18 May 2019
Iraqi children endure a crippled healthcare system
Published online 7 September 2014
Thirty years of conflict, sanctions and a mass exodus of medical professionals has severely compromised the health of Iraqi children. And there’s no respite on the horizon.
Iraq’s children are bearing the brunt of a faltering healthcare system, which suffered due to war and mismanagement, and every now and then begins a short-lived stuttering recovery.
An estimated 3.5 million Iraqi children are living in poverty. Addressing their physical and psychological health needs remains exceedingly difficult with the ongoing political unrest. The future looks grim for the millions deprived of the right to good health and a secure childhood.
The decline of Iraq began with the eight-year Iran-Iraq war, continued with the Gulf War and the following 12 years of sanctions. “There were shortages of food, medicines, medical equipment and electricity. Buildings fell into disrepair and doctors had no access to international medical developments,” says Joanne Baker, coordinator at the NGO Child Victims of War.
By the time the US-led forces invaded Baghdad in 2003, the once state-of-the-art healthcare system was already crumbling and children, in particular, were suffering dire consequences.
Every year more than 35,000 children in Iraq die. For those children that do survive, one in four aged under five displays stunted physical and intellectual development from chronic malnutrition. Infant mortality is currently 28 per 1000 live births and for children under five, mortality is now 34 per 1000.
A devastated society doesn’t care about healthcare, it only cares about the basics like food and safety.
One of the most disastrous legacies of the 2003-11 US-led war in Iraq was the mass exodus of the country’s doctors. Their departure pushed the tenuous healthcare system to the brink of collapse.
To practice meant risking your life, as threats, assaults and kidnappings became commonplace, says Nabil Al-Khalisi, who has been researching the Iraqi medical brain drain and its implications since he fled Baghdad to the US in 2010.
Since 2003, Al-Khalisi reports that 250 doctors in Iraq have been kidnapped, 2,000 have been murdered and an estimated 20,000 have fled. Today, the tide of emigration has decreased, but sectarian violence still polarizes Iraq and many doctors continue to have their lives threatened.
“Iraq lost 50% of its workforce in one year between 2007 and 2008. It still doesn’t have enough doctors as, once they graduate, they leave to neighbouring countries or for the West due to low pay, insecurity and unbelievable workloads in Iraq,” Al-Khalisi explains.
Al-Khalisi says few doctors abroad intend to return and of those remaining in Iraq, a staggering 50% want to leave. “[The authorities] don’t provide security to doctors, but it’s in their interest to keep them safe so they can practice. Iraq is pushing doctors away at the same time the world is pulling them,” he explains.
The shortage has cost Iraqi children; immunization rates for children have decreased 20% since 2000, and only half of toddlers between 18 to 29 months receive all recommended immunizations when they are supposed to. This led to the reemergence of preventable diseases and this year, the first outbreak of polio was reported in Iraq since it was declared free of the disease in 2000.
Acute respiratory infections and diarrhea, both easily treatable, are the two largest killer diseases of the country’s children.
The remains of past wars
The legacies of past wars continue to have grave consequences for Iraqi children.
Research by Souad Al-Azzawi, associate professor at the Mamoun University for Science and Technology, on the use of depleted uranium (DU) in Iraq found clear correlations between exposure to the low-level radiation and increases in birth defects, children’s leukaemia and malignancies registered since 1995, including some forms of cancer not seen prior to 1991.
Children are especially vulnerable to DU – which deposits in bones, organs and cells – because their cells divide rapidly as they grow, says Ahmad Hardan in a study prepared for the Iraqi Ministry of Health.
Landmines pose another threat to children in Iraq, which has one of the world’s highest concentrations of landmines and unexploded ordinance. UNICEF says the presence of landmines and cluster bomblets have killed or maimed hundreds of children in Iraq and have impacted an estimated one million more by restricting their access to simple daily tasks or making such tasks fraught with danger.
UNICEF estimates half of Iraq’s 2.3 million internally displaced persons (IDPs) are children. Inadequate nutrition, unsanitary living conditions and a lack of access to healthcare services increase the spread of disease and exacerbate chronic health conditions. The absence of safe water causes high rates of intestinal and skin diseases among IDP children.
The future of health for Iraqi children
Against the backdrop of daily violence and conflict, the government is struggling to restore basic functions to the devastated state and has been unable to address the public health issues that it urgently needs.
Al-Khalisi says Iraq has not caught up with the rest of the world in terms of medical education. As a result, the children of Iraq are under the auspices of a healthcare system still grappling with a shortage of skills and resources, a health strategy that remains weak and uncoordinated, and a ministry of health that has not kept up to date with the major epidemiological and demographic changes the country has gone through.
“A devastated society doesn’t care about healthcare, it only cares about the basics like food and safety,” says Al-Khalisi – although he cautions that Iraq cannot be compared out of context. “Even during the war, and after all that the system has been through, it’s still functioning, and I admire the system for its resilience.”
Resilient as the system may be, Baker says, without stability and a functional government the situation has little capacity for improvement and the futures of Iraqi children continue to be in jeopardy. “One must ask, how much can a people endure?”