WHO health briefing on Iraq

UN humanitarian briefing
9 April 2003

Hospitals and medical staff in Baghdad

Television pictures and other reports from Baghdad paint a very mixed picture of celebration mixed with looting. In these circumstances, the World Health Organization reminds all those involved in the conflict of their obligation to protect the neutrality of medical facilities and health workers. If health workers cannot get to their places of work - or worse, if they are injured or killed - the urgent health needs of the civilian population cannot be met.

Reports from Baghdad tell of serious civilian casualties and growing pressure on hospitals and health workers. Electricity supplies are erratic - and standby generators are being overworked to the point of collapse; many hospitals are running short of clean, safe water. Staff are working extremely long hours in unimaginable circumstances and some vital surgical and medical supplies are running short. Information from the Iraqi capital is sporadic and incomplete, but there is a clear picture emerging of enormous pressure on the city's health and other basic services.

We want to give you an idea of what it is like in a hospital where the basic infrastructure is not functioning and where doctors and nurses have to perform difficult emergency surgical operations and provide intensive care without access to some of the most basic services and supplies.

Water is the most vital need. Without a ready supply of clean, safe water, medical staff cannot clean wounds, replace dressings or ensure the most basic hygiene. Wounds and surgical scars that are not kept clean rapidly become septic, particularly as external temperatures rise. Surgery becomes more of a threat than a solution.

Electricity is vital for all but the most basic hospital equipment - without it, medical staff cannot monitor the vital signs of the most injured patients. Operations may have to be carried out by the light of paraffin lamps or torches. Vaccines, some medicines and blood supplies have to be kept below a certain temperature otherwise they spoil and cannot be safely used. Electricity also powers water pumping stations. Most of the hospitals in Baghdad have some form of backup power supply - but generators are not designed to work 24 hours, day after day.

Bullet wounds and injuries caused by shrapnel or missile blasts may require extensive surgery, including amputation. Again, a sterile environment is vital. Without it, infection sets in and the result can be life-threatening. People who are crushed when buildings collapse need intensive medical care, often including kidney dialysis. People who are burnt by blasts or the fires they cause have to be cared for constantly and their dressings have to be cleaned and changed regularly - with clean water and sterile equipment. Infected wounds deteriorate rapidly and the stench they produce is foul, further worsening the working environment for hospital staff. Doctors and nurses have to make rapid assessments and difficult decisions about which of many badly injured people they should treat first. As a result, some people may die. The stress and psychological toll on health care workers is impossible to overestimate.

Hospitals may run out of emergency medical supplies if, as now, large numbers of people require surgical or intensive care. There are already reports from Baghdad of shortages of surgical supplies, anaesthetics and strong painkillers.

WHO is flying in 50 surgical kits, which will arrive in Amman on Wednesday and Thursday. Each kit contains sufficient anaesthetics, surgical equipment and medical disposables, such as bandages and syringes, for 100 surgical interventions and several days post-operative care. We are working hard to find a way to deliver these kits to the hospitals where they are most urgently needed.

Outside Baghdad

Although the information from Baghdad is incomplete, it is considerably better than the information from much of the rest of central and southern Iraq. WHO is extremely concerned about the situation in Nasiriya, Najaf, Karbala and the many other towns where there has been conflict, where there are also reports of water and power shortages, and where the health needs have not been assessed.

WHO and its partners in the health sector again remind of the urgent need for negotiated access to the civilian population of Iraq. We are working hard to get our international staff back into Iraq. We will move back into as much of the country as we can, as soon as it is safe to do so.

For further information, please contact WHO spokespersons Fadela Chaib in Amman (00 4179 475 5556) or Iain Simpson in Geneva (00 4179 475 5534)

The following WHO specialists are available to respond to media questions:
Dr G Popal, Head of the WHO country office in Iraq (+962 795 7092);
Dr Mohamed Jama, Deputy Regional Director, WHO Eastern Mediterranean Regional Office, Cairo (+202 276 5026 );
Dr Jim Tulloch, WHO Regional Health Coordinator, (+4179 509 0640);
Dr David Nabarro, WHO Executive Director, Geneva (+41 22 791 2363, +41 79 217 3446)