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Iraq :: A COuntry in chaos Isabel Simpson has been Head of Mission for Médecins Sans Frontières in Iraq since the end of the war. Prior to this she was Director of Operations in Australia.
Baghdad was a city in chaos. Streets were filled with debris and garbage and vehicles sat in lines several kilometres long queuing for fuel. Many shops were boarded up as protection against looters and US military tanks and armoured personnel carriers were roaming everywhere. STILLL SMOULDERING The destruction was not as great as I had imagined but all major government buildings in the city had been bombed. Many were still smouldering, from the burning and looting frenzy which followed. Every image of Saddam Hussein had been disfigured and beheaded. Over the next 10 days, our task was to evaluate the health situation south of Baghdad, in the upper-southern governates. It was already clear that there was no critical medical emergency (no famine, for instance) – but the situation was changing rapidly and not in a positive direction. Iraqi medical staff had prepared themselves well to cope with the war. Each hospital had had a three-month contingency supply of drugs and medical materials. But now these were in short supply or already finished – and caseloads were increasing. Doctors had no idea when their next supplies (or their pay) were going to come from. Many of the primary health facilities had been looted or damaged during the war and so patients were seeking access to hospitals as their first line of care. Queues outside hospital out-patient departments were growing longer every day. There was growing aggression towards health staff, as families panicked that their relatives would not receive treatment. The well-prepared coping mechanisms put in place before the war were slowly being eroded and, as yet, no practical solutions were being offered by the Coalition Authority. Everywhere we travelled, people would stop our vehicle and ask us for medicines – drugs for hypertension, diabetes, epilepsy, asthma and even sophisticated cytotoxics for cancer treatment. DISEASE RAGING One particular concern was lack of treatment for visceral leishmaniasis (Kala Azar). The disease is endemic throughout the southern regions of Iraq and affects exclusively children under five years. It’s a dangerous disease, fatal in most cases if untreated. Although curative treatment is possible, access and supplies of the specific drug (SSG or Pentostam) had been affected by the years of sanctions imposed on Iraq. In the majority of health facilities, they had not had access to Pentostam since the end of last year. Health staff could only estimate how many children might be in need of treatment, as cases only presented in the late stages of the disease – some hospitals quoted a caseload of more than 100 per month. Now with the onset of summer and the effects of the war, diarrhoeal diseases are raging through Iraq. Already more than 90% of paediatric admissions are presenting with some form of diarrhoeal illness. Since the war, water supplies in many areas have been seriously affected, either due to damage or lack of electricity to maintain the pumping stations. Everyone is worried about an outbreak of cholera but at present dysenteric illnesses are posing a greater threat. If health services are to be maintained over the next few months, temporary practical support is clearly required. The Coalition Authority are already delaying plans for a new Iraqi government and, despite their massive military presence, are not providing essential basic services to the population. The Iraqi people had high expectations of an optimistic future without Saddam – it looks like it’s going to be a long time before these expectations are met. Isabel Simpson
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