The Eyes of The Truth

Author Dr. Safaa T. Bahjat, Iraq

Before the war with Iran (1980-1988) Iraq had a series of hospitals and primary health care centers and public health care laboratories in each of its 18 governates. During the 1970s and 1980s many of these were well established and well equipped through partnerships with European and Japanese corporations. However resources dwindled during the Iran-Iraq war and the situation greatly deteriorated after the Kuwait invasion in 1990 and subsequent Gulf war when comprehensive economic sanctions were imposed in August 1990 .This deterioration had a severe impact on Iraqi citizens and health infrastructure .According to UNICEF the number of primary health centers and maternal and child health clinics in Iaq declined from a pre-Gulf war network of 1800 to 929 in the 1990s.The UN Oil for Food Programme was started in late 1997 and offered some relief but the looting and the destruction of hospitals and laboratories following the war of March 2003 substantially affected the ability of the health care system to diagnose treat and monitor and prevent disease .The post-war damage was clearly extensive. All government public health laboratories were demolished and looters had plundered every thing including floor tiles, window panes, pipes, wires etc. The surviving health care institutions were in urgent need of generators, air conditioner fans, medicines, labotatory reagents and increased capacity to accommodate the increasingly large number of individuals and casualties of violence. There are no disinfectants and all glassware and microscopic slides had to be washed and reused. Underlying this was the collapse in the administrative systems, lack of funds, the inability to import materials, and shortage of basic supplies and medical equipment that was either in a state of disrepair or cannibalised for spare parts due to the sanctions. The situation improved gradually through NGOs and by the donation from the WHO. On August 20 a car bomb exploded in Baghdad and killed 17 UN personnel and injured over 100 people freezing their duties and movements. Later kidnapping of the staff of the NGO and asking for ransoms by some insurgences forced the NGO to withdraw and close their offices. Among the problems in the health sector is the pervasive corruption and the political conflicts in administration slowed down the flow of donations which were promised by the USA and the rest of the world. All these hampered reconstruction and the rehabilitation processes.

There is a remarkable increase in infectious diseases due to poverty and malnutrition and the daily street violence leading to the loss of food earning members in the families and the little decompositions they get. The main reason for the unreliability of infectious disease surveillance is the unavailability of well equipped laboratories, for example, most laboratory results for meningitis are either negative or contaminated, even at the big general hospitals (formerly Saddam's general hospitals) and paediatric hospitals (in each governate capital) adding to that is the increasing no. of cases with the limited staff .The uses of biosafety level 2 hoods at these hospitals was prohibited by biological war inspectors who had visited Iraq before the war. Accordingly the use of safe lab practices constituted a major problem. Generally serology for Typhoid fever is conducted by the misleading slide agglutination tests .Tuberculosis is one of the endemic diseases in Iraq ,neither T.B culture nor sensitivity tests for multidrug resistant straina ar done at the governate chest hospitals .Because the problems in water treatment ,water distribution sewage pumping acute watery diarrhea is very common and there are great no. of hepatitis among poor people .UNICEF had reported that 40% of water samples analyzed in Iraq failed tests due to contamination or insufficient disinfection. Many households do not have individual connection to treated pipe water or 24h access to water ,such householders typiocally store water in the home and this water is vulnerable to contamination(primarily from handling ) during transport and storage even if it is clear at source. Damage of the electrical grid lead to the perishing of considerable amounts of vaccines ,lab. reagents ,looting of shipments and medicines during transportation exacerbate the problems. Bacterial culture and susceptibility a necessary component for a rational antibacterial prescribing is not uncommon and diagnosis is made largely on the strength of clinical signs and symptoms. Many physicians have been known to use chemotherapy as a diagnostic tool where cure confirm diagnosis .In addition to physicians ,nurses and pharmacists others are licensed to supply antimicrobials e.g midwives ,community health workers and dispensing assistants .However these drugs can also be obtained for unsanctioned stall keepers itinerant vendors ,hawkers and purveyors of other materials who ae often the first point of call for patients. To complicate the matter there are drug venders .It is a quiet a widespread habit to ingest antimicrobials and to store others from uncompleted courses even beyond the expiration date and later self administer these drugs for self diagnosed conditions or dispense them to family members and friends this is because poverty and the lack of access to health care for many reasons such as daily street violence, insecurity ,transportation difficulties because of the high prices of the gasoline but the more precise this persists even among high income and educated patients also. The Iraq health sector is in urgent needs for a shot in the arm and is essentially vital for evolutionism a new statistical campaign with the help of the WHO and to back up this with all the measures.