INDEX:
Baghdad Hospitals
DR. SAPPHIRE AHMED
SARAH SLOAN
SCOTT SCHEFFER-DUFFY
SHARON EOLIS RN
The Iraq health care system is largely a hospital based curative
structure. Except for a small very affordable fee amounting to less than $O.50,
services are free in the public hospitals. In the capital there are 20 public
hospitals. There are also private clinics, which are expensive.
Visit: Saddam Hussein Pediatric Hospital in Baghdad, 5-7-98
The Saddam Hussein Pediatric Hospital is located in Baghdad. It is the main teaching hospital and the best-equipped hospital in the nation. It has a 400 inpatient bed capacity but due to the supplies, medications and nursing shortages it is utilizing only about 300 of these beds. There is a rapid turn over and a long waiting list also due to limited resources and unpredictable, supply deliveries experienced with the UN oil for food and medicine processes. The OPD sees an average of 1500 to 2,000 patients a day.
Most admissions now days are emergencies, chronic diseases, malignancies, especially childhood leukemia cases which have increased and for which there are limited oncology medications. In addition, there has been an increase in birth defects, congenital malnormalities, and ten-fold increase in kwashiorkor and marasmus since 1989.
We were referred to the Depleted Uranium book written by professor
Gander (?), a German scientist to explain some of the new health problems that have been
experienced since the war.
Doctors feel that if they have nothing to offer the patients then there is
no need to admit them simply, to watch them suffer and/or die.
We toured the emergency room, isolation department, and cancer wards of the pediatric hospital, etc..
The general condition of the major hospital of Baghdad was equivalent to
that which one might have seen in a public hospital serving the poor and minorities in
America in the 1950’s. The hospital was fairly clean but it was difficult to
appreciate this because the paint was very old, the lighting was limited, machinery was
dusty, oxygen tanks were old and discolored, the bed sheets were off white and the
patients cloths were neither bright nor clear. It appeared that many of the patients
were poor people and not very education. The scenario was that which one would
expect in a very poor African country not in a developing oil rich nation.
Al Mansor Hospital
This is a general hospital in a poor area called Saddam City in Baghdad. The population in this in this area is about 2 million. There are 4 hospitals serving this area. About 20 new patients are admitted a day and the OPD sees about 1,000/day. In addition to general medicine there are GYN, Peds., Rehab., ENT, DERM, and general surgery departments. The doctors echoed the same story pertaining to shortages of medicines, medical supplies, and medical equipment as was reported by the doctors working at the Saddam Pediatric Hospital. However, all shortages were visibly more severe and the hospital and machinery more dilapidated than was at the former hospital.
In addition to the increase in medical problems mentioned above, the doctors reported an increase in crime related injuries and social problems, homicides and accidents Also they reported an increase in psychological, psychiatric and social problems i.e. wife and child abuse and family fights, especially in the poverty stricken areas. There is a large increase in malaria cases. yet, the supply of anti-malaria medications are limited. There is a shortage of all vaccines especially DPT, and an irregular flow of all vaccines and medications.
Doctors mentioned that the refrigeration system and electricity supply is poor and the generator is weak and breaks down often.
Shortages
There are shortages of everything require to run hospitals and clinics.
There is even an irregular flow of the medications accepted by the UN system.
Food: Shortages as fundamental as artificial milk
has been experienced. Due to an increase in maternal depression and malnutrition and
other psycho-social affects of poverty, many mothers are not accepting the advice to
breast feed their babies for longer periods. Consequently, the variable availability
of 4 to 6 tins of artificial milk per child per month is not meeting the need of 8 to 10
tins of milk needed per month. Therefore, there is an average deficit of 4 million
tins of artificial milk per month.
Basic Supplies Shortages:
1. bed coverings
2. air condition is limited and most of the
equipment needing repair or replacing.
3. The number of ambulances is very limited
4. Refrigerators
5. Suture materials
6. Sterilizing chemicals
7. pencils, pens, writing pads
Medical Shortages
1. limited IV fluids
2. no parental nutrition
3. There are shortages of all medicines including antibiotics,
anti-tuberculosis medications to treat the increase incidence of extra-pulmonary TB that
has been noted, anticonvulsant medications, hypertension and anti-angina medications to
name a few. Many first line cancer and leukemia drugs are not available.
4. The radiology, laboratory, and all specialty equipment and
supplies are extremely limited or not available. For example, the defibrillation and
ECG machines are limited, outdated and broken. There is no functioning CT scan or
MRI.
Man-power shortages:
Over 50% of the nurses left Iraq after the war. Prior to the war 30% of them were Cuban and the other 20% were from various Asian nations. The Iraqi women have not yet accepted the nursing profession. Also, approximately a third of the doctors have left the country but training of new doctors have kept up fairly well with this loss.
Some Iraqi doctors whom we meet:
1. Dhia Al Obaida Consultant Pediatrician
in charge, Director of the Saddam Hussein Central Hospital for Children.
2. Dr. Abdul Mutalib Ali, ECG Specialist
3. Dr. Ramal Askar, Pediatrician, general director
4. Dr. Talib Saddam, Rheumatologist
S. Dr. Mudhar A.K. Kannuna, Pediatrician
6. Dr. Weam Bihram, Surgeon
7. Dr. Abdul Al Jebbar, D. G. Preventive Health
Director
8. Dr. Qussai Al Khetijat, D. G. of Foreign Affair
Health
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According to the World Health Organization (WHO--a UN agency), malnutrition is the greatest problem and it increases every year; every person in Iraq suffers from some degree of malnutrition. This lowers immunities and makes them more susceptible to communicable diseases which hospitals often do not have the medicine to treat. This creates a vicious cycle that the doctors do not have the means to break. Doctors told us that they are treating many illnesses that, before sanctions, they had only read about in textbooks. In 1997, there were 10,000 people in Iraq with cholera but in 1990 there were none. Leukemia has increased because of depleted uranium from US weapons (also the cause of the 'Gulf War syndrome'), a contaminated water supply, and pollution. In seven years (1990-7), leukemia increased fourfold at a Baghdad hospital.
The sanctions are also on knowledge; that is, they prevent doctors from accessing textbooks and medical journals, and from going to conferences. The doctors are working based on outdated information. They teach with textbooks from the 1980’s, making photocopies, though students often cannot even afford this.
Two or three children sit in each bed of the pediatric hospitals. A doctor in a hospital with 400 beds sees 3,000 patients a day. Many are discharged far too early. These beds often do not have sheets. Only very few lights are working. The air conditioners have broken. The shelves of the pharmacies are bare. Two children with different illnesses sit in the isolation room. Healthy children must accompany mothers with sick children, so these healthy children become sick. The hospitals lack the cleaning agents necessary to decontaminate the walls and floors so more disease is spread. Flies land on the children. Mothers-who constantly stay with a sick child (if they must help their husbands in the fields, another relative stays)- -fan their children because of the heat and the flies. Pollution and sewage causes gastroenteritis. They lack IV fluid and the means by which to give it to patients (bags, tubes). Malnutrition causes protein deficiency. A small cut becomes infected and, because of lack of antibiotics, a child dies. Another child dies from rickets. Children are born with brain and other deformations that did not occur before the war. They are dying from preventable and easily treatable problems. Doctors told us that no organization can bring the amount of food and medicine that is required-- the sanctions need to be lifted. Some countries, such as India, are facing conditions worse than this, but the point I am making is that this was not the situation before the sanctions--the UN and US have done this to Iraq, and they can stop it.
Families sell off their furniture, other possessions, and eventually homes to finance purchases of medicine from the black market. And then their child dies also. They sell off remaining medicine to support their other children, the source of most of the black market medicine. The UN monitors all humanitarian aid and consistently gives Iraq high distribution ratings, meaning that this medicine is going to hospitals and not the black market. Even rich families cannot afford enough medicine; for example, two years worth of medicine is required to treat leukemia. Families spend all of their money, only get the child part way through the treatment, and then the child dies. A number of women in Basra told us that they were once rich --now their children are dying on beds that do not even have sheets. Sometimes, even if a family can afford black market medicine, the correct type is not available. What hospitals do have, they give to patients--Iraq has a universally free health care system that was once one of the best in the Middle East. Very few, including government officials, can go abroad for treatment. This is extremely expensive and civilians often die waiting for visas.
I visited two hospitals in Baghdad. In one, there was no survival rate for leukemia patients. Each week they admit seven to ten leukemia patients. Each week they lose seven to ten leukemia patients. This used to be the best leukemia hospital in Iraq and one of the best in the Middle East. The doctor does not even mention transplants to patients because they do not have the means to perform them. Hospitals either lack necessary machinery or have broken machinery because of lack of spare parts. There is one nurse for every thirty children. They are using 20-year-old incubators and have seen the number of premature births rise. They must switch the type of antibiotics used on patients because what they have changes. Over half of all patients suffer from severe malnutrition. A doctor I spoke to told me that he does not feel he can do anything for his patients. And this, as the biggest hospital in Iraq, is better supplied than any others. When we left, there was a woman sitting by the gate, holding her dead child in her arms, weeping.
The other hospital in Baghdad, before 1990, was one of the premier
teaching and research centers in the Middle East. They now have one ambulance. Doctors
reported medical, social, financial, and psychological problems caused by sanctions. The
number of admissions does not reflect the numbers of death and disease in the country
because many people cannot even come in to hospitals. This means that numbers are even
less than in actuality (not overestimates as the US is now claiming). Since there are only
three main cities in Iraq, most of the country being dessert, many must travel away from
their homes for treatment. The father of one child stays in a hotel and the mother remains
with the child; this is an expensive cost and the father is away from work. In describing
a patient's poor prognosis-- this eight year old, writhing in pain in front of us, would
be dead in a few days, he is dead now--the doctor spoke in a blunt tone. She says this all
of the time. She told us that she feels helpless in front of patients and their families.
At this hospital since 1989 (giving her about two years of experience there before the
sanctions), she said that "so many things are deteriorated, but we are trying to cope
and give the patient the best treatment...I hope I'm doing something amazing." Many
of her patients would live if they had the necessary medicines.
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***SCOTT SCHAEFFER-DUFFY’S TAPE TRANSCRIPTS
Interview with Dr. Samir Kalendar at Saddam Pediatric hospital:
“...Malnutrition is our number one problem. According to the
World Health Organization’s last report, all the children of Iraq are suffering from
different degrees of malnutrition. This will leave them with low immunities;
vulnerable to diseases and infections. As a result, communicable diseases are
increasing year by year. For example: In 1988 we didn’t have a single
case of cholera and in 1997 we had 10,000 cases of cholera. In children we have
increasing numbers of mumps and leukemia. In my hospital, leukemia has increased
four-fold from 1990 to 1997. Our main shortage is with the psytotoxins.
Chemotherapy requires expensive medicine. We are losing our children partly because
of the medicine.... We know the protocol. We know how to give the medicine. We
have very good instructees and doctors, but we don’t have the means. We are not
treating all children correctly.” (A question was asked about weapons used
during the war and the causes of cancer.) “Causes of cancers are either
endogenous or exogenous. The endogenous factors would not be changed and if we have
an increasing number of patients, then it should be attributed to exogenous factors.
We have been subjected to different kinds of weapons--depleted uranium, chemicals, and if
you add poor hygiene all over, poor water supply, no sewage treatment. These are the
factors.
Al Mansure Teaching Hospital for children
Dr. Salma Haddad, Head of Oncology United:
“...Just a few years after the sanctions, the problems started due
to lack of chemotherapy,... good generations of antibiotics, antifungal drugs, antiviral
drugs, the whole facilities, intravenous fluids, spinal needles, even the blood bank
services are all closed partly due to lack of maintenance and lack of bags for collection
of blood for transfusions. We are facing so many problems. For example, this
patient [boy in background groaning with his mother crying at his side] he’s a high
risk acute lymphoblastic leukemia and we started chemotherapy one month ago but
unfortunately he relapsed. Now he’s no palliative care.... We should start a
more intensive regime to gain a second remission but unfortunately we don’t have
what’s needed for this chemotherapy. Sometimes we repeat the same protocol
which shouldn’t be used.... [moves on to another room and stops by the bed of a
two-years-old girl] This patient is dying.... We don’t have potent
antibiotics. We only have the old generation which are not helpful for these
children. So he’s still having bleeding, fever, and sometimes the platelets
required for bleeding are not available in the bank. So we lose patients due to
bleeding. [The question is asked how she gives hope in such a situation.]
“In fact, I cannot give the patient hope; only for those patients whose family can
offer the complete treatment. The treatment of leukemia takes more than two years
and different schedules of chemotherapy are difficult even for rich families. The
drugs are very expensive. It’s very hard on all of us, especially on the
person. I am the head of this department. I’m facing too many
difficulties and I feel helpless most of the time and in front of the families and
patients because, what to do? I try to do the best but sometimes I can’t for
lack of so many things. Sorry.”
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As we walked through a ward of the Saddam Central Hospital for Children, we saw infants and toddlers suffering from malnutrition. Some had big bellies and listless eyes. In the next ward, we saw older children with swollen faces, arms and legs, experiencing acute renal failure.
Their mothers stayed with them in the hospital. The women watched and held their children, some with tears in their eyes. They asked us to take pictures of their children to show American mothers what is happening to Iraqi children.
In some overcrowded wards two children had to share a bed. Nearly all the children we saw in the hospital were malnourished. Many lay close to death.
"Malnutrition is our number one problem," Dr. Samir Kalendar explained to our delegation. That fact is corroborated by the World Health Organization. "All of the children of Iraq are suffering from different degrees of malnutrition. This leaves them with a low immune system and vulnerable to diseases and infections."
The emergency ward was packed with more than 50 children and their relatives.
Some children were already being hydrated with intravenous fluids; others were waiting to be seen. Two isolation rooms had three children in each.
One group had whooping cough; some had measles. Both diseases are contagious and could be life-threatening to other infants and toddlers.
Measles is now at epidemic levels among Iraqi adults and children. Both measles and whooping cough are taking such a toll because the U.S.-led sanctions so severely restrict the medicine, vaccines and thousands of other essential products that Iraq can import.
These imperialist-imposed sanctions will result in a death sentence for many of these children.
Dr. Berta Joubert, one of the delegates, said: "There is nothing more agonizing than seeing thousands of children suffering and dying without having access to the treatment you know will save them. And this lack of resources is not the result of a natural disaster, but of the willful, premeditated act of the U.S. government—driven by greed for more oil profits—to strangle the people of Iraq into submission."
Before the United States/United Nations sanctions and the Gulf war, Iraq had a developed, nationalized health-care system that provided care to everyone. The level of technological development in health care was on a par with industrialized Western nations.
In 1989, Iraqi hospitals were performing 15,125 operations a month. By January 1998, the ravages of war and the strangling economic blockade had brought the average down to 3,795 procedures per month.
Hospitals lack surgical supplies, anesthesia, heart valves and antibiotics.
Sanctions are genocide
Imagine a blockade on the people of the United States that prevented the population from having safe drinking water, food, milk for babies, antibiotics and vaccines to fight infections and disease. These are the conditions the Iraqi people have lived with since the war.
Safe drinking water is a basic human need. Chlorine is used to disinfect water. UNSCOM, the UN Sanctions Committee, limits the amount of chlorine imported to Iraq because it is considered a dual substance that can be used to make poison gas.
Iraqis at a Baghdad water treatment center told delegate Dave Sole—a water specialist from Detroit—that there is not enough chlorine available to make the water safe to drink.
According to one of the Iraqi doctors we spoke with, 80 percent of the cases of amoebic dysentery could be eradicated if there were clean water. In 1989, there were 19,615 cases; in 1997 the number rose to 543,295 cases.
In 1980, there were no cases of cholera in Iraq. In 1997, there were 10,000 cases caused by contaminated water and food.
In order for food to be distributed equitably to the entire population, it is rationed through the Ministry of Trade. Families can only get six tins of milk per month for babies up to 1 year old.
However, infant growth and development requires 10 cans of milk per month. The mothers have to dilute the milk to stretch the supply for a month. As a result, the formula is so weak the babies cannot develop normally.
The lack of sufficient food for pregnant and nursing mothers leads to low birth-weight infants and an inability to breast-feed.
Sharon Ceci, an ISC delegate who is a home-care nurse from the Baltimore-Washington area, said, "The U.S./UN sanctions are killing Iraqi children through mass starvation, poor water and lack of medicine."
The infant mortality rate is 92.7 per thousand live births. Maternal mortality is 117 deaths per 100,000 births. Ceci pointed out that the U.S. government spends $450 billion to $460 billion to keep the sanctions in place against Iraq. At the same time, funding for prenatal care in Washington has been cut so that almost half the expectant mothers there have no access to health care.
In spite of the genocide against the people of Iraq, food and medicine are being distributed on an equitable basis. The patients are treated with dignity. Doctors are doing the best they can in the most desperate circumstances. They have the skills to cure but not the means to do so.
The only answer is to end the sanctions now.
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