IPPNW European Student Congress Napoli May 2006. Enduring effects of war: health in Iraq Photo:...
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Transcript of IPPNW European Student Congress Napoli May 2006. Enduring effects of war: health in Iraq Photo:...
IPPNW European Student CongressNapoli May 2006
Enduring effects of war: health in Iraq Photo: Doctors for Iraq
“We have opened the Pandora’s box and the question is what is the way forward?” US ambassador to Baghdad Los Angeles Times 7 March 2006
81% of households lack proper sanitation 68% lack access to potable waterSpecial Inspector General for Iraq Reconstruction January 2006
“Doctors fear to be attacked by the occupying forces and…many times cannot attend…due to road blocks and curfews…”medical student Ramadi Iraq Communique Summer 2005
Medact
UK charity for global health highlights the health impact of violent
conflict, poverty and environmental degradation
membership organisation of health professionals
UK affiliate of International Physicians for the Prevention of Nuclear War (IPPNW)
Medact: work on conflict and health
health costs of 1990-1991 Gulf War psycho-social work in former Yugoslavia improving refugee health in the UK seminars on reconstruction of health system in
Afghanistan impact on health of war on Iraq:
reports 2002; 2003; 2004
updates July 2005; March 2006
Medact: work on conflict and health
2004 Report:
enduring effects of war:
health in Iraq 2004
www.medact.org
Medact reports on Iraq: why?
to stimulate debate on health effects of war to hold government to account to assess the adequacy of reconstruction efforts to use health data to help prevent war
Medact reports on Iraq: how?
desk studies interviews with a range of people working in Iraq 2004 report: visits to Amman wide dissemination through IPPNW affiliates and
media
Medact reports on Iraq: how?
multi-skilled research teams panel of expert advisors funding from Oxfam (GB), Lionel Penrose Trust and
Polden-Puckham Charitable Foundation
Medact reports on Iraq: how?
Role of students and doctors 2002 Iraq report: research by Catherine Ford and Robert
Henderson, medical students on international health course 2003 Iraq report: researcher and author Dr Sabya Farooq,
epidemiology and public health masters graduate 2004 Iraq report: researcher and editor Dr Trishan Panch
physician, international health consultant 2004 Iraq update: researched and written by Tom Yates,
medical student 2005 Iraq update: researched and written by Kingston Reif, US
international relations graduate; MSc intern in UK
Medact reports on Iraq: constraints
inadequate baseline data lack of information denial of information war and aftermath
Situation before war on Iraq 2003
1990-91 Gulf War; sanctions; Saddam Hussein’sregime dramatic “break” in health improvement after 1990 decline in functioning of health system decline of health-sustaining infrastructure increase in poverty increase in corruption
health of population very vulnerable to new war
collateral damage: the health and environmental costs of war on Iraq Medact 2002
Overall picture since 2003 war
Casualties of war and aftermathCombatant: Iraqi Deaths: 13,500-45,000 estimate
Injuries: 40,500-135,000 generally calculated x3 number of deaths
Combatant: coalition Deaths: 2,428 (US); 109 (UK) 111 (other) Injuries: 17,869 (US) Iraq Coalition Casualty Count 10 May
2006
Combatant injuries
Iraqi combatants: no information available
Coalition combatantsUS: survival rate 90% (WWII 70%, Vietnam 76%) 6% required amputations 20% have suffered head and neck injuries at least 1,700 brain injuries: estimated long term cost of treatment
$14 billion
UK: 230 injured: 12 required amputations January 2006
30-40 have suffered paralysing injury, loss of eye or brain damage January 2006
Casualties of war and aftermath
Iraqi civilian deaths
98,000 excess deaths estimated from nationwide cluster sample survey September 2004. Roberts et al. 2004
39,258 reported maximum Iraq Body Count 10 May 2006
Average violent deaths per day rising: Iraq Body Count 20 March 2006
Year 1 post-combat 20 per dayYear 2 post-combat 31 per dayYear 3 post-combat 36 per day
“30,000 more or less” Iraqi civilians dead President George Bush
The Washington Post December 12 2005
Iraqi civilian deaths
Photo: Doctors for Iraq
Weapons used by coalition in combat
cluster weapons: unexploded bomblets causing child deaths and injuries
depleted uranium: general health risks unclear; cancer risk from inhaled particles
napalm bombs; white phosphorus
Geneva Convention Protocol 1 prohibits indiscriminate attacks, use of indiscriminate weaponsespecially in built up areas; prescribes protection of civilians
question of legality of use of these contentious weapons
Cluster bomb injury
Photo: Doctors for Iraq
Decline in health of population
rise in deaths from all causes since invasion substantial increase x58 in risk of death from violence high child mortality; 50% children malnourished high maternal mortality; reported rise in back street
abortion vaccine preventable disease preventable child deaths from diarrhoeal disease,
acute respiratory infection: 70% child deaths in 2004 rise in mental health and social problems
Living amidst conflict
crisis of law and order: insecurity and fear insurgency & sectarian violence; threat of civil war crime; kidnappings detention of 15,000 Iraqis by US + allies March 2006;
12,000 by Iraqi authorities November 2006 torture and killings
Living amidst conflict
women and girls threatened: rape; human trafficking education severely disrupted surges in internally displaced people health and aid workers targeted
Mental health
Civilians impact of estimated 50% unemployment increase in anxiety and mood disturbance longer term: expected increase in suicides, drug and
alcohol abuse, social and domestic violence almost no mental health services increased behavioral and learning problems in
children and adolescents
Mental health
“The only things they [Iraqi children] have on theirminds are guns, bullets, death and a fear of the USoccupation” Association of Psychologists of Iraq, February 2006
children suffer fear of kidnapping and explosions 92% found to have related learning impediments
report of Association of Psychologists of Iraq, 5 February 2006
Mental health
Photo: Doctors for Iraq
Mental health
Combatants up to 1/3 returning US troops suffer mental health
problems (estimated 40,000) or marriage problems returning US soldiers: higher incidence of post
traumatic stress disorder than in Vietnam or first Gulf war
by January 2004 21 US troops were reported to have committed suicide
Health sustaining infrastructure
reconstruction faltering: funding falling; corruption; 25% - 50% of funds spent on security
water and sanitation facilities damaged and looted power network extensively damaged and looted water and electricity key for nutrition and functioning
of health system: supply well below pre-war level majority depend on food baskets under Public
Distribution System
Health sustaining infrastructure
Photo: Doctors for Iraq
QuickTime™ and aTIFF (LZW) decompressor
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Health system
all activities to promote, restore or maintain healthWHO
Health system
“Imagine yourself trying to operate on a patient in a two-
hour surgery and the power goes out… You pray toGod, and you sweat” Dr Waleed George, May 30, 2005
Health system
Photo: Doctors for Iraq
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Health system
destruction; looting; 90% hospitals needed repair or reconstruction March 2005
large increase in funding but still low: $38 per capita in 2004
corruption; medical supplies diverted increase in pay for health workers: but low relative to
rising cost of living overwhelmed by surges in violence the system struggles to function…
Health system
lack of basic supplies: patients purchase drugs & supplies from black market
widespread commercialisation: twice as many Iraqis use private services than public services
constitution pro-privatisation lack of capacity of Iraqi Ministry of Health lack of coherent Iraqi health policy inequities in distribution of health facilities
Health system
doctors & health workers attacked, shot at, threatened & told to leave or die
2,000 physicians murdered since 2003 estimate
65 doctors killed in 2005 250 physicians kidnapped since invasion estimate
34,000 registered physicians before invasion; 12,000 have left since due to security situation
medical care and access to medical care impeded by military operations
breaching of medical neutrality
Baghdad medical teaching
facility
Photo: Doctors for Iraq
Relief and reconstruction
no plan pre-invasion for health reconstruction UN marginalised then bombed confused relationship between military and
humanitarian actors Coalition Provisional Authority did little: a lot of money
was spent but much unaccounted for only 30% of Madrid Conference pledges received hampered by violence
Reconstruction
“We were never intending to rebuild Iraq…. Wewere providing enough funds to jump-start thereconstruction effort in this country.”Gen. William H. McCoy commander US Army Corps of Engineers, January 15 2006
emphasis on reconstruction of hospitals and clinics rather than how they would function
£1.1 billion profits made by British construction and security firms
USAID cancelled contract with US healthcare company because of incompetence
Conclusions
death and injury of tens of thousands of Iraqi civilians and
combatants numbers rising 2003 war exacerbated damage to health of Iraqis
from previous wars, former regime, and sanctions immediate impact of conflict on health represents a small
proportion of the longer term suffering security crisis; collapse of state; continuing
violence; threat of civil war health system in crisis with rising demands; poor
progress in reconstruction; health workers targeted; skills drain
Medact: key recommendations
Independent inquiry an independent commission should make a thorough
investigation of casualties and the state of health in Iraq since the invasion in 2003
Count the Casualties Campaign 2005
www.countthecasualties.org.uk
Medact: key recommendations
Protecting health in conflict
require occupying forces to: comply with the Geneva Conventions monitor casualties and civilian protection re-evaluate the impact of weaponry in populated
areas ensure health services are accessible to civilians in
conflict areas and the protection of health workers
Medact: key recommendations
Longer term interventions
to improve health and build peace: strengthen stewardship role, capacity and funding of
Iraqi Ministry of Health to rebuild an Iraqi health system based on primary health care principles moving away from charges at the point of delivery to fully tax-based system
role of health system in nation building and building peace
Further work
by Medact monitoring of health in Iraq: update on Iraq health
situation Communiqué March 2006 proposal for 2006 report on health in Iraq development of an advocacy programme, using health
impact of violent conflict in prevention of war, and upholding of rule of law
www.medact.org
Further work
by other organisations Iraq Body Count press release on civilian casualties
9 March 2006 Crisis Action: Medact collaboration on health risks of
potential attack on Iran IPPNW appeal to Kofi Annan to set up a mediation
commission on Iran
www.iraqbodycount.netwww.crisisaction.org.uk
Postscript: "what one person can change"
NGOs working in conflict and health :opportunities for students, young doctors, public healthspecialists as volunteers or in project work analysis authorship editing testimony advocacy campaigning
www.medact.org