Monday, April 03, 2006

Conflict fuels Iraqi health crisis

From ReliefWeb, the web site of the UN Office for the Coordination of Humanitarian Affairs

"When we went there last week we would not leave the base, indeed walking from building to building in the base we had to put on full body-armour. The security situation has deteriorated, there is no doubt about that".(1)Paul Keetch, Liberal Democrat member of the Foreign Affairs Committee.

Much has happened since Medact's Iraq Health Update was published in July 2005. A nationwide constitutional referendum in October was followed by national elections in December to determine the makeup of Iraq's new government. Yet despite these encouraging developments, a U.S. military report released on 23 January 2006, showed a 30% increase in insurgent attacks in 2005 compared to the previous year.(2) The rise in violence has been accompanied by a dramatic increase in the number of kidnappings. According to the Iraq Index Project of the Brookings Institution, up to 30 Iraqis were kidnapped nationwide every day in December 2005.(3)

The total number of international troops in Iraq is currently 157,000.(4) In a remarkably candid assessment that challenges optimistic accounts by the UK and US governments, USAID describes Iraq as a place of 'social breakdown' where 'criminal elements within Iraqi society have had almost free reign.'(5) Attached as an appendix to a paper calling on contractors to bid on its $1.3 billion Focused Stabilization in Strategic Cities Initiative (January 2006), the USAID document claims that 'Baghdad is...divided into zones controlled by organized criminal groups/clans.'(6)

The disastrous security situation has paralysed the Iraqi health sector. Already devastated by eight years of war with Iran from 1980-1988, the first Gulf War in 1991, and more than twelve years of UN sanctions from 1991-2003, the health situation was tenuous even before the U.S.-led invasion in March 2003. Medact's previous updates revealed few improvements and many problems in the first two years of the occupation. An analysis of key health indicators reveals that the health sector remains in dire straights as the 'post-war' period in Iraq nears the end of its third year.

Iraqi death toll still rising
Dr. Bradley A. Woodruff, a medical epidemiologist at the U.S. Centers for Disease Control and Prevention, referring to the study published in The Lancet in late October 2004 that put the number of Iraqi civilian dead as a result of the U.S. invasion at 98,00, called it " the most valid estimate."(7)

In Medact's last update it was reported that the British government had endorsed figures published by the Iraqi Ministry of Health that put the number of civilian dead between 5 April and 5 October 2004 at 3,853 and the number of wounded at 15,517. These figures may or may not have included insurgent dead and wounded. As was noted at the time, this count only covered a 6-month period and included only casualties attributed to insurgent action.(8) Iraq's Interior Ministry has now taken over responsibility for counting Iraqi dead and their most up-todate figures are that 8,175 Iraqis -- including civilians, soldiers, and police -- were killed by insurgents from August 2004 to May 2005.(9)

Until recently, the U.S. has said very little about Iraqi civilian casualties. However in late October 2005, it was reported in the New York Times that the U.S. military has in fact been monitoring civilian deaths in Iraq.(10) Then, in an answer following a highly publicized speech on December 12, 2005, the President put the number at '30,000, more or less.'(11) This is almost exactly the same as figures kept by Iraq Body Count (

The problem with estimates provided by Iraqi officials and Iraq Body Count is that they only include those deaths that have resulted directly from violence. A much more comprehensive nationwide survey of all cause mortality in Iraq was published in The Lancet in late October 2004. Researchers, led by Dr. Les Roberts, interviewed 988 households and, after extrapolating the results to the rest of the country, found that post-invasion excess mortality amounted to 98,000 civilian deaths. Violence -- rather than myocardial infarctions, cerebrovascular accidents and chronic diseases that had been the leading causes of death prior to the invasion -- accounted for most of these deaths.

Any attempt to gauge mortality in the midst of a conflict will be marked by a degree of uncertainty, but what should be beyond dispute is that the Lancet study is based on sound methodology. Yet in 2005 this continued to be questioned in the press.(12) It is interesting that Roberts used nearly identical sampling techniques to study mortality in the Democratic Republic of the Congo (DRC) in 2000, and that U.S. and British officials have quoted these findings without question in speeches condemning the killing in this case.(13)

Meanwhile, innocent Iraqis are continuing to be killed and wounded at an alarming rate. According to one recent estimate, nearly 800 were killed in January 2006, making it the deadliest month since September 2005.(14) In addition to Iraqi casualties, 2274 Americans have been killed and 16,420 have been wounded. More than100 UK soldiers have been killed.(15)

Deepening health crisis
"The only thing I eat all day is a piece of bread with some tomatoes and fried potatoes... .If we eat more than this our father doesn't let us eat the next day."(16) Khalid Amir, a ten-year-old boy living in Baghdad

In 2004 Medact's last Iraq update provided detailed excerpts from the Iraq Living Conditions Survey. COSIT, UNICEF, and the WHO, are currently involved in survey efforts that have either not yet begun or whose results are not yet available to the public.(17) While statistics in a violence-plagued environment such as Iraq are hard to come by, some recent health data has been reported:

According to Hayder Hussainy, a senior official at the Ministry of Health, approximately 50% of Iraqi children suffer from some form of malnourishment and one child in10 is also suffering from chronic disease or illness.(18)

A UN study undertaken in 2005 found that a third of the children in southern and central Iraq are malnourished (the same as in 2003).(19)

According to a 2004 Health Ministry study, 'easily treatable conditions such as diarrhoea and respiratory illness account for 70% of deaths among children.'(20)

For a link to the full report and references go here