A nation in need of healing

By Sharifah Hafsah Syed Hasan Shahabudin, The New Straits Times Press (Malaysia)
12 April 2000

AT the emergency department of a hospital in Babylon, I saw a father carrying a very
sick child into the examination room. The infant had been referred to the hospital from a
smaller hospital with suspected encephalitis (infection of the brain).

As there was no ambulance, the anxious father had to find his own transport to take his
daughter to hospital. She was already comatose and gasping for breath by the time the
doctor on call attended to her.

The doctor tried hard to give oxygen through an ill-fitting mask but gave up and tried
sticking the tube up the nose instead. There wasn't the usual bustle of activity one sees in
our emergency rooms. I suppose it was because drugs, drips and other resuscitation
equipment and materials were also in short supply. I was told the girl died a few minutes
later.

This scene is typical of a hospital in Iraq these days. Since UN sanctions were imposed
on the country almost 10 years ago, the standard of healthcare has deteriorated to such
an extent that doctors have to make do with inadequate drugs and facilities.

Many of the 130 hospitals built between 1960 and 1980 have not been repaired nor
maintained properly. Public health in Iraq is dependent on 1,000 basic dispensaries and
84 health centres throughout the whole country. Shortage of medical equipment is
widespread. These centres lack basic tools like stethoscopes, sterilisers and
ambulances. The impact on patients is, needless to say, many-fold.

But Iraq was not a poor country prior to the UN sanctions as it had already established
an extensive education system with eight medical colleges which produced well-trained
doctors and health personnel. It had excellent water treatment, pumping facilities and
modern sanitation. Its hospitals were very specialised, even in the provinces. The
modern facilities gave Iraqis the best health care standards in the region.

Sadly, circumstances have changed dramatically.

I witnessed this change when I joined a group led by Datuk Seri Dr Siti Hasmah Mohd
Ali who made a working visit to Iraq in late March to observe how UN sanctions had
affected the people there.

The other members of the group were Toh Puan Dr Aishah Ong, Datuk Ruby Lee,
Datuk Dr Raj Karim, Assoc Prof Datin Dr Rashidah Shuib, Assoc Prof Datin Dr Mizan
Adiliah Ahmad Ibrahim, Datin Noorhayati Kamaluddin, Datin Siti Aishah Ghazali, Dr
Gladys Lopez and Aishah Ali.

We had planned our itinerary before our departure. Despite the tight security, the Iraqi
officials accompanying us tried very hard to accommodate all our requests. Some visits
were even impromptu, such as the one to the Maternal and Children's Hospital in
Babylon.

Dr Sadiq Hameed AlWash, a retired physician who also is the fulltime president of the
Iraqi Red Crescent Society, was the first person who gave us an insight on the
devastation caused by the war.

"About 7,000 children die every month and the number is still increasing," he said.

About 25-30 per cent of children below five years are malnourished and easily succumb
to respiratory infections and diarrhoeal diseases. As a direct effect of depleted uranium,
more children are dying from leukaemia, and foetuses are either aborted, stillborn or
born with congenital deformities.

Pregnant women are also badly affected. "Because of the shortage of food, mothers are
malnourished," he said. "They give birth to underweight babies and are at great risk to
complications in pregnancy such as postpartum haemorrhage (bleeding after delivery)."

Maternal mortality has risen 10-fold to 310 per 100,000 live births and underweight
babies contribute to the high mortality amongst toddlers.

Such findings confirm the fact that in times of natural disaster, famine, war and conflict, it
is the children, women and the elderly who suffer the most.

Old diseases which have been under control are now re-emerging. Because Iraq cannot
import chemicals that kill mosquito larvae, malaria is on the rise. Poor preventive
measures are also resulting in increased incidences of pulmonary tuberculosis,
poliomyelitis, amoebiasis, leishmaniasis and other infectious diseases.

Drugs, both for acute as well as chronic problems, are in very short supply. Special
formulas such as high calorie diets are difficult to come by. Doctors are grappling with
resistant strains of bacteria which require newer and more potent antibiotics. Some
doctors have not even seen third- generation antibiotics, what more fourth-generation
ones. People who suffer from chronic illnesses such as diabetes mellitus, arthritis and
hypertension are in dire need of drugs.

Dr Fadhil Abbas Abu, the director-general of the health authority in Babylon, worries
about the spring. "This is the time of asthmatic attacks and we don't have enough
bronchodilators. We may have to continue using subcutaneous adrenaline."

Dr Salsem Mohamad, the obstetrics and gynaecology specialist in Babylon, says
maternal death is high because 75 per cent of the mothers are anaemic and they get into
complications such as postpartum haemorrhage.

"What is worse," she said, "is that we don't even have oxytocin (a drug commonly used
during delivery) to conduct a proper delivery. When a mother bleeds, we cannot
transfuse her because we don't even have the bags to collect blood for a blood
transfusion. Even when we can collect blood, we don't have the basic kits to test for its
safety."

Episiotomy wounds are sutured with silk (which is not appropriate), thus exposing the
mothers to higher risks of infection and maternal death.

All doctors are personally affected by the fact that they are unable to keep up to date
with medical advances. Because of financial restrictions, they cannot subscribe to
medical journals. Medical literature are also prohibited under the embargo.

Despite the aim of the sanctions - to get the Iraqi people to rebel against their leaders -
the contrary is true. It has hardened their resolve to stand united against what they
perceive to be injustice and persecution. They have shown spectacular resilience, inner
strength and creativity in coping with the situation.

Even when resources are scarce and hospitals are in disrepair, cleanliness is maintained.
Doctors attend to their patients promptly with care, dedication and compassion.

They take pride in the fact that they are not a poor Third World country that requires
humanitarian aid. All they want is to be able to have reasonable control over their
resources so that they can determine how best to meet their health needs.

Tomorrow: The sanctions' impact on young children ..

* Professor Dr Sharifah Hafsah Syed Hasan Shahabudin is director of the Centre for
 Academic Advancement,
UKM, and deputy president of the NCWO