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Senior WHO official, Dr David Nabarro, describes his experience in the UN bombing

Press briefing to the United Nations Press Corps, Geneva

Dr NABARRO:
Thank you. Good morning everybody. Just to say that I am here able to talk about health issues in Iraq as I am the Task Manager for what is called the Situation Analysis and Needs Assessment for the Health Sector that is being undertaken jointly by the Iraqi Government, the Coalition Authority, the UN and the World Bank. I am able, if you wish, to talk about the World Health Organization’s work in Iraq. If you wish, I could talk about what happened at the Canal Hotel on Tuesday at 4.35 because I was in the office of Romero Lopez de Silva, which is one floor below Sergio’s suite when the bomb went off. If you wish I could talk about what we were doing on Wednesday and Thursday with people who had been affected by the bombing and what things were like when I left Baghdad at about 6 o’clock last night Baghdad time. I have come back through a peculiar route across Europe to be here this morning. I am just really at your disposal; I am not quite sure Chair what is the best thing to do, because there is a lot in my head and a lot has been happening. So I will just really be guided by you as to which direction you would like to go in. I think ???? is also wanting to speak.

Chair:
Thank you. Do we have questions? Yes question

Question:
I feel very moved by this. I am sorry. I would like to know if you could talk about the health situation as you saw it when you were there and how you think this attack will indeed affect the health needs, the work that you and other organizations would like to perform, need to be performed. And if I might Alena, there are people who have their mobile phones on – they are ????, they interrupt the recording; it is very distressing. Could they shut it off. Chair: Yes, I agree with you and as usual I would like to ask you not to use mobile telephones during our briefing. (repeated in French).

Dr NABARRO:
All right, that is an easy one to start with really. The health situation of the Iraqi people is really not at all good. If we go back to the 1980s, they enjoyed good health, a good health service and a really pretty good standard of living. My first time in Iraq in, for example, in mid-1970s, although I was most of the time in Kurdistan, I was in a country that was really doing well. As well as its neighbours in terms of health and human development. I returned to Iraq in 1991, after the Gulf War, and saw a country that really was starting to experience a lot of real difficulties. Mostly because basic services were just not in place. Water supplies were contaminated; and also, in addition, at that time, people were not assured of the food and other requirements they needed. And then obviously I have been involved in Iraq since I joined WHO, but particularly over the last year. And we see a country that has got an extraordinary combination of the health indices of a really underdeveloped nation – high child mortality, high maternal death rates – whilst at the same time its got a lot of chronic conditions like diabetes and hypertension, cancers affecting people as well. And the Iraqi health service was just holding together; but really in a fairly unsatisfactory way in about 1996 and 1997. But then the budget available to the country really fell down through the floor. We don’t quite understand why – perhaps the money was being diverted or perhaps there were other reasons. And from then onwards, there has been very little money going into health care. Possibly around $10 to $15 per person per year, and the results of that, plus sanctions, plus other factors, has led to a community which really is suffering extreme ill-health in every respect. And the challenge – and it is not an unreasonable challenge – now over the next few years is to rebuild the health system in Iraq that moves the country back towards the levels of health and health care that it had in the 80s. Which was frankly the envy of the region.

Now while I was in Iraq. I was there this time for eight days. This is my third visit since the war. We had an extraordinary phenomenon. We had the Iraqi doctors and nurses from the Ministry of Health meeting together with the UN systems’ agencies, UNICEF, WHO, plus the World Bank, plus a number of donors, plus NGOs (both Iraqi and international), plus the Coalition Authority and some military medical officers. Round the table. There were only 26 of us. We met for three days. And it was the most productive and energetic health planning workshop I have been to in my professional life. The key feature we always have to remember about Iraq is that it is full of some of the most talented and gifted professionals anywhere. They just need the space, the resources, the energy to do the work. And I was pretty impressed too, this time, with the way in which the Coalition Authority seeing the energy of the Iraqi doctors and nurses present, realizing they had the capacity to plan the recovery of their own health system, within the very limited resources available, took an increasingly back seat role as the workshop went on. Well we set up a process, finished on the 19th at 3 o’clock in the afternoon. We set up a process of long-term work involving WHO and the Bank, and others, including particularly the European Commission to help get the health system going. And I feel that this is going to be something exciting and worth investing in.

We then went to a meeting on the future of the Oil for Food Programme in the Canal Hotel which started at 4 o’clock and in a way since then life has been a bit different. Though I have felt in talking to my Iraqi colleagues yesterday afternoon before I left that we are going to be able to pick up and move forward. That neither they nor anyone else who is working in the country want to let this event just blow the kind of positive energy and action that we had going earlier this week out of the water. So we will keep going.

Chair:
Thank you. Question

Abu Dabi/Kuwait News Agency:
Can you please go into detail. I mean a detailed account, of the events since 4.35 and the aftermath?

Dr NABARRO:
OK. Thank you. So, well we arrived at the Canal at about 4 o’clock. Normal. You know when you come in the front entrance they are very meticulous on security; searching underneath of your vehicle. In fact they had stepped up security because there was a bit of a worry of something big perhaps happening. But not necessarily to the UN. A report had come in to Mr Chalaby and he had passed it on. And then we went in, straight upstairs and you get the top, the top of the first storey, and turn left into the suite that is where, in fact you have seen the pictures, where the bomb blast happened. And I arrived at the door of Benon Saven’s(?). He is the Under-Secretary who runs the Oil for Food Programme, and he and his assistant were there and he said “Oh lets not have the meeting in my room, it is not a nice room. Let’s go across to Romero’s room”. He is the Humanitarian Coordinator – Romero Lopez da Silva – “he’s got better coffee and he’s got a nice fish in a tank that you can look at”. Which is true, he has got a little fish swimming around – or had. And so we went across. There was myself, Mohammad Jamma, who is a colleague of mine from our Cairo office, Benon and Romero, they were sitting opposite, I was sitting on the window side of the room and we’d had quite ….. I mean there is some big, big difficulties about the finalization of Oil for Food and we were going through how we can deal with the difficulty of completing some of the hospital construction in the Kurdish area and so on. And we had got to, I think, a reasonable point. And I said “Well it’s about time for me to go see my friend Nadia Younes upstairs, who’s a colleague from WHO” and I had rung her just five minutes before I arrived at the building and she said “Hello, David. Great to hear you. Come up and see me. I’ll be free. I might be in a meeting with Sergio, but I should be free”. And so I was about to go, but I hadn’t got up and suddenly there was this extraordinary thud. And I felt like I had been hit in the back of the neck. Just at that level there. In fact I think it was something fell out of the wall and hit me in my neck. And I fell forward, fortunately I didn’t hit the table that was in front of us and Romero opposite, he said “Ah, I have been hit”, and he had got glass stuck in his forehead. And Mohammad Jamma said “Oh I think I am hit as well” and he had blood coming down – I am afraid it is still on my notebook. And the two other colleagues also were cut a bit by flying glass and I’d had glass stuck in the back here – in the back of my neck – and it was all over the place. And the lights went out and Romero’s secretary next door was very distressed and there was a terrible smell like you had got a load of fireworks in a big barrel and you smell the gunpowder. And there was dust. And then we started to hear the screams and the moans. And they just went on and on and on. And we were trying to work out, is it just local, is it just our room, or how much has been affected. Anyway, this all sort of flashed through the mind. So we linked hands and went out. And then suddenly I saw Romero’s secretary come in she said the name of the fish and she wanted to rescue the fish. And we said “Come on, get out”; and anyway the fish tank was broken, I think. Because beams had come down. Then we had to climb under a few beams. And I remember picking up my mobile phone off the floor, thinking this could be really useful. And taking my bag. And we went out into the corridor. To the left, going up to the end of the building, suddenly saw that the corridor was blocked with fallen masonry, to the right suddenly a man lying in the corridor, blood all over his shirt, difficulty breathing because something had punctured his lung; another man sitting saying “My head hurts”; security officer comes up, because I am trying to deal with the guy who is bleeding then, because the others had walked out and he said “Get out, it’s dangerous” and he was really upset. And I said “Well hang on, let’s kind of work out a plan” and we managed to exchange a few words in a few seconds and then we agreed that we would go downstairs together. And we had four doctors – Dr Jamma and myself who were in the meeting, we had another friend who was badly cut from the World Bank, and then another friend from the International Office of Migration. And by that time, we suddenly realized that this was a really big bomb because already people were being brought out. And they were lying, being put on the little lawn. Those of you have been to the Canal Hotel, there’s a tiny lawn. And already there are about 18 people lying there. And there were just, there were people dying and dead, and there were people with cuts, people with whole sides of their faces off because of glass. There was a guy with a pole into his head that went – metal pole – right through, who was just talking but who was obviously dying. And there was screaming and moaning. And so we found some first-aid kits and we divided the group into four rough groups and we took the stuff out and we got bandages, because we wanted to stop the bleeding because we didn’t want people dying of blood loss, and then we found some airways and we turned people onto their sides so that they could breath, and we found some drip sets and the one or two people who were in real trouble, we got drips up; we were looking for a colleague of ours – Omar Mekki – a Sudanese epidemiologist. And we could not find him. And then suddenly we saw this person who had got no side of his face and his lip was off his mouth, and it was Omar Mekki. And I said, “Omar, is it you?” and he said “Yes”. And he couldn’t talk very well. And so my friend, Mohammad Jamma, patched him up and we tried to get drips up on him. And I was thinking “how long is it going to take the military to arrive”, because we have got at least 10 people already who must be evacuated quickly. We can’t possibly handle these people. And I didn’t know how quickly they would come. And then, it kind of got condensed in time, really, because that first 20 or 30 minutes was like, kind of, very slow movie really. And then the Americans came and we started sorting out. We had got people who had died, people who needed to get out quickly, people could hang around the back, people walking wounded, we had them going across the tents. And then it sort of settled down. And then I suddenly realized that we hadn’t really gone to where the epicentre of the bomb blast had been, so I went and by that time Romero went round there. And of course there were other people around there by now. And then I realized who was under there. That almost certainly Sergio was under there, that Nadia was under there. And they had gone up onto the roof and they were starting very gently to dig out and people said that they could hear Sergio. And well the rest in a way is quite well written in other newspapers because by that time there were journalists there, and shortly afterwards Ambassador Bremmer’s Assistant, Mr Kenny, was there, and the Acting Minister of Health was there and suddenly the candidates (?) were there – the whole of, all the people we knew had suddenly arrived. And what had been at the beginning just us working like we were in a cloud on our own in this fog of moaning and crying, suddenly everybody was there. And then we went to hospital some of us; we went to Iraqi hospitals if we were mild, and we went to American hospitals if we were really injured. And most of the day before yesterday, and yesterday, was spent going round and trying to find everybody because of course with something like 110 people injured, some of them were in the Iraqi hospitals, some of them were in the US hospitals, they were in lots of different US hospitals. And we had to do a lot of work to try to make sure that people, you know, because they were being stitched up, there must have been hundreds of thousands of stitches put into cut tissue. And so were trying to make sure that there was local anaesthetic available and antibiotics. And by yesterday afternoon, we had just about managed to account for everybody, except those you’ve heard – still two people. But we think that’s because there are, I’m afraid, unrecognizable bits of people. And then I got on a plane.

Sorry that was a bit of a monologue, but I haven’t talked about it before, you see. Because it’s the first time.

Chair (?):
Thank you. Yes please question

Question:
Could you tell us why it was impossible to dig through the blast.

DR NABARRO:
Concrete, concrete.

Question:
It was too difficult.

Dr NABARRO:
It was the soldiers who were doing it. In fact, I will tell you what it was like. First of all, it was concrete, but a bit broken; secondly, there was a general feeling that we left that to the soldiers. We didn’t all go up and scrabble there. And that was right. And the soldiers were trying very hard to lift the bits of broken concrete, some of which were quite large, off where they could. But obviously they didn’t want to dislodge anything and possibly then have a bit of concrete fall down on somebody else who might be alive, because they knew that as well as Sergio we were hoping that other people were alive under there. It’s very difficult. It is like being in an earthquake. The building is not a strong building. You have looked at the pictures. The walls are kind of about that thick and so it was very important at that early stage not to try to disturb the rubble too much. And you couldn’t get in from the inside, we checked that out.

Chair:
Thank you. Question

Question:
Yes. You said in the beginning that you had some information. You received some information, that something was going to happen. Or not exactly the UN, but some place. Can you give us more details about this? When was this information …..

Dr NABARRO:
Heightened sense of security, everywhere. In WHO, which has an office round the corner and in other places. There was a heightened sense of security at that time any way. (Question in the background) Well for about the last week or two, there had been a heightened sense of security. Basically since the Jordan Embassy bombing, I think. And so. This notion that Mr Chalabi’s put around that there was a specific threat against the UN and against his Congress Party headquarters, I hadn’t heard that until afterwards. But there was definitely an increased sense of need for security precautions. We were certainly being more careful. When you are in Baghdad you have a very, if you are working for the UN, you have a very intricate radio drill, protection drill in terms of wearing stuff and so on, especially if you go to certain places or at certain times. And we were on a much higher level of security protection than usual.

Chair:
Thank you. Some more questions?

Question:
Hi, I am sorry I do want to go back to this issue of reconstituting the health situation in Iraq. And you mentioned the World Bank, and I had heard in a news dispatch that six World Bank people had been sent to Baghdad. They were there on Monday. All of them were injured and all of them. Can you hear me, because you don’t have your?

Dr NABARRO:
I think I can hear you very well. Yes.

Question:
And all of them subsequently were evacuated out of Baghdad. Now the question is, you, you said that you were sure that the health situation would go forward. (Dr N – yes). But how will it go forward? Throughout, through the past few months, we have been hearing about the terrible financial situation and I think all the staff now is being evacuated? Right? So this must be an enormous setback. Will you be getting the money, and can you count on the cooperation of the Coalition forces to actually help in this.

Dr NABARRO:
Thank you. I would like to talk about this. First of all, we know now what the Coalition. Sorry, what the CPA budget for health is going to be in 2004. It’s divided into two parts. It’s divided into an amount for non-salary and divided into an amount for salaries. I mean, it is not an unreasonable amount. It’s kind of between – I can’t tell you the exact figure because I have lost it out of my head – it’s between 25 and 30 dollars per person per year, if you add the two together. We anticipate from talking to colleagues in the European Commission that there may be resources for health and other social sectors in 2004 out of their money. And I am sure there will be other donor money. I do not believe that the Spain Conference at the end of October will not yield money for such an important sector as health. So I believe that we may well end up with an amount of money for health equivalent to between 30 and 40 dollars per person per year. It’s not at the level that Iraq ought to have. I have said in this room, that compared to neighbours we ought to be up at 80 dollars per person per year. It’s not at that level. But it’s a start for 2004. Everybody is saying that it is going to take two or three years to get the oil money and other money going. So, I am first of all delighted that there is that kind of money available and delighted also that between the new Ministry of Health and the CPA are taking a radical look at the efficiency of all health spending, all over the place. They are going to prioritize high impact public health spending and try not to put money into things that have less impact. It would be great to have the World Bank in as well. For two reasons. They are very good at analysing institutional and financial issues. We had Jean-Jacques Frère of the World Bank with us. Who was by the way, was a total hero in the Canal Hotel grounds. Nobody will know about it. I saw it. He was absolutely amazing, despite the fact that he had been cut. He was there doing his stuff. He left because they all left. But who knows. I am sure that they will re-evaluate and think and talk to the UN, and talk to others. Talk to the UN. I would be amazed if they don’t have some continued involvement in the Iraq redevelopment after 2004. So I am reasonably confident that there is resources and the will, and it may well involve the World Bank as well.

Chair:
Thank you very much. And now I will the floor to Jean Favre(?) of the UNDP.

UNDP:
Spoke in France.

Chair: (In French):
Asked if there were any questions for Jean. No. ?? for UNICEF.

UNICEF:
Also spoke in France.

Chair and Christiane(?) and Chair again:
In French

Elizabeth:
(Also in French)

UNHCR

ETC.

Question:
The question goes to the representative of WHO. On television, when it happened, we saw here a press conference by Martin Barber with quite a few journalists, saying that it happened while, the explosion, happened while the press conference was taking place. Is that correct? And secondly, are there any injured among the journalists. And what about Martin Barber?

Dr NABARRO:
Yes. In one of the rooms inside the building, it is actually quite well inside the building. The windowless room, some way tucked in. It’s a windowless room, some way tucked in. There was a press conference about demining going on and my understanding, talking to Martin Barber, who was also at the dais there, he was on the same plane as me yesterday afternoon, coming from Baghdad. My understanding is that there were not any journalists who were severely injured, though, like others, some of them got cuts. I’ve got to go, Chair. Can I just make one small point before I go. Sorry you want to ask ...

Question:
Dr Nabarro, was it UN guards who were in charge of security within the perimeter of the hotel, and were any of them injured or killed, do you know?

Dr NABARRO:
Yes, there were UN guards responsible for security and certainly some of them were injured. I do not know. Because I have not seen the total list of the fatalities, and, as you know, that hasn’t actually been made available for various reasons, I don’t know whether any of them were killed, but I saw at least one of them when I went round the hospitals yesterday. So, yes. There are quite a lot of Iraqis who were injured. I think it’s important for us to recognize this. A lot of Iraqi people do work in Canal, and so a proportion, I would guess, from just remembering the lists that we were preparing, perhaps one-fifth or so of the people were Iraqi citizens, but I can’t be certain. I’ll just add one small point that I wanted to say, because I do have to run. In an obituary that I just say before this meeting, in the Economist, of Sergio, I don’t know whether you can read me the last sentence of that obituary.

The very last sentence or the last paragraph?

Dr NABARRO:
Well, its something about evil has won, right at the end.

The last sentence says: Evil triumphed, at least temporarily.

Dr NABARRO:
Right, it said: Evil triumphed, at least temporarily, and I’ve thought a lot about this over the last two or three days, and I’m not sure that that’s the right analysis. Because, it is my belief that if people knew how good people like Sergio, Nadia Younes, Chris Kline Beekman, and the many other people who were killed or injured, how good they are in an absolute sense, by any criteria, these are some of the very finest human beings that have ever walked on this earth. And if people knew how good they were, even if they were amazingly evil people, they would never be able to kill them. So it is my view that it is not so much evil, it’s actually ignorance, that the people who do this kind of stuff have no understanding at all of what a man like Sergio, a woman like Nadia, a woman like Fiona Watson, what these people, and their Iraqi colleagues, who have also been so badly hurt, what they stand for, and what they are doing with their lives. It just hasn’t crossed their radar, because their radar is full of a number of other issues, which I don’t want to judge whether they are good or bad, but they just don’t know about absolute goodness. Because if they did, they’d never, ever think of killing these kinds of persons.

Chair:
Thank you very much Dr Nabarro for coming for our people. Thank you.

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