This is an updated version of Health Care in Iraq, Sanctions Take their Toll, published March, 1997 in Middle East International, London.

Only early this month, the first purchases of medicines under UN Resolution 986, arrived in Iraq. They are awaiting distribution.

By Barbara Nimri Aziz

How long can Iraqis hang on to their crumbling medical system? The day may not be far off, even in this devastated country, when government health care comes to an end. Without oil revenues, even under UN Resolution 986, Baghdad is strapped for cash and is looking for ways to sell what state assets it can. Before 1990, Iraq's quality medical services to its people was little publicized in the West. But among developing nations, it was a model system. Since the early 1970s, Baghdad had a policy of investing a substantial part of its oil revenues in two main social programs: education and health. Medical education was free and medical schools received the nation's top students. All Iraqis enjoyed quality health care and it was free. Today Iraq's medical facilities lie in shambles. [The government seems to have lost hope of salvaging it and is now talking about privatizing the entire system.] Journalists and human rights groups cite health statistics in Iraq to illustrate the devastating human cost of the UN embargo imposed more than 6 years ago. A September 1995 survey by the United Nation's Food and Agricultural Organization and other agencies calculated that 570,000 children under the age of 5 had died due to conditions created by the sanctions. (This figure is estimated to have reached 800,000 by now.) Health experts report 4 fold increases in some types of cancer, and the reappearance of diseases irradicated 30 years ago. Malnutrition effects most of the population and water born infections are rampant. This is happening at the same time that medicines are unavailable. The tragedy of disease, stunted growth and death is compounded by the collapse of Iraq's health system. In theory, drugs are not embargoed. But they are nevertheless scarce. Iraq has no cash to import, and most foreign suppliers simply refuse to deal with the government. Medical equipment suffers the same problem, so hospitals are in disrepair and can barely function. In recent years, most state hospitals across Iraq have closed down at least 50% of their rooms. Thus far medical colleges are still functioning, but no one knows how long they can maintain their standards. One dean of medicine in Baghdad reports that since 1991 he lost 25% of his teaching staff. All left to seek work overseas. Medical education in Iraq had received heavy government support, and was conducted in English. [This is the case in most Arab states.] The government also financed overseas studies of medical graduates. Some opted to remain abroad but most doctors returned to Iraq. "We had the best uptodate equipment, professional conferences and all the medical journals we wanted," says Aziz Ali. He was trained at Great Ormond Street Children's Hospital in the UK. When he returned to Kerbala 15 years ago, he thought that a productive life as a surgeon awaited him. His salary of 500 dinars a month, then equal to $1,500. allowed him to enjoy a comfortable middle class life like most civil servants in the country. Because of the collapse of the dinar, due to UN sanctions, Dr. Ali's salary has been boosted to 3,500 dinars. This is equivalent to merely $2.50 today. Worse, he can barely function as a surgeon because of deteriorated facilities. Like other doctors across Iraq, Ali supplements his salary with income from a small private clinic he runs in the city center every afternoon. (Every medical graduate is required by law to work for the government.) Senior consultants have built new hospitals to increase their incomes and capitalize on their reputations. Especially in Baghdad, well-known doctors have formed partnerships to finance and run these private centers. As many as 50 small hospitals of this kind, all with under 100 beds, sprung up in the Iraqi capital after 1993. They also employ young doctors like Moyed Khairy who also can't live on a government salary. Dr. Moyed works in a government pharmaceutical center in the morning for the regular 3,500 dinars; then he serves at al-Ferdos private hospital. "I can earn an additional 10,000-15,000 a month. It is still not enough to live as well as we did before the war," he says. Al-Ferdos, al-Jadriya and other private hospitals have the appearance of being in the business of medical care. In contrast to most government hospitals, they are well maintained and suspicious of outsiders. They serve a new rich class who emerged in the wake of the war and have money to pay for their treatment. "A gall bladder operation is 200,000 ID; a cesarean delivery is 150,000 ID. We give the patient a list of medicines they will need and tell them to secure it in the market. No morphine or other painkillers are available," says the young resident. Is relief on the way? UN Resolution 986 was signed almost a year ago. It's the oil-for-food deal that allows Iraq to sell $2 billion worth of oil each 6 months. Iraq will receive about half, and more than half of this will go towards food purchases. Early in February, Iraq's minister of trade reported that about $210. million is budgeted for medical supplies. "Thus far, we have not yet received any medicines," says Deputy Minister of Health, Dr. Showki Marcus. "We have to follow (UN) procedures, " he says. Covering his deep frustration and anger with the UN, he patiently explains: "When the UN Sanctions Committee in New York give us the go ahead, we will place the orders. Most products will have to be manufactured specifically for us, and this takes time." Officials do not expect anything to reach Baghdad before April. Doctors in various hospitals are anxiously awaiting the supplies. They say they will need much more than their pre-1990 budget because health needs are greater and hospitals have to be almost totally rebuilt. The International Action Center in New York, headed by Ramsey Clark, and other critics of the sanctions estimate it would be years before the system can function again, even if sanctions are completely lifted. But such discussions may be theoretical if a plan to privatize Iraq's medical system is implemented. "We are thinking loudly about this," The Iraqi Ministry of Health said in a recent interview. "We have as yet put nothing on paper." Other doctors working in government hospitals are certain the plan will be effected. They do not appear happy about it, although in the long run they themselves would gain materially from privatization. "Our people are now poor; and there will be more poverty by the time this is over," says one physician. It is still unclear who will buy these hospitals and where the medical stocks would come from. Such a plan will also mean that medical education will no longer be state-supported.