions
"11 years of sanctions, 6000 die each month, over 250 die a day,1 child every 7 min
1.5 Million Total " Unicef
"What had been one of the most advanced health, education and welfare systems in
the Arab world was now in what seemed to be a state of terminal collapse."
Eight years of war with Iran (1980- 1988) followed by the Gulf War of 1990-1991 left Iraq
and the Iraqi people exhausted. The economy and, as a result, the infrastructure of the
country lay in ruins. After nine years of trade sanctions, imposed by the UN after Iraq's
invasion of Kuwait in August 1990, the situation of civilian population is increasingly
desperate. Deteriorating living conditions, inflation, and low salaries make people's everyday
lives a continuing struggle, while food shortages and the lack of medicines and clean drinking
water threaten their very survival. In Iraq, it is the weakest and most vulnerable who suffer
from sanctions, the elderly and people with chronic diseases.
The sanctions contributed to a brutal and mere genocidal war.


Health of children
According to a UN Children's Fund (UNICEF) survey published in
August 1999, infant mortality in most of Iraq has more than doubled
in the nine years since UN sanctions were imposed. In central and
southern Iraq, home to 85% of the population, the death rate for
children under five rose from 56 per 1,000 live births in the period
1984-89 to 131 per 1,000 in 1994-99.
For the first time in decades, diarrhea has reappeared as the major
killer of children. The highly specialized Iraqi doctors are now faced with third-world health
problems which they were not trained to handle. According to UNICEF statistics from
November 1997, a third of all children under five are chronically malnourished. This
represents a 72% rise since 1991. Results from a nutritional survey of 15,000 children of the
age of five, conducted by the Iraq Ministry of Health together with the UNHCR and WFP in
May 1998, show that the level of malnutrition has stabilized since 1997 but that the situation
is unlikely to improve substantially unless water and sanitation and other sectors receive
larger financial input. The iraqi children have not had proper drinking water or sanitation
since they were born.
Malnutrition is now endemic amongst children.

Water
One of the major threat to the health of the population is the
quality of the drinking water. The Gulf War severely damaged
Iraq's infrastructure, interrupting the power supply and
consequently the operation of pumping and treatment facilities. A
UNICEF / Government of Iraq survey in 1997 on the availability of
water and sewage systems reported than more than half of the
rural population did not have adequate access to clean drinking
water, while for sewage disposal some 30% of the total
population, predominantly in rural areas, were without adequate
services. Much of the waste is discharged directly into rivers and
streams, so that much of the water supplied is contaminated or below acceptable standards.
As a result children are dying of what should be treatable diseases: simple diarrhea, typhoid,
dysentery and other water-borne illnesses.

Hospitals and health Centers
Standards of care in hospitals and health centers have reached appalling levels, despite the
doctors' dedication and high qualifications. Iraq's 130 hospitals, many of them built by foreign
companies in the 1960s and 1980s, have not received the necessary repairs or maintenance
since the Gulf War, but above all since the imposition of sanctions. The buildings are in an
advanced state of disrepair (cracked and leaking roofing, broken windows and doors, bulging
floors), as are the hospital sewage works, the electricity and ventilation systems. Expensive
imported equipment, or even more basic items are no longer being replaced. Hospitals are
short staffed with doctors and nurses salaries insufficient to support them. Medical equipment
like incubators, X-ray machines, and heart and lung machines are banned.
Equally worrying is the state of the primary health centers, which serve the widest sector of
the population. Public health in Iraq rests on the existence of over a thousand basic
dispensaries covering the entire country and 84 intermediary health centers, which are in
charge of coordination. The centers cannot function properly owing to the shortage of
equipment and material. They often lack the most basic tools such as stethoscopes, sterilizers
and writing paper. The negative impact on the treatment received by patients and hence on
their health, is immense.

Uranium
After the Gulf war Iraq was not allowed the equipment to
clean up its battlefields. More than 1 million rounds of
weapons coated in depleted uranium (basically nuclear
waste) were used by the allies during the war.
As much as 300 tonnes of expended depleted uranium
ammunition now lies scattered throughout Kuwait and Iraq. Depleted uranium dust gets into
the food chain via water and the soil. It can be ingested and inhaled. Prolonged internal
exposure leads to respiratory diseases, breakdown of the immune system, leukemia, lung
cancer and bone cancer. Consequently, the number of cases of cancer has risen sharply
especially in southern Iraq. If cancers continue on the present upward curve, 44 per cent of
the population could develop cancer within ten years. Cancer specialist Dr Jawad Al Ali says
40-48% of Basra's population have been contaminated with depleted uranium.