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Issued June 21, 2005 and endorsed by:
Geneeskunde Voor de Derde Wereld
* Also: Asian Women’s Human Rights Council, Association of Humanitarian Lawyers, SOS Iraq * This report is submitted as evidence to the Jury of conscience during the culminating session of the World Tribunal on Iraq, Istanbul 23-27 June |
I. INTRODUCTION
II. THE STUDY
III. SUMMARY OF FINDINGS
IV. CASE STUDIES
A. Equipment and Medicine Shortages
B. US Military Interfering With Medical Care
C. Lack of Water and Electricity Affecting Medical Care
VI. BRAIN DRAIN
VII. RECONSTRUCTION CONTRACT WORK IN LIMBO
VIII. CONCLUSIONS
IX. SECTIONS OF GENEVA CONVENTIONS I, III AND IV OF 1949, RELEVANT TO HEALTH RIGHTS AND HEALTH CARE
Although the Iraq Ministry of Health claims its independence and has received promises of over $1 billion of US funding, hospitals in Iraq continue to face ongoing medicine, equipment, and staffing shortages under the US-led occupation.
During the 1990s, medical supplies and equipment were constantly in short supply because of the sanctions against Iraq. And while war and occupation have brought promises of relief, hospitals have had little chance to recover and re-supply: the occupation, since its inception, has closely resembled a low-grade war, and the allocation of resources by occupation authorities has reflected this reality. Thus, throughout Baghdad there are ongoing shortages of medicine of even the most basic items such as analgesics, antibiotics, anesthetics, and insulin. Surgical items are running out, as well as basic supplies like rubber gloves, gauze, and medical tape.
In April 2004, an International Committee for the Red Cross (ICRC) report stated that hospitals in Iraq are overwhelmed with new patients, short of medicine and supplies and lack both adequate electricity and water, with ongoing bloodshed stretching the hospitals’ already meager resources to the limit.[1]
Ample testimony from medical practitioners in the interim in fact confirms this crisis. A general practitioner at the prosthetics workshop at Al-Kena Hospital in Baghdad, Dr. Thamiz Aziz Abul Rahman, said, “Eleven months ago we submitted an emergency order for prosthetic materials to the Ministry of Health, and still we have nothing,” said Dr. Rahman. After a pause he added, “This is worse than even during the sanctions.”[2]
Dr. Qasim al-Nuwesri, the chief manager at Chuwader General Hospital, one of two hospitals in the sprawling slum area of Sadr City, Baghdad, an area of nearly 2 million people, added that there, too, was a shortage of most supplies and, most critically, of ambulances. But for his hospital, the lack of potable water was the major problem. “Of course we have typhoid, cholera, kidney stones…but we now even have the very rare Hepatitis Type-E…and it has become common in our area,” said al-Nuwesri, while adding that they never faced these problems prior to the invasion of 2003.[3]
Chuwader hospital needs at least 2000 liters of water per day to function with basic sterilization practices. According to Dr. al-Nuwesri, they received 15% of this amount. “The rest of the water is contaminated and causing problems, as are the electricity cuts,” added al-Nuwesri, “Without electricity our instruments in the operating room cannot work and we have no pumps to bring us water.”[4]
In November, shortly after razing Nazzal Emergency Hospital to the ground,[5] US forces entered Fallujah General Hospital, the city’s only healthcare facility for trauma victims, detaining employees and patients alike.[6] According to medics on the scene, water and electricity were “cut off,” ambulances confiscated, and surgeons, without exception, kept out of the besieged city.[7]
Many doctors in Iraq believe that, more widely, the lack of assistance, if not outright hostility, by the US military, coupled with the lack of rebuilding and reconstruction by foreign contractors has compounded the problems they are facing.
According to Agence France-Presse, the former ambassador of Iraq Paul Bremer admitted that the US led coalition spending on the Iraqi Health system was inadequate. “It’s not nearly enough to cover the needs in the healthcare field,” said Bremer when referring to the amount of money the coalition was spending for the healthcare system in occupied Iraq.[8]
When asked if his hospital had received assistance from the US military or reconstruction contractors, Dr. Sarmad Raheem, the administrator of chief doctors at Al-Kerkh Hospital in Baghdad said, “Never ever. Some soldiers came here five months ago and asked what we needed. We told them and they never brought us one single needle… We heard that some people from the CPA came here, but they never did anything for us.” [9]
At Fallujah General Hospital, Dr. Mohammed[10]said there has been virtually no assistance from foreign contractors, and of the US military he commented, “They send only bombs, not medicine.”[11]
International aid has been in short supply due primarily to the horrendous security situation in Iraq After the UN headquarters was bombed in Baghdad in August 2003, killing 20 people, aid agencies and non-governmental organizations either reduced their staffing or pulled out entirely.
Dr. Amer Al Khuzaie, the Deputy Minister of Health of Iraq, blamed the medicine and equipment shortages on the US-led Coalition’s failure to provide funds requested by the Ministry of Health.[12]
“We have requested over $500 million for equipment and only have $300 million of this amount promised,” he said, “Yet we still only have promises.”[13]
According to The New York Times, “of the $18.4 billion Congress approved last fall, only about $600 million has actually been paid out. Billions more have been designated for giant projects still in the planning stage. Part of the blame rests with the Pentagon's planning failures and the occupation authority's reluctance to consult qualified Iraqis. Instead, the administration brought in American defense contractors who had little clue about what was most urgently needed or how to handle the unfamiliar and highly insecure climate.”[14]
The World Health Organization (WHO) last year warned of a health emergency in Baghdad, as well as throughout Iraq if current conditions persist. But despite claims from the Ministry of Health of more drugs, better equipment, and generalized improvement, doctors on the ground still see “no such improvement.”[15]
From April, 2004 through January, 2005, the author and his colleague surveyed 13 hospitals in Iraq in order to research how the healthcare system was faring under the US-led occupation. While the horrendous security situation in Iraq caused the researchers to confine the survey to hospitals primarily in Baghdad, hospitals west, north, and south of the capital are included in this report.
Hospitals surveyed:
Al-Karama Hospital, Sheikh Marouf, Baghdad
Falluja General Hospital
Saqlawiya Hospital
Amiriat Al-Fallujah Hospital
Balad General Hospital
Alexandria Hospital, Babylon Province (just south of Baghdad)
Al-Kena Hospital, Baghdad (Prosthetics/Rehabilitation)
Yarmouk Hospital, Baghdad
Baghdad Teaching Hospital (Baghdad Medical City)
Chuwader Hospital, Sadr City, Baghdad
Al-Noman Hospital, Al-Adhamiya, Baghdad
Al-Kerkh General Hospital, Baghdad
Arabic Children’s Hospital, Baghdad
Early in 2004, prior to this report, Dr. Geert Van Moorter, a Belgian M.D., conducted a fact-finding mission to Iraq where he surveyed hospitals, clinics, and pharmacies. Van Moorter concluded: “Nowhere had any new medical material arrived since the end of the war. The medical material, already outdated, broken down or malfunctioning after twelve years of embargo, had further deteriorated over the past year.”[16]
Findings in this report suggest that Dr. Van Moorter’s statement remains true today, albeit with the continued deterioration of equipment, supplies, and staffing, further complicated by an astronomical increase in patients due to the violent nature of the occupation of Iraq. This report documents the desperate supply shortages facing hospitals, the disastrous effect that the lack of basic services like water and electricity have on hospitals and the disruption of medical services at Iraqi hospitals by US military forces.
This report further provides an overview of the situation afflicting the hospitals in Iraq in order to highlight the desperate need for the promised “rehabilitation” of the medical system. Case studies highlight several of the findings and demonstrate that Iraqis need to reconstruct and rehabilitate the healthcare system. Reconstruction efforts by US firms have patently failed, while Iraqi contractors are not allowed to do the work.
The current model in Iraq of a “free trade globalized system,” limited in fact to American and a few other western contractors, has plainly not worked. Continuing to impose this flawed and failing system on Iraq will only worsen the current healthcare crisis.
Compounding the problems due to a lack of equipment and medicine in Iraqi hospitals, occupancy rates at all but one of the hospitals surveyed was between 80-100% because of heavy fighting, car bombs, and an exceedingly high crime rate in occupied Iraq.[17]
|
Hospital |
X-Ray |
Ventilator |
Ambulances |
Pharmaceuticals |
Lab Supplies |
US Military Incursions |
Al-Karama Baghdad |
Have ……….. 6 Working……. 2 Total Needed ..6 |
Have ……..… 10 Working…….. 4 Total Needed ..10 |
Have ……..… 4 Working…….. 2 Total Needed .. 5 |
Supply Sporadic |
Supply Sporadic |
Sporadic
|
|
Fallujah General |
Have ……..… 5 Working…….. 2 Total Needed .. 7 |
Have ……..… 8 Working…….. 3 Total Needed .. 8 |
Have ……..… 5 Working…….. 2 Total Needed .. 6 |
Supply Sporadic |
Supply Sporadic |
Sporadic |
|
Balad General |
Have ……..… 3 Working…….. 1 Total Needed .. 4 |
Have ……..… 5 Working……..2 Total Needed .. 5 |
Have ……..… 3 Working……..1 Total Needed ..3 |
Supply Sporadic |
Supply Sporadic |
Sporadic |
|
Alexandria (south of Baghdad) |
Have ……..… 3 Working…….. 1 Total Needed .. 3 |
Have ……..… 3 Working…….. 1 Total Needed .. 3 |
Have ……..… 4 Working…….. 1 Total Needed .. 4 |
Supply Sporadic |
Supply Sporadic |
Sporadic |
|
Al-Kena, Baghdad |
Have ……..… 2 Working…….. 1 Total Needed .. 4 |
Have ……..… 4 Working…..... 2 Total Needed .. 4 |
Have …….… 2 Working…..... 1 Total Needed ..3 |
Supply Sporadic |
Supply Sporadic |
None |
|
Yarmouk, Baghdad |
Have ……….. 4 Working……. 3 Total Needed. 5 |
Have …….…. 28 Working….... 16 Total Needed...28 |
Have ………… 6 Working…….. 4 Total Needed… 6 |
Supply Sporadic |
Supply Sporadic |
Frequent |
|
Baghdad Teaching |
Have ……...… 7 Working...….. 4 Total Needed.. 4 |
Have ……….. 20 Working..…. ..20 Total Needed…0 |
Have ………… 4 Working…….. 4 Total Needed ... 6 |
Supply Sporadic
|
Supply Sporadic
|
None |
|
Chuwader General |
Have ………... 13 Working….… 6 Total Needed .. 13 |
Have ……..…14 Working…… 7 Total Needed ..12 |
Have ……….... 5 Working……... 3 Total Needed .. 10 |
Supply Sporadic
|
Supply Sporadic
|
Frequent |
|
Al-Noman Baghdad |
Have …….…. 2 Working….... 1 Total Needed .. 3 |
Have ……….. 5 Working……. 3 Total Needed .. 6 |
Have …………. 2 Working……… 1 Total Needed .. .3 |
Supply Sporadic
|
Supply Sporadic
|
Frequent |
|
Al-Kerkh General |
Have …….…… 6 Working……... 5 Total Needed… 5 |
Have …..…… 9 Working…..... 3 Total Needed.. 9 |
Have ……….… 5 Working……… 2 Total Needed….5 |
Supply Sporadic
|
Supply Sporadic
|
Sporadic
|
|
Arabic Children’s |
Have ………… 3 Working……. 1 Total Needed .. 5 |
Have ………... 6 Working…….. 3 Total Needed .. 8 |
Have ……….. 3 Working……. 3 Total Needed .. 0 |
Supply Sporadic |
Supply Sporadic |
None |
White indicates critical needs, i.e., an area with an unsustainable level of operation, yellow demarcates a difficult level of operation that needs immediate attention, and green indicates an area in which a hospital is operating sufficiently and does not need assistance.[18]
Highlighting some of the critical areas of need in the hospitals surveyed, the case studies focus on the following areas:
A. Shortage of Equipment and Medicine
In Baghdad, Al-Kena Hospital also serves as a prosthetics workshop and is the only facility that provides rehabilitation services for persons with disabilities in the entire country. It provides one example of how the US-funded Ministry of Health is abjectly failing to provide Iraqi hospitals with equipment, medicine, and funding.
A General Practitioner at the prosthetics workshop, Dr. Thamiz Aziz Abul Rahman, said they even lack the necessary machinery needed to make artificial prostheses. “We are using antiquated machinery from the 1970s which is missing parts,” he said while pointing to broken machinery in the dusty workshop.[19] While holding a leg brace in need of repair, Dr. Rahman noted: “In addition to this, the lack of adequate funding means we are unable to treat more patients who need prostheses, as well as [having] a very long waiting list for people who need our care.”[20]
Dr. Thamiz Aziz Abul Rahman, a General Practitioner at Al-Kena Rehabilitation Hospital in Baghdad. Al-Kena is the only hospital in Iraq that makes prosthetics and provides rehabilitation services. The hospital is critically under-funded and undersupplied.
Dr. Ahmed Kassen, a specialist in rheumatology at the hospital and supervisor of the workshop, said most of the materials used by the workshop for prostheses are imported from France and Germany. In a situation resembling that in other hospitals around the country today, Dr. Kassen added: “This takes time and we must await the shipments. They are also delayed by the security situation and delays at the Ministry of Health for approvals of these materials.”[21]
The prosthetics workshop has only one wheelchair to transport patients in and out of the clinic, and there is not enough funding to hire wheelchair assistants or purchase more wheelchairs. Thus, simply to reach the clinic, patients must bring friends or family members.
The clinic also received broken promises made by coalition authorities. After the invasion of Iraq, US personnel from the Ministry of Health came to the workshop to find out what supplies were needed. Dr. Kassen said he provided both a catalogue and a computer disk of the materials the workshop needed but never heard from the officials again. “The Americans who came here didn't even know what a clinic like this was for,” he exclaimed. “Of course we got no assistance.”[22] Both he and Dr. Rahman said that the workshop had yet to receive any new materials from the Ministry of Health since the 2003 US-led invasion of Iraq.
Reasonable accommodation? A broken wheelchair at Al-Kena physical rehabilitation hospital. Most patients with mobility impairments have no access to the services at Al-Kena because there are not enough wheelchairs.
The workshop lacks even the most basic materials necessary for constructing prosthetics, such as leather, pins, metal bars and joints. Reliant upon the Ministry of Health for these supplies that are not forthcoming, hospital personnel are forced to obtain from the market what they can afford with their meager funds. “We don't have enough money, and barely enough of the most simple supplies we need to treat amputees,” explained Dr. Rahman. “Of course we've had a dramatic increase in the number of amputees because of the invasion and now the occupation.”[23] While helping a small boy with a new back brace to counter the effects of scoliosis, Dr. Kassen added: “We lack locking joints for prosthetics. Most of the time we are unable to serve smaller children and geriatrics. And if one component from the prosthetics is missing, we cannot help the people.”[24]
Scoliosis patient at Al-Kena Hospital being fitted with a back brace. The hospital usually lacks the parts necessary to serve its patients properly.
Like nearly every hospital in Baghdad during the aftermath of the invasion, the hospital and workshop were looted heavily and have received neither funding nor supplies from the US-funded Ministry of Health for compensation.
At the Arabic Children’s Hospital which treats young cancer patients in Baghdad, Dr. Waad Edan Louis, the Chief Visiting Doctor, said that before the war most of the cancer cases came from the south, but now the doctor says there are numerous cases from Baghdad as well and this has caused a great strain on their supplies and staff.[25] While the extent of this increase in cancer rates are difficult to substantiate owing to inadequate disease surveillance or working cancer registries, this problem highlights the additional strain applied on the already struggling healthcare system overburdened by the costs of the invasion and military operations under the occupation.
Children in the cancer ward at the Arabic Children’s Hospital in Baghdad oftentimes have to bring their own food since the hospital lacks the funding needed to offer meals.
Dr. Louis said the cancer rate jumped dramatically in the late 1990’s, and his hospital alone is treating four new cases each week.
While the Pentagon admits to using over 300 tons of Depleted Uranium (DU) munitions on Iraq in the 1991 Gulf War, the actual figure is closer to 800 tons. Thus far in the current war there have been 200 tons of DU used in Baghdad alone, according to Al-Jazeera.[26]
As far as availability of medical supplies, Dr. Louis said there are always shortages, and what they need varies from week to week. At present they are lacking IV sets for blood transfusions and cannulas. Patients are compensating for this by purchasing their own supplies that they bring with them to the hospital.[27]
Dr. Louis stated that these deficiencies are due to a lack of money from the US that supplies the Ministry of Health with its funding.[28]
Dr. Namin Rashid, the Chief Resident Doctor at Yarmouk Hospital, echoed this opinion when he stated that the only medical help his hospital had received lately had been a load of medical supplies from Grand Ayatollah Ali Al-Sistani.
He complained that the Ministry of Health consistently does not give them enough supplies, and his hospital currently only had 100 sets of IVs and blood transfusion equipment. He added: “We are getting less medical supplies now than we were during the sanctions!”[29]
He said his hospital is receiving only one half as much supplies as it was prior to the invasion. This is also compounded by the fact that Iraqi companies have yet to be identified or allowed to participate in supplying equipment and medicine to the hospitals.
A doctor at the Al-Karama hospital speaking on condition of anonymity also said: “Things for us here now are worse than they were during the sanctions. We have certain items that we have shortages of -- kidney transplant supplies, immuno-suppressive drugs, anti-rejection drugs, gauze, IV supplies and antibiotics.”[30]
He said that they have received no funding from the US reconstruction funds, and that most of the minimal funding they are receiving has come from NGO’s.[31]
A doctor at Al-Kerkh Hospital said that the hospital is lacking IV supplies and blood transfusion fluids. Most operating tables there were broken. Also speaking on condition of anonymity due to fear of US military reprisals, a second doctor working as an administrator doctor there reported, “the hospital is currently in a very bad situation. Before the invasion we had a much better supply situation, 80% better than now.”[32]
Operating tables in many Baghdad hospitals are in dismal condition while hospitals attempt to function without necessary funding, equipment and medicine.
B. US Military Interfering With Medical Care
Another common impediment affecting Iraqi hospitals under occupation is interference by the US military. While this intrusion has most often taken the form of soldiers entering hospitals to interrogate or detain alleged resistance fighters, perhaps the most glaring example of the US military impeding medical care of Iraqis occurred in Fallujah during the heavy fighting of April, 2004.
Doctors from Fallujah General Hospital, as well as others who worked in clinics throughout the city during the US siege of Fallujah reported that US Marines obstructed their services and that US snipers intentionally targeted their clinics and ambulances.
“The Marines have said they didn't close the hospital, but essentially they did,” said Dr. Abdulla, an orthopedic surgeon at the General Hospital who spoke on condition of using a different name. “They closed the bridge which connects us to the city [and] closed our road…the area in front of our hospital was full of their soldiers and vehicles.”[33]
He added that this prevented countless patients who desperately needed medical care from receiving medical care. “Who knows how many of them died that we could have saved,” said Dr. Abdulla. He also blamed the military for shooting at civilian ambulances, as well as shooting near the clinic at which he worked. “Some days we couldn't leave, or even go near the door because of the snipers,” he said. “They were shooting at the front door of the clinic.”[34]
Medical workers in the city claim that Marine snipers deliberately targeted several ambulances operating in Fallujah during the US siege of the city.
