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Iraq’s Public Health Crisis

Will improving public health in Iraq help end the war and bring stability?

February 18, 2008

Will improving public health in Iraq help end the war and bring stability?

It is the kind of news that everybody had been dreading. An outbreak of cholera in Iraq, which started in two northern provinces, has already reached Baghdad and has become Iraq’s biggest cholera outbreak in recent memory.

Statistics from the WHO indicate that there have already been more than 3,300 cases of cholera in the country, and more than 33,000 cases of watery diarrhea — which could be a milder form of the disease.

The cholera epidemic aggravates what is, under any measure, an already serious humanitarian and public health emergency.

While in industrialized countries a cholera outbreak can be easily controlled, in developing countries — and particularly countries at war — cholera can become a fast killer, sometimes in just a few hours. Contaminated water, the absence of basic sanitation and infection spread through human contact are the main causes.

Carl von Clausewitz, the noted 19th-century military historian and strategist, was one of its best-known victims.

Oxfam International has also reported a dramatic increase in malnutrition among Iraqi children — a fact obscured by the high levels of violence.

It is estimated that 28% of Iraqi children are malnourished, compared with 19% before the 2003 invasion. In 2006, more than 11% of newborn babies were born underweight, compared with 4% in 2003.

Malnutrition contributes to death from other conditions such as intestinal and respiratory infections, malaria and typhoid.

The lack of food affects not only children. It is estimated that four million Iraqis — 15% of the total population — cannot regularly buy enough to eat and are now dependent on food assistance.

The suffering doesn’t end there. Last year, the Association of Psychologists of Iraq (API) released a report which states that the U.S.-led invasion has greatly affected the psychological development of Iraqi children.

Under UN Security Council Resolution 1483, both the United States and Great Britain are recognized as Iraq’s occupation powers. As such, they are bound by The Hague and Geneva Conventions to not only maintain order, but also respond to the medical needs of the population.

At present, 70% of the Iraqi population is without adequate water supplies, and 80% lacks adequate sanitation. The Baghdad Health Directorate has declared the city’s sewage system to be defective — with doctors warning that the drinking water in some of Baghdad’s poor neighborhoods is contaminated with sewage.

Hospitals are unable to respond to people’s needs. Some 90% of hospitals lack essential resources such as basic medical and surgical supplies.

Most international aid agencies have left the country, a situation compounded by the emigration of qualified personnel, particularly medical personnel. Of 34,000 doctors living in the country in 2003, 12,000 have emigrated — and over 2,000 have been murdered.

The war is not only affecting Iraqis. The Congressional Budget Office in the United States has issued a report to lawmakers stating that the war could ultimately cost the U.S. government well over a trillion dollars — at least double what has already been spent.

Even under the best conditions — an immediate and substantial reduction of troops — the impact of the war will be felt by U.S. taxpayers for at least the next decade.

To adequately respond to the situation in Iraq, it is crucial to improve the mechanism for distributing food and medicines, and to support the work of non-governmental agencies there.

The Association of Psychologists of Iraq has urged the international community to help establish centers specialized in child psychology and programs devoted to children’s mental health — a most urgent need.

For this to happen, it is imperative to lower the climate of hatred and distrust now reigning in Iraq. Improving Iraqis’ health at all levels could indicate to them that they have not been forgotten and disregarded.

A task force should be constituted with UNICEF, the World Health Organization, NGOs working in the country and local health officials to address Iraqis’ most pressing health needs and plan future actions.

Improving people’s health can be the key to breaking a vicious circle of anger and distrust — and give Iraqis a much-needed sense of hope.


Four million Iraqis — 15% of the total population — are now dependent on food assistance.

Occupying powers are responsible not only for maintaining order — but also for addressing the medical needs of the population.

Of 34,000 doctors living in Iraq in 2003, 12,000 have emigrated — and over 2,000 have been murdered.