Facing Iraq's health crisis

Five years after the invasion of Iraq and assuming her role as the World Health Organisation's (WHO) representative in the country, Bahraini national Dr Naeema Al Gasseer is dealing with a grim situation.

A report recently released by the Red Cross said that healthcare in Iraq was 'now in worse shape than ever' and that millions of Iraqis had little or no access to clean water, sanitation or healthcare.

The services that are available are too expensive for many people, hospitals lack qualified staff, basic drugs, and 50,000 extra beds are needed, the report claimed.

Dr Al Gasseer corroborated many of the report's findings, highlighting the drastic shortages of drugs, doctors, nurses and hospital beds.

"I can't give you a rosy picture because there is not one, but there are elements of hope," she told GulfWeekly before boarding a flight to Amman, Jordan.

Acting as director general and regional director of WHO in Iraq, supporting the government in implementing the country's national health strategy, Dr Al Gasseer is in the process of reviewing the country's troubled health scheme.

But she faces some major challenges.

"There have been so many changes, so much violence, so much extra security," she said. "The new minister of health is number nine for me in less than five years."

As the UN's 'Health Cluster Task Manager' Dr Al Gasseer oversees co-ordination between all UN agencies involved in Iraq's health activities - a task that is hampered by endemic and chaotic violence.

From her headquarters in Amman, she heads a staff of more than 100 who work throughout Iraq's major urban centres. "There are health professionals who have been attacked, violence against officials who have been terrorised and some have been killed," she said.

Of her own staff, many have been attacked, tortured and kidnapped, she said. Two were killed.

"No health facility in the world can be sustained when you have daily attacks launched against them," she said.

She added that several wars, 13 years of economic sanctions and the looting and civil unrest that followed March and April 2003, had left a heavy toll on the country's health infrastructure and services.

"When we arrived in August 2003 everywhere was destruction, burnt buildings, looted places, soldiers and humvees," she said.

That month she narrowly escaped the brutal terrorist attack on the UN headquarters, which killed 17 people, including the chief UN envoy to Iraq, and seriously injured her deputy.

As a result she was restricted from entering the country again until November 2004.

Dr Al Gasseer spent most of January and February in Iraq, and visits to primary health care centres and hospitals in the north of the country are scheduled this week in a bid to assess drastic drug shortages.

"It has been difficult to do before because of security and last minute changes," she said, adding that in Baghdad her movements are even more restricted.

This week's visit is part of the revision process that Dr Al Gasseer and her team are working on alongside the ministry of health and the Iraqi parliament, ahead of a June conference.

"We work with the government, parliament and ministry of health very closely. We are assisting the ministry of health to review the strategies and create a plan of action," she explained.

Five key areas are being assessed.

Human resource development will be addressed, assessing the current situation, building capacity and protecting those who are working in the healthcare service, she said.

"There are no nurses, and this is a big challenge. The doctors - many of the good ones - have been killed or have gone," she said.

Health care standards and services are also being assessed and options to finance the country's health care are being looked at.

"Health care is free, but how can we make it that everyone has access?" said Dr Al Gasseer.

Although healthcare charges were abolished by coalition forces, today, many Iraqi families are paying huge prices for treatment.

A report by an organisation of health professionals called Medact published earlier this year claimed that charges have been quietly reinstated by health authorities unable to pay salaries and buy the drugs they need.

Dr Al Gasseer said that family expenditure on healthcare has been studied and the problems of pharmaceutical and medical shortages will be a key area of the revision's focus.

She said a fifth area of health legislation and governance will also be addressed alongside the Iraqi parliament.

As the full impact of five years of conflict on Iraq's healthcare system is unveiled, Dr Al Gasseer says there are rays of hope and, despite the bleak picture painted by international aid agencies and the media, she pointed out a number of successes.

"In 2003 the central public health lab was not functioning, except for 20 per cent; neither was the blood bank. By 2005 we had rehabilitated the central public health lab and received international recognition for our work. By early 2006 we had rehabilitated the drug quality control lab and added a research lab," she said.

Last year the WHO and the health ministry successfully contained a cholera epidemic that swept across the northern regions of Kirkuk and Sulaimaniya.

"There were very few deaths which means access to care was good," she said.

The WHO also worked rapidly to control avian flu HN51 which killed two people in the northern town of Sulaimaniyah in 2006.

"We immediately went in. I led the first UN group of eight people to Sulaimaniyah. Iraq did a good job of containing it," she said.

She also explained that they had contained thousands of diarrhoea cases across the country and reduced skin diseases in children. Measles has also been dramatically reduced, although there are still pockets of outbreaks, she said.

"There are success stories but people don't want to hear them," she said. "But there are lots of people out there who are working hard."