WARTIME IRAQ A GLOBAL HEALTH CRISIS

Global Health Crisis: Iraq the Mayhem of War

Iraq is a War torn country located in the deserts of the Middle East, Iraq is surrounded by the Nations of Turkey, Iran, Saudi Arabia, Kuwait and Syria and has one small Southern coastline along the Persian Gulf. Currently Iraq receives much media and political attention due to the ongoing occupation of U.S. military troops and a history war involvement with the
United States. Beginning with the Gulf Wars in 1991 to present the people of Iraq has suffered the consequences of long term of warfare.

Politically Iraq is still in turmoil as the recent dictator president Suddam Hussein, who developed a pervasive personality cult, ran an authoritarian government, and maintained power through the devastating Iran-Iraq War (1980–1988) and the first Persian Gulf War (1991), which both corresponded with a sharp decline in living standards and the human rights situation (wikipedia 2005). In November 2003, the US-managed Coalition Provisional Authority announced plans to turn over sovereignty to an Iraqi Interim Government by mid-2004. The actual transfer of sovereignty occurred on 28 June 2004. The interim president was Sheikh Ghazi Mashal Ajil al-Yawer, and the interim Prime Minister Iyad Allawi.

On January 30, 2005, the Iraqi people voted in an election conducted by their transitional government which elected a 275-member Transitional National Assembly. In the January 30, 2005, Legislative elections, the Iraqi people chose representatives for the newly-formed 275-member Iraqi National Assembly. The voting represented the first general election since the United States-led 2003 invasion of Iraq, and marked an important step in the transition of turning control of the country over from US occupation forces to the Iraqis themselves (wikipedia 2005)


Years of war and continuous attacks on the economic and healthcare infrastructure of Iraq have resulted in a major health crisis for this country. The cost to the health of the Iraqi citizens is tremendous and continues to worsen. Beginning in 1991 with the Gulf War which many analysts believe was not a war in the usual sense as Iraq was no fair match for the advanced weapon systems of the United States Military. 88,000 tons of bombs were dropped on Iraq, equal in destruction to seven of the bombs which were dropped on Hiroshima (Abdul-Hamid 2005).

During the Gulf war military targets were civilians and the economic infrastructure of Iraq, destroying irrigation facilities, hospitals, pharmaceutical plants, water sources, factories, electrical and communication lines There are also reports of experimental biological and chemical weapons being used of which many American Soldiers have been exposed to resulting in a cluster of symptoms known as The Gulf War Syndrome (Middle East Watch 1991).
Chronic symptoms such as fatigue, rashes, aching joints, headaches, neurological and emotional instability, memory loss and diarrhea have been extensively reported by not only U.S. soldiers but also by Iraqi civilians who do not have the medical resources to manage the syndrome. According to sources the debilitating symptoms first appeared during the Gulf War in U.S. troops as well as in the hospitals of Southern Iraq and Kuwait. Additionally and even more alarming these symptoms have also been reported in family members of U.S. troops after returning from combat leading medical authorities to suspect a biological or chemical agent.


Suspected causes have been documented as; chemical or biological such as nerve agents,
Anthrax, Brucellosis or possible viral or DNA altered micro organisms, depleted uranium munitions and radiation poisoning, toxic environmental substances such as nitrogen oxides, sulfur dioxide and organic carbon and metal from large scale oil well fires and insecticides and pesticides (Hammell 2003).

Research conducted at the Gulf War Illness research Unit and London based, U.S. funded
Research lab continue to study the etiology of symptoms of Gulf War Veterans and certain deficiency’s were found in previous studies, such the effects of depleted uranium, further studies into the same symptoms in Iraq civilians and the proven incidence of higher morbidity rates among Gulf war veterans than those in other conflicts.

Gulf War syndrome is only one aspect of the Iraqi health crisis included are other widespread infectious diseases such, physical trauma and injury related to gunfire, bombs, landmines and insurgent terrorism. Iraqi women suffer severe reproductive irregularities such as stillborn fetuses, deformities , premature births and low birth weights, acute malnutrition and starvation, currently the life expectancy of Iraqi civilians in 55 years, child mortality rates were estimated in 2003 to be 200-300 deaths per 1000 births (Panch et al 2004).

Additionally the psychological impact of war has taken is evident with mental illness such as depression, suicide, psychosocial trauma and acute anxiety increasing exponentially. In a recent edition of Medicine, Conflict and Survival, a psychiatric journal, it was reported that there was an increase in domestic violence, child and spouse abuse, acts of public violence and mental/behavioral disorders (Adjukovic 2004).

‘The magnitude of communicable diseases continues to increase,’ says the Minister of Health and international health authorities are in agreement that the major threat to the health of Iraq are from the communicable diseases which have reached epidemic proportions and continue to increase due to the destruction of Iraq’s infrastructure including water and sanitation, the healthcare system, lack of immunizations, malnutrition and greater exposure to pathogens.

Additionally, violence has also been named as one of the top causes of death in Iraq, the combination of traumatic injury and infectious disease has proven to be deadly. The number of civilian deaths directly related to war which includes suicide bombing by insurgent terrorists who may attack crowded civilian areas and explode a grenade, bomb or rocket killing themselves and possibly hundreds of innocent bystanders. The civilian population is continuously under attack, not only by occupying forces such as the U.S. and British Military but also from numerous local militant groups and armies. These groups known as insurgents commit brutal acts of murder and mutilations as terror tactics upon military and civilians alike and are known for the public beheadings of several American citizens in the name of Religion
(Roberts et al 2004)
Primary infectious diseases reported in Iraq are; cholera and other diarrheal diseases, typhoid, TB and other acute respiratory infections, HIV/AIDs, hepatitis, leishmaniasis, measles, mumps, rubella, malaria. Typhoid was reported to be the leading infectious disease in 2004, with over 5000 reported cases and likely more unreported (Ministry of Health 2004). The Iraq of today is truly a place of war and death with ongoing military combat, increased civilian violence and violence on women, vulnerable groups such as children, elderly and misplaced. Iraq civilians are people living with destruction of the life-sustaining infrastructure, lack of water, sanitation, electrical power and food shortages.

The Healthcare system of Iraq has also been destroyed by war, physically health care facilities have been bombed and destroyed, others are crumbling or looted, healthcare facilities which still exists struggle with shortages of supplies and medicines, equipment and workforce shortages. Such essential drugs such as antibiotics, insulin, chemotherapy available in any public hospital. For the Iraqi people this results in severely restricted access to care, poor quality service. There are few, if any, immunization programs intact, further increasing the epidemic of communicable diseases spreading across the Country. Health promotion and disease prevention activities are non-existent. It is estimated that in 2003 alone there were 100,000 deaths of civilians related to the invasion and occupation of Iraq which began n 1991 with the Persian Gulf War. Due to inadequate communication and reporting resources these statistics are most likely significantly higher (Hassan 2004).

The epi-triad analysis of the infectious disease epidemic closely identifies the factors of agent, host and environment and how they interrelate to create this health crisis. The agent responsible for the health crisis in Iraq is clearly war. The immediate effects of violence and destruction combined with widespread communicable disease, biological and chemical contamination of water and food supplies, high maternal/child mortality rates and the future disease burden related to disability and tertiary medical care on a destroyed healthcare system seem like impossible circumstances to overcome. The host, the people of Iraq are at risk due to a variety of factors, all which can be related to war. The population has become severely weakened by violence, disease or disabilities. High maternal/child mortality rates threaten the future generations of the culture.

The level of current risk to the health and future of the Iraq population can adequately be described as a crisis on all levels.
Relief efforts include remaining health care workers and support from international humanitarian organizations by from the U.S. and U.K. who acted as the initial Coalition Primary Authorities (CPA) since assuming control of Iraq after the regime of Sadaam Hussein was overthrown. They are also now responsible for humanitarian relief, due to the strong military forces in Iraq the responsibility was given to military control and the U.S. Department of Defense, which was a departure from the usual practice of allowing associated organizations control of relief efforts. The Department of Defense having little preparation for humanitarian response delayed much needed support to Iraq. This decision became controversial as reports of human rights violations and starvation increased with the death rate (Burke and Noji 2004).
The cost of rebuilding a Country from the ground up is astronomical. In August 2003 a rapid needs assessment was conducted by the UN and World Bank estimated that to rebuild the infrastructure of Iraq would be 32$ billion. Currently Iraq survives primarily on donations from other countries and humanitarian aid. Restoration of Iraq is further burdened as they are still paying for the Gulf War, having borrowed billions of dollars from US corporations such as Coca Cola, Texaco and other corporations in the Us and UK. In 2004 health care decision making and responsibility were given to the newly reformed Iraq Ministry of Health, this agency continues to struggle as funds allotted take a long time to arrive and there is great disparity between health care needs and implementation. (Iraq Revenue Watch 2004).

In addition to the soaring financial cost of rebuilding Iraq the negative perceptions and security concerns put relief workers at risk from terrorism. Some programs have made concerted efforts to overcome negative perceptions of Americans and British Military by engaging with community leaders and foster trust and support. However, some areas of Iraq are still out of bounds to humanitarian relief as they are still war zones and are too dangerous and negative perceptions run too high (Feinstein International Famine Center 2004).

Among the solutions proposed to address the health care crisis in Iraq are; closer monitoring of war casualties by current Iraqi government, compliance with the Geneva Convention, Assistance from the Iraqi government in encouraging trust and support of humanitarian relief workers, it must be clearly defines that they are not a part of the military, clearing of the parts of land in Iraq where landmines remain active, further study on the long-term health effects of Depleted Uranium. Restructuring of the Health care infrastructure begins with the Global support of the Iraq Ministries of Health. Allowing the Ministries of Health the capacity to exercise control over National healthcare policy and administrative development of the health care system. Access to health care can be improved by insuring that health care facilities remain accessible to civilians and that coalition troops, government security forces and insurgents do not misuse or exploit medical facilities, insure health care funding is steady from international sources, strengthen primary care and offer incentives to health care professionals locally and abroad for working in clinics, especially in rural areas where health care is most needed.
Ultimately the key is prevention of further conflict and an end to the war. It is essential that more effort and energy be put into alternatives to violence and resolution of political differences.
The cost to human life and the well-being of the planet are too high as a result of the war in Iraq


References
Abdul-Hamid, W. (2004, January). Where are the statistics on the Iraqi health disaster ? [stand alone document] Retrieved June 19, 2005, from Radical Statistics: http://www.radstats.org,uk/no072//article2.htm

Ajdukovic, D. (2004). Social contexts of trauma and healing. Medicine, Conflict and Survival, 20(2).

Burke, F., & Noji, E. (2004, October 9). Health and politics in the 2003 war with iraq; lessons learned [editorial]. The Lancet.

Fienstien International Famine Centre. (2004). The future of humanitarian action [open document].. retrieved , 2005, from www.reliefweb.int: http://www.reliefweb.int/w/rwb.nsf/0/6431b3cc216bb14985256e300051bbc?

Hammel, E.. E. Hammel (Ed.), International Environmental Problems and Policy: Vol. 378. Gulf war syndrome among veterans : Iraq and our energy future [Research report university of Wisconsin]. Iraq & Our Energy Future.

Hassan, G. (2004, December 1). Iraqs healthcare under the occupation, 200 children die every day. Counter Punch Magazine Online. Retrieved , 2005, from www.counterpunch.org: http://www.counterpunch.org/hassan/12012004.html

Health in Iraq, a brief review of the current health siruation and the challenges facing health development in Iraq. [open document]. (2004). Ministries of Health. Retrieved , 2005, from www.medact.org: http://www.medact.org

Needless deaths in the Gulf War, civilian casualties during air raid campaign and violations of the law. (1991). Message posted to NewYork: Human Rights Watch: http://www.radstats.org.uk

Panch, T., MB,BS, BSc, Reeve, G., Rowson, M., & Salvage, J., RGN, BA, Msc. (2004). Enduring Effects of War Health in Iraq 2004 [Medact 2004 report]. Retrieved , 2005, from Medact.org: http://www.medact.org

Roberts, L., Lafta, R., Garfield, R., Khudharri, J., & Burnham, G. (2005, October 28). Mortality before and after the 2003 invasion of iraq:cluster sample surveys. The Lancet, 364(9445).

Wikipedia, online encyclopedia. (in progress). Iraq:History [open document]. Retrieved June, 2005, from www.wikipedia.org: http://en.wikipedia.org/wiki/Iraq