Medical Care in Iraq

There was a 60 minutes program on Medical Care in Iraq on July 1, 2007. For US troops injured or sick in Iraq, they get “full-press court” from US medical services. They work HARD on getting the injured to medical care within minutes to treat them during the “golden hour” after the injury. One helicopter retrieved a US soldier and transported him to medical care in 17 minutes. Then, when they get to the US hospital, the staff bust their asses to save lives. It is all-out, no-stop, no step too large or small, medical care. If there are injured Iraqis around the US troops, they sometimes get assistance also – nearly half the patients in the hospital being filmed was Iraqis.

In this hospital, they can hold surgeries that go on for hours. The plane that takes US troops to Germany is a full scale ICU, capable of doing surgeries while in flight. The Iraqi patients are not eligible for transport to Germany; instead they are transferred to Iraqi hospitals. In the 60 minutes piece, there was a young Iraqi girl with shrapnel in her brain. The staff determined that they could not help her, so she died in the US military hospital. (I’m not sure the final outcome would have been any different for a US soldier, it’s just that they would have kept trying, I think. I do not have an opinion on whether this was the right thing to do or not.)

One million dollars is a conservative number on the cost of medical care for one injured soldier. As we know from the Walter Reed scandal, this administration does not care for the welfare of our troops, so I am under the impression that this money is spent to keep the death toll low, so support for the war will not decrease here in the USA. I think it is worth spending that money to save their lives, but I do think the oil companies should pick up the tab, not the US taxpayers.

We have the best survival rate from war injuries in the recorded history of the world from this particular war.

And, the facilities for treating US troops is expanding into permanent structures, per this report called “Curtain Falls On Iraq’s M.A.S.H.”

The opening of that 107,000-square-foot hospital, in stages throughout July, not only brings a more standard, state-of-the-art facility to Iraq. It also announces that the U.S. military, after more than 3,500 dead and 25,000 wounded in four years of war, will be well prepared to deal with severe casualties for years more to come.

And, again, there are Iraqis being treated in this US run medical facility:

But Balad's casualties are not just American. Among the side-by-side tents that serve as hospital wards, the Iraqi patient population at times has rivaled the American. On one recent night, as the quiet was broken occasionally by moans, seven children lay in a 10-bed Iraqi ward, victims of explosions and other violence whose origins — crossfire, terrorism, U.S. airstrikes — usually remain murky to those who treat them.

Hey, if I worked there, I would want it to remain murky too. And I am glad they are treating some of the Iraqi people. But I am really here to talk about the usual medical care for the Iraqi people.

How bad are things in Iraq? How much violence is the average person exposed to, or subjected to? How much stress are they under? According to this article from last March, it’s pretty bad:

The personal toll is enormous. More than half of Iraqis, 53 percent, have a close friend or relative who's been hurt or killed in the current violence. One in six says someone in their own household has been harmed. Eighty-six percent worry about a loved one being hurt; two-thirds worry deeply. Huge numbers limit their daily activities to minimize risk. Seven in 10 report multiple signs of traumatic stress.

So, things are very, very bad. And the level of stress is only going to make people more susceptible to illnesses.

In a violent situation in Iraq, they may die because they don’t reach ANY medical facilities in time, or receive any on-site medical care, not even first aid. This is generally due to the fact that the violence is ongoing, and no one can get the injured person to a hospital, or get an ambulance to the injured person. There are no med-evac helicopters available for that “golden hour” for the vast majority of injured Iraqi people. Here is one story where it took two hours for this teenager to die from a bullet wound. He bled to death while everyone was waiting for the violence to calm down.

Close and deadly contact

On a sunny April afternoon, a bomb ripped a jagged hole in the road near Abu Mohammed's small grocery store. Gunfire crackled along the street as U.S. soldiers responded to the attack. Someone pounded frantically on the grocer's locked door, pleading for help. Mohammed recognized the frightened voice as that of a local teenager and let him inside. The 17-year-old had been struck by a bullet in the chaos that followed the explosion and was bleeding heavily. Within two hours, the boy was dead. Witnesses charge he was killed by U.S. troops firing randomly. U.S. military officials say troops are trained to avoid civilian casualties and do not fire wildly. Iraqis, however, say the shootings happen frequently and that even if troops are firing at suspected attackers, they often do so on city streets where bystanders are likely to be hit. Rarely is it possible to confirm such incidents. In this case, the boy was the son of a Los Angeles Times employee, which provided reporters knowledge of the incident in time to examine it. Witness and military accounts of the shooting offered a rare look into how such killings can occur.

Sometimes, they cannot reach medical care because of US policies. This is especially true in Curfew-Bound Fallujah. They have imposed a security crackdown there, and local aid organizations are not allowed access to the city. Medical services are often inaccessible because there is no way to get around, or security checkpoints slow down movement. There is no ambulance service or even cell phone service to call for help. The Iraqi Aid Association had this to say about medical conditions in Fallujah:

"We have supplies but it is impossible to reach the families. They are afraid to leave their homes to look for food, and children are getting sick with diarrhoea caused by the dirty water they are drinking," IAA spokesman Fatah Ahmed told reporters. "We have information that pregnant women are delivering their babies at home as the curfew is preventing them from reaching hospital."

And, in certain neighborhoods, ambulances are just not allowed to enter. So the Iraqi people are on their own to try and get the injured to the hospitals. There are multiple pictures on Yahoo News, too many for me to count, that show Iraqis loading the injured onto carts or into cars, in an attempt to get them medical care.

And then, when the Iraqis can get the injured person to a hospital, that often does not change the outcome either. In the story below, the first hospital said they could not treat the injury to the pregnant women or the unborn baby, so they sent them to another hospital. In the second hospital, they could not get blood fast enough – they did not have any on hand for the rare blood type. From the sounds of it, they were also unable to do a Caesarian section to save the baby, and unable to do any surgery on the pregnant women. She took twelve hours to die, after reaching not one, but two hospitals.

Iraqi woman mourns loss of sister, baby

At 10 a.m. an explosion outside the school shattered the classroom windows and sent a piece of shrapnel into her right thigh. Her blood spread like that of a slaughtered sheep across the classroom floor. The girls started crying and screaming in panic and others rushed upstairs, thinking at first that she had gone into labor after the shock of the explosion. When they saw the blood coming from her thigh, they improvised a stretcher from a blanket, carried her to a police car that was standing near by the school and drove through Baghdad's clogged traffic to nearby Al-Nu'maan hospital. The doctor said he did not have what he needed to stop the bleeding, so they took Luma to another hospital.

It was 12:15 p.m. when my brother-in-law called. By then, Luma had been bleeding for nearly two hours. He assured me that Luma would be fine, and there was no need to worry, but I could tell by the tone in his voice that the situation was serious. It took us — my older brother, his wife and me — more than an hour to reach the hospital. I ran inside, down halls with people whose voices I could not hear and a feeling of numbness all over. We found her in the X-ray room, covered in a blanket with her husband and two of her colleagues at her bedside. She was moaning quietly. I could only blow a kiss toward her pale yellow face and whisper under my breath: "Stay safe. I am waiting for you."

Later, a doctor appeared and asked us to provide her at least 10 units of A-negative blood, a rare type. They said they had none at the hospital. I remember shouting and crying and screaming in the hospital's passages, asking for the director-general's office, but he never appeared. Finally, we managed to locate two units of A-negative blood. I would have given Luma all of my blood, but our blood types didn't match. I began calling relatives and friends. One of my brothers donated two units, another relative two more. By the time a cousin arrived to donate two more units, the baby had already died. Another cousin arrived to donate two more units of blood, but by then it was over. Luma had passed on a few minutes earlier. She died at about 10:20 p.m., after struggling with pain for nearly 12 hours. I fell to the ground. Everything stopped inside me.

Of course, medical issues are not limited to the immediate aftereffects of the massive violence going on in that country. Cancer is a huge problem, particularly in the south, and this is likely an aftereffect of the bombing done by the US. This is what a cancer patient will have to deal with in the southern part of Iraq:

“Lack of treatment for cancer patients and outdated radiotherapy and chemotherapy techniques have led to lower survival rates of patients. The shortage of oncologists, who have fled to neighbouring countries, has worsened the situation,” said Hussein Abdel-Kareem, an oncologist and senior official in the Basra Health Secretariat. “Exposure to radiation from old cluster bombs, the high use of chemicals in agriculture as well as water contamination is having a serious impact on the health of local people, since these factors are important promoters of cancer related diseases. Many of the patients could have been treated but they died because of lack of facilities,” Abdel-Kareem added.

So, not only are they getting cancer from the bombs the US dropped (among other things, like a lack of clean drinking water), they are lacking adequate care. And, they are therefore dying from lack of care and lack of facilities - when they might otherwise live.

And this Daily Kos diary has a link to the video made by Greg Palast. He covers the sanctions and their impact on the health of Iraqis, particularly children.

So, what is the overall impact? This report says that Iraqi infant mortality has soared by 150%, which is the highest recorded increase in the world. This was reported by the organization Save The Children. The article goes on:

According to the report, in 2005, the last year for which reliable data is available, one in eight Iraqi children—122,000 in all—died before reaching their fifth birthday. More than half of these deaths were recorded among new-born infants, with pneumonia and diarrhea claiming the greatest toll among Iraqi babies.

So, that’s 122,000 dead in one year alone – and people questioned the Lancet report! And people tell me not to call it genocide! Why, that is exactly what it is!

This overall destruction of basic social infrastructure unleashed by the US invasion and occupation has been translated into a horrendous decline in child health. “Only 35 percent of Iraqi children are fully immunized, and more than one-fifth (21 percent) are severely or moderately stunted” as a result of malnutrition, the study found.

Infant mortality in Iraq in 2005 was 125 per 1,000 live births, which is on par with Uganda and Haiti. That’s 12% infant death rate. And it took a while for this situation to develop, since the war in 1990-1991 caused the bombing of much of the infrastructure like sanitation systems (and I imagine the bombing since 2003 just finished it off). Then there were the years of sanctions – which deprived Iraqi children of medical supplies and adequate nutrition.

Even chlorine, needed to purify water, was embargoed, depriving infants and small children of a clean water supply and condemning many to death.

And access to clean drinking water is still an overwhelming problem in the country, as I imagine it would be in my town if someone had bombed the city enough to destroy houses, the underground pipes for both water and sewage would be toast also. Not to mention the bombing of the water treatment plants and sewage treatment plants and the lack of treatment supplies available. Here’s what the Iraqi Health ministry had to say about the upcoming increase in waterborne diseases:

"Many cases of viral hepatitis, diarrhoea, typhoid and bacterial infections have been registered in Baghdad due to polluted drinking water," Ahmed Assad Naji of Baghdad's health directorate said. "Water is an enormous need, and people take it where they can get it, and they are getting it from places where it is not always clean. The deteriorated security situation has made it very hard to repair the country's sewage and water networks to work properly and that caused these waterborne diseases," Naji said.

….Naji said the most vulnerable persons for these diseases were children under five, women aged 19-45 and elderly people.

And, there is evidence that he is correct:

In late June, five cases of cholera were reported among children in the southern city of Najaf, about 200km south of Baghdad, said Nasser Mohammed Ali of the city’s health directorate. "All of the cases were among children under 12," Ali added.

As to nutritition, there is this report called Situation of Iraqi Children Much Worse:

"Children today are much worse off than they were a year ago, and they certainly are worse off than they were three years ago," said Dan Toole, director of emergency programs for the United Nations Children's Fund. He said Iraqis no longer have safe access to a government-funded food basket, established under Saddam Hussein to deal with international sanctions.

……"Nutritional indicators, health access indicators are all changing for the worse," Toole said. He said recently published data showing improvement referred to the situation a couple of years ago and is outdated.

God bless the children.

And God bless the children some more. “When I woke up, my legs were gone.” (Please note that in this link they never said who attacked the girl’s home. They do show that there was a gun battle at this home, but it is not mentioned who was fighting whom.) This link to a video was the only information that I had found on rehabilitation services for Iraqis who have lost a limb for quite a while; but The Observer wrote a more recent article about amputations bringing a serious health crisis to Iraq. They stated there was a request for 3,000 replacement limbs in one year in the city of Mosul alone. If that statistic were to hold across Iraq (and more than likely it does), that means there is a huge health care crisis in this area alone. This has been ignored by the rest of the world, and of course by the USA. They also point out that the number of amputations suffered by Iraqi civilians is not surprising in light of the number received by US troops.

No More Victims is bringing one of these children with double leg amputations to the USA for treatment.

And then there is the issue of mental health services, surely a dire need at this point, but a near total lack of such services exist today in Iraq. In this article, Traumatised Iraqi children suffer psychological damage, there is a hint of what is happening:

Last year the World Health Organization (WHO) conducted a survey of 600 children aged 3-10 in Baghdad: 47 percent were found to have been exposed to a major traumatic event over the past two years. Of this group, 14 percent showed symptoms of post-traumatic stress disorder. In a second study of 1,090 adolescents in the northern city of Mosul, 30 percent showed symptoms of the disorder. Many of the children Hamid treats have witnessed killings. They have anxiety problems and suffer from depression. Some have recurring nightmares and wet their beds. Others have problems learning at school.

And a hint of what services are available:

"Iraq's conflict is taking an immense and unnoticed psychological toll on children and youth that will have long-term consequences," said Bilal Youssif Hamid, a Baghdad-based child psychiatrist. "The lack of resources means the social impact will be very bad and the coming generations, especially this one, will be aggressive," Hamid added. According to UNICEF, half of Iraq's four million people who have fled their homes since 2003 are children. Many were killed inside their schools or playgrounds and gangs routinely kidnap children for ransom.

Of course, this lack of clean drinking water and lack of adequate nutrition and lack of rehabilitation services are impacting on adults in Iraq also. It is just that I happened to find reports on the children of Iraq. Maybe that’s because the children are the hardest hit of any single group in Iraq.

The number of Iraqi children who are born underweight or suffer from malnutrition has increased sharply since the US-led invasion, according to a report by Oxfam and a network of about 80 aid agencies. The report describes a nationwide catastrophe, with around 8 million Iraqis - almost a third of the population - in need of emergency aid. Many families have dropped out of the food rationing system because they have been displaced by fighting and sectarian conflict. Others suffer from the collapse in basic services caused by the exodus of doctors and hospital staff.

For these are all our children. We will all profit by, or pay for, Whatever they become.
—James Baldwin

Getting medical supplies is very difficult in Iraq, and while what I have seen of photos of Iraqi hospitals would indicate that the Kurdish areas are doing better, this plea went out recently: Kurdistan Government Appeals for Medical Supplies

Younis added that many of the region's 48 hospitals and 672 primary health care centres lack the basic medicines and medical supplies needed to treat wounds or provide basic care. "Our children suffer from one of the world's highest rates of heart disease and leukemia and we lack the facilities to treat them here in Kurdistan," he said.

But they are not the only ones making such a plea, Sadr City also makes a plea for medical equipment.

Doctors at Sadr City Hospital said they urgently needed medicines and emergency kits, as they believed the situation would worsen. “We cannot cope with the number of casualties. They should send us materials to fully equip our hospital before people start to die for lack of medicines. I know there weren’t many casualties but militants and locals are revolted by the recent actions by US troops and they might take revenge any time,” said Hassan Khalif, a physician at Sadr City Hospital. “We need needles, pain-killers, antiseptic and cotton. Also our X-ray machine is nearly broken and needs to be repaired urgently,” Khalif said.

From the many stories I have read and blogged on Iraq, and from the many photos that I have looked at and saved, I can say that the majority of hospitals in Iraq are filthy messes, and are lacking in gaze, bandages, sheets, and basic supplies. There is a video that shows someone working on a child with a chest wound, WITHOUT ANY SURGICAL GLOVES. I have worked in the American and Canadian healthcare system since 1983. I have never seen anything like that – not even once. Here is a picture of a doctor working on a burn patient without gloves. That is my own blog, you can find lots of pictures of Iraqi hospital scenes on that blog.

But lack of sanitation and basic equipment is only a part of their concerns. This is from a BBC article that is trying to track the violence in Iraq:

One of the hospitals covered by the survey provides some grim details about the death toll. Al-Yarmouk received 10 limbs with the rest of the bodies missing, 22 victims who had been beheaded, 45 people killed by one car bomb alone in the al-Baaya district and the bodies of 13 people who had been shot in the head.

And then there is the problem of violence directed towards the health care providers. There was on recent report on the doctors in Basra going on strike to demand protection. This happened in July 2007. They said that 12 doctors had been killed in Basra by gunmen since the US-led invasion, and dozens of others have fled the city. And, many medical employees have fled. From the same article cited:

According to figures from the Iraqi Health Ministry released earlier this year, 618 medical employees, including 132 doctors, as well as medics and other health care workers, have been killed nationwide since 2003. Hundreds, possibly thousands, of other medical personnel are believed to have fled to Iraq's northern semi-autonomous Kurdistan region and neighbouring countries.

It is in the thousands, per other reports. And this article has more information on the abuse and terror visited on the hospitals and doctors of Iraq – only this time it is in Diyala General Hospital in the provincial capital Baquba. They feel the majority of the problems stem from a lack of security. But that is not the only problem. They give some indication of where the problem of a lack of supplies comes from:

Complicating matters further has been corruption within Iraq's Ministry of Health in Baghdad. The ministry, which has been run by officials loyal to Shia cleric Muqtada al-Sadr, has been accused of favouring Shia areas in Iraq. Baquba, a mixed area, has been considered a Sunni area by the ministry. Doctors at Diyala General Hospital told IPS they believe that the Heath Ministry has hindered the supply of medical equipment and supplies to their hospital for sectarian reasons.

And what is medical care like in the shantytowns for internally displaced persons that are springing up in Iraq? This report is from one such camp in Najaf province:

There were more than 2,000 people in what is a collection of tents, with 60 percent of them women and 30 percent children. They lacked proper water access and the heat makes potable water too hot and undrinkable. There was no medical care, and many of the children suffer from typhoid, diarrhea and skin rash. The people had to cope with snakes, scorpions and mosquitoes. They had no change of clothes, and there were no toilets.

And here is a plea from a UN refugee agency concerning Palestinian children living in a desperate situation inside Iraq:

"We currently have 12 cases in urgent need of medical evacuation, the youngest just 15 months old," he added. Last week a UNHCR team travelled to the isolated Al Waleed camp near the border with Syria and found that several young people among the 1,071 displaced Palestinians there were in serious need of specialized medical treatment. They included a youth with a hole in his heart, two children with Hodgkin's disease, one youth about to lose his leg because of a vascular disease and a young man with severe diabetes who is losing his sight. But Redmond said there were more cases in need of urgent attention. "We have also identified a two-year-old with cerebral palsy who has very low immunity, is in urgent need of physical therapy and has stopped eating. Another child, a 13-year-old girl suffering from a spinal injury, will be permanently paralyzed from the neck down unless she gets treatment soon," he said adding that the girl's mother died a few years ago, her father was murdered in January and her home was burned by militia.

And the lack of medical care in Iraq has extended into the countries where Iraqis have fled for their lives, per this report. It is not that there is no medical care available, it is just that they do not have the money to pay for it.

Audio: Iraqis in Jordan Dogged by Medical Costs

Violence in Iraq has brought the health care system there close to a collapse, according to aid agencies. Neighboring Jordan is one of the few places Iraqis can get advanced medical treatment. But the system there is expensive — and pay-as-you-go. In Amman, many Iraqi exiles say the Iraqi government could do much more to cover expenses. The Iraqi government has pledged $25 million to help support Iraqis forced to flee the country. But so far, that money has not been dispersed.

Here is a link to HOW YOU CAN HELP the Iraqi refugees.

And here is a link to the IRAQ WATER PROJECT, which is an effort by the Vets for Peace. They are trying to bring water sterilizer units to Iraqi hospitals, and prior to the war, they repaired several water treatment plants.

Here is a link to

NO MORE VICTIMS.

"The truth must not only be the truth, it must be told."

This was also posted on Daily Kos on August 12, 2007 under the title "When I woke up, my legs were gone"