Global Policy Forum

By Jeremy Laurance

Soaring rates of disease and a crippled health system are posing a new crisis for the people of Iraq, threatening to kill more than have died in the aftermath of the war. Deadly infections including typhoid and tuberculosis are rampaging through the country, according to the first official report into the state of health in the country.

The alarming evidence is the legacy of years of neglect, crippling sanctions and two bloody conflicts. Iraq's network of hospitals and health centres, once admired throughout the Middle East, has been severely damaged by war and looting, leaving staff struggling to cope and adding to the crisis.

The report, compiled by the Ministry of Health in Baghdad, provides the first detailed portrait of the health of the Iraqi population and the state of its health services since the 2003 war. It is being launched today by Dr Ala'din Alwan, the Iraqi interim government's Minister of Health, at a conference of international donors in Tokyo.

It charts the drastic decline in the health of the population and the catastrophic deterioration in health services during Saddam Hussein's era, one which has accelerated since the war. One third of the health centres and one in eight of the hospitals was looted of furniture, fridges and air conditioners or had equipment destroyed in the immediate aftermath of the war.

Damage to water supplies and sanitation has led to a surge in typhoid, with 5,460 cases recorded in the first quarter of 2004. Almost one in five urban households and three in five rural households do not have access to safe drinking water. Poverty has risen sharply, with an estimated 27 per cent of the population living on less than $2 a day in 2003, in a nation with among the richest oil reserves in the world.

One in three children are chronically malnourished, putting their lives at serious risk from outbreaks of measles, mumps and jaundice, which are sweeping the country and infecting thousands. The report, compiled from Ministry of Health data and international surveys, says mothers and children have been hardest hit by a combination of domestic policies and international sanctions stretching back over a decade. Infant and child mortality doubled during the 1990s at a time when health was improving in most other countries.

Between 1990 and 1998, the number of infants dying before their first birthday rose from 40 to 103 for every 1,000 live births. Maternal mortality rose almost threefold during the same period, with 279 deaths in childbirth for every 100,000 live births. Adult death rates have risen and life expectancy has fallen to below 60 for men and women. Overall, Iraq's state of health is now rated on a par with the impoverished countries of the Sudan, Yemen and Afghanistan, where once it was ranked alongside Jordan and Kuwait, the report says.

Dr Alwan said yesterday: "More Iraqis may have died as a result of inappropriate health policies, sanctions and neglect of the health sector over the past 15 years than from wars and violence. The main causes were poverty, poor nutrition, the deterioration of water and sanitation services and the collapse of health services ...Iraq used to have one of the best health services in the region but Saddam did not consider it a priority.The budget was cut by 90 per cent."

The report details the extensive looting and destruction of health facilities since the war, which combined with unreliable electricity and water supplies and the continuing threat of violence have added to the problems.

Dr Alwan said Iraq was now facing a "double burden of disease" from chronic conditions such as cancer, diabetes and heart disease, which were growing rapidly, alongside a resurgence of infectious diseases. Cancer has been rising sharply for a decade, with most cases diagnosed only when advanced, fewer than a quarter of diabetics receive insulin and there is a growing problem of post- traumatic stress disorder, especially among children, the report says.