Potential impact of conflict on health in Iraq
Briefing note: March 2003
Historical perspective on the health of Iraq’s people
Prior to the Gulf War, health conditions in Iraq were comparable to those of other middle or high-middle income countries. The health system was considered one of the best in the Middle East region. Malnutrition was not common. There was an extensive network of well-equipped and well-staffed health care facilities. These were linked by a good communications network, facilitating the referral of people needing extra care to specialist units. The government of Iraq estimated that 97% of urban and 79% of rural populations had access to health care. The health system also included public health programmes for malaria and tuberculosis control, and an expanded programme of immunization. Deterioration in health infrastructure during the last two decades
The deterioration of health status among the people of Iraq is associated with the degradation of the country's infrastructure following the 1980-1988 war with the Islamic Republic of Iran and the 1991 six-week war. Plants for generating electricity, water purification, and sewage treatment, together with some parts of the health system infrastructure, were damaged. Routine health service provision was disrupted and this hampered the treatment of persons with chronic illnesses.
Economic sanctions were imposed by the UN Security Council starting on 6 August 1990. They covered all items imported to Iraq, except medicine. In April 1991, pursuant to Security Council Resolution 687 (1991) Iraq was permitted to import food and other humanitarian supplies in addition to medicine.
In 1997, general malnutrition (underweight for age) occurred in 24.7% of children under five years of age in the 15 governorates in southern/central Iraq. Chronic malnutrition (low height for age) was 27.5% and acute malnutrition (low weight for height) was 8.9%.
From 1991 to 1997 information services, and facilities for warehousing, testing and communications which are necessary for the distribution of medicines, progressively deteriorated.
Problems with maintaining essential medical equipment have affected the functioning of health facilities. By 1997, major surgical interventions had been reduced to 30-35% of the 1990 levels because of an acute shortage of anesthetics, surgical equipment and supplies. In 1997, it was estimated that only one-quarter of the medical equipment available in health care facilities was operational.
Laboratory services have been impaired by a lack of essential equipment (including catheters, gloves and syringes), chemicals and reagents, without which basic biochemical, bacteriological and pathological investigations cannot be conducted. By 1997, the level of laboratory services had declined to about 40% of pre-1991 levels.
The progressive loss of qualified and experienced health workers has led to gaps in coverage and quality of health care services. Iraqi health professionals did not gain the full benefit of new medical knowledge that became available during the 1990s.
Widespread unemployment and shortages of convertible currency have significantly eroded the purchasing power of most families. This is reflected, in part, in levels of malnutrition, communicable diseases (including waterborne, foodborne and vector-borne diseases) and rates of death from chronic illness.
In the period 1990 to 1997, the Government was able to meet 10-15% of the country’s medicine needs. In the same period, the food ration provided people with about half their daily energy needs.
Effects of the Oil-for-Food Programme on health
Launched with United Nations Security Council Resolution 986 on 14 April 1995, the OFFP permits Iraq to export oil (at first limited quantities, but restrictions were removed in 1999) and spend the revenue on imports of food, medicine and essential supplies. The OFFP was initiated in December 1996, with the first humanitarian goods arriving in early 1997. In the succeeding five years, $37 billion worth of supplies and equipment were delivered to Iraq or are in the pipeline.
As well as increasing the content and availability of food for Iraq’s people, the OFFP has relieved some of the shortages of medicines, medical supplies and hospital equipment. Health care delivery services have improved significantly. Compared to 1997, major surgeries have increased by 40% and laboratory investigations by 25% in central/southern Iraq.
With the first food through OFFP arriving in spring 1997 and the food ration providing adequate food and nutrient levels in 1999, the OFFP played an important part in averting major food shortages in Iraq. Malnutrition rates in 2002 in central/southern Iraq were about half those observed in 1996 in children under the age of five (see Children's health).
The deterioration of water facilities has been halted by the greater availability of supplies and equipment. Access to potable water has improved. In 2000 and 2001 the Iraqi Ministry of Health reported a decline in the percentage of drinking water samples that failed tests for bacteriological and chlorine content.
In spite of this massive humanitarian operation, health facilities are still in poor condition and there are continuing inadequacies in the basic infrastructure of electricity, water and sanitation. There has been no reported reduction in the burden of specific diseases, despite the importation of large quantities of medical supplies.
A general map of Iraq from the United Nations Cartographic Section, December 2002, may be found at: http://www.un.org/Depts/Cartographic/map/profile/iraq.pdf
A map, dated March 2003, showing authorised entry points for humanitarian supplies, major roads, oil pipelines, political boundaries and governorate capitals is available on the United Nations' Office of the Iraq Programme website: http://www.un.org/Depts/oip/