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18 April 2003 :: Over the past week, medical teams from the independent
emergency relief organisation, Médecins Sans Frontières have been
visiting hospitals in a number of cities in Iraq to assess the most urgent needs
and to find ways to meet them.
The surgical team in Baghdad has continued to help in one of the hospitals
there with the workload of the emergency department. Other Médecins Sans
Frontières volunteers have been visiting and offering assistance to some
of the other hard-pressed medical facilities in the city. Meanwhile, mobile teams
have been travelling to Basra, Karballah, Al Hillah, Al Najaf, Al Nasariya, Al
Qut and Mosul.
These were very rapid assessments and they may not be representative of the
whole country. The results are summarised below. The exploration is continuing
and Médecins Sans Frontières will report on conditions as we find
them. Médecins Sans Frontières as been carrying out this work completely
independently of the coalition military forces and believes that it is essential
that truly impartial humanitarian agencies are present and active to offer support
to the Iraqi people and medical staff.
Médecins Sans Frontières’s recent medical surveys
Baghdad
At Al Yarmouk Hospital, which was bombed 10 days ago, only the emergency department
is operating. Thursday was its first day back at work. There is a serious lack
of nursing staff and a very limited supply of essential drugs. Much of their medical
equipment was also looted. The management of the hospital is finding it difficult
to cope. Only one generator out of three is running, which means that the kidney
dialysis machine is only working for part of the day. The staff are having to
turn patients away to other hospitals.
Karameh Hospital on the West bank of the river has around 450 beds and is
continuing to work effectively. The staff found ways to guard the hospital and
there was no looting. There were not many material needs here but there was concern
about insecurity in the wider city that was discouraging staff from travelling
and returning to work.
The Paediatric Hospital had very limited treatment capacity.
Médecins Sans Frontières’s surgical team has continued
to work in the Zafarinia hospital, where they have been helping with routine operations:
ovarian cyst, appendicitis, limb injuries.
Médecins Sans Frontières delivered drug supplies, particularly
painkillers, and some surgical materials to these hospitals where there were clear
needs and requests.
The Médecins Sans Frontières Medical Coordinator in Baghdad summarised
the overall problems as follows.
- Many patients – possibly thousands - were discharged to their homes
after initial surgery due to insecurity. Some will need secondary surgery. It
is currently impossible to get an overview of the remaining surgical needs.
- Some patients with chronic medical diseases, such as kidney disease (no dialysis
machines working well), diabetes (no refrigerators to store insulin), cardiovascular
diseases (no drugs, no medical attention, no pharmacies open) will have serious
problems.
- There are 34 hospitals in Baghdad, with about a half of them are believed
to be functioning. The few we have seen are generally under great stress with
organisation and management often limited. Patients are being taken care of but
the quality of care may be far from optimal. Moreover, most people do not know
which hospitals are functioning or where to go if they are ill.
- Many hospitals were looted but the ones now more or less open seem to have
enough medical supplies, apart from specific items such as anaesthesia drugs and
external fixations. There is still insufficient information about stocks.
- There is a lack of public transport due to insecurity and lack of petrol.
Staff in the hospitals, especially nursing staff, are not coming to work. Patients
are not coming in the numbers we should expect due to the same transport problem.
So the low number of admissions we see in the hospitals is probably not a true
indication of the need for emergency treatment.
- The administration and the security of hospitals is in flux.
Al Hilla
The Surgical Hospital’s structure was intact and appeared to be functioning
reasonably well. There were some shortages of nursing staff and requests for painkillers,
external fixators, colostomy bags and suture materials. During the height of the
fighting in the area, the hospital staff say they had 450 surgical cases.
The Hospital of Internal Medicine with 200 beds appeared to be working well.
Electricity and water supplies were available in the town. There are 76 health
centres in the area and the local authorities expect to have reports from all
of them shortly.
Al Najaf
The overall Ministry of Health structure is still in place in the city. The 5
hospitals deliver 1,000 beds for the million people in the governerate and there
are 37 health care centres operational. The main city hospital has local armed
guards. There were no obvious medical needs or emergency. requirements.
Al Nasariyah
3 hospitals. The 300 bed hospital had been ransacked and was not operational.
Another with 400 beds was intact and working well. The 200 bed maternity hospital
was only partially in use. There was a lack of mains water but a relatively good
stock of medicines. Food supplies were satisfactory. Three quarters of the war
wounded had already been treated and discharged.
Al Qut
8 hospitals and 32 clinics. Some shortages of specific drugs. For example, endemic
kalar azar has taken more lives recently because the treatment drugs were exhausted.
There are shortages of oxygen. However, water and electricity are reaching the
medical facilities and the staff report that there were only 17 war wounded from
the period of intense fighting near the town.
Mosul
The two main hospitals in town were visited yesterday: al Zahwari surgical teaching
hospital and Saddam teaching hospital. They have several hundreds beds each. There
was no sign of war damage or looting and the water and electricity services were
functioning. Some 400 wounded had been treated since the beginning of the war,
25 in the past week of clashes in the town. There were staff working and drugs
available. We were told of some shortage of anaesthetic drugs. The Médecins
Sans Frontières team is continuing to visit other health structures in
the city.
Basra
The medical service is the only civil structure within Basra that is functioning
at this point. There are currently 4 functional hospitals within Basra city, though
they are not operating at their previous level due to staffing shortages and equipment.
Two of the 4 teaching hospitals have been reported to be looted.
There has been an increase in diarrhoeal cases. Small water tankers and individuals
are collecting water directly from the river and the Directorate of Health has
stated that the hospital is not receiving enough water. The mains water is limited
by the power problem.
More than half of the Primary Healthcare Centres are currently working, many
of others have been damaged or had material stolen during the lootings. Local
sources say that the lack of protein is a nutritional problem.
Karbala
A Médecins Sans Frontières emergency medical team visited the main
hospital of the Karbala Governate earlier this week.
Médecins Sans Frontières found that the senior doctors of the
hospital have reacted to the recent upheaval in a professional manner: steps were
taken to ensure the safe storage of drugs and medical material, while doctors
and medical staff have carried on with their regular work as much as the circumstances
have allowed. So, although they spoke of some specific drug shortages, they were
generally well supplied. Security and electricity problems still need to be overcome
to limit any threat to the medical facilities. Médecins Sans Frontières
remains in contact with the hospital to provide what support may be necessary.
A spiral of violence
After having been blocked from entering Iraq between 1992 and 2002, MSF was given permission by the former government to start providing care to civilians in Baghdad shortly before the war began in March 2003. Although heavy fighting ended in April 2003, the country's security situation deteriorated sharply in mid-2003, and humanitarian aid workers began to be viewed by some as a component of the Western military effort. In a statement, MSF emphasized that recent actions and statements made by Western officials attempting to incorporate aid into their political plans were contributing to humanitarian groups' vulnerability to attacks. While MSF had withdrawn many of its international volunteers by September 2003 due to both unacceptable risks and reduced emergency health needs, teams continued to provide assistance in a number of ways... » More |
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