Dr. Safaa T. Bahjat,
Iraq
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Before the war with Iran (1980-1988)
Iraq had a series of hospitals and primary
health care centre 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 centre 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, laboratory 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.
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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 number 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 multi-drug
resistant strain are done at the governate
chest hospitals. Because the problems in
water treatment, water distribution sewage
pumping acute watery diarrhoea is very common
and there are great number 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
typically 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, laboratory
reagents, looting of shipments and medicines
during transportation exacerbates 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 are
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.
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