Monday, July 20, 2009

WWB: destruction of health care

WHAT WAR BRINGS: the destruction of health care in affected countries

PHOTO: At another hospital for refugees in Mardan, signs of disarray are clear. (Emilio Morenatti - AP) This is in Pakistan.

In the years before sanctions and the US invasion and occupation, Iraq had a health care system that was considered to be one of the best in the region. The years of sanctions made many medicines unavailable. The onset of violence in 2003 overwhelmed the health care system, and later on in 2005-2007 many Iraqis did not feel safe going to hospitals under the control of another sect. That fear has now passed, but the health care system is still in shambles.

I saw a video a few years back of a young child who had a serious open chest wound. The doctors working on him did not have gloves, and for years I looked at photos of patients in hospitals getting medical care without gloves. The hospitals were often filthy, and the floors covered in blood. I have been looking at pictures of what is happening to Iraqis for a few years now, and saved some of them on this blog:

Faces of Grief

A lot of the pictures were taken in hospitals.

One of the major problems is a shortage of doctors and other medical professionals. I wrote about that in my post on ‘brain drain’ recently.

Iraq's once-envied health care system lost to war, corruption

The Teaching Hospital's emergency room is cleaner than most in Baghdad. In fact, it's widely considered the best in the Iraqi capital. Still, flies buzz overhead, and on busy days there aren't enough beds or oxygen tanks. Across the room, a crude sign made with binder paper and tape marks the department's two-bed cardiac unit, which lacks a reliable defibrillator.

Iraq’s hospitals routinely send relatives of patients to fetch medicines, IV fluids, and even syringes. There is a shortage of nearly everything, and a large part of the problem is graft and corruption. Bribery is fairly common. A good number of the hospitals are in need of repairs, some still have sections that are about to fall down or actual holes in the walls.

Stories of missing drugs, of desperately ill-equipped doctors and of patients left to suffer the consequences are everywhere in Iraq's public health care system. Some hospitals are filthy and infested with bugs. Others are practically falling down. More and more, the blame is being placed on Iraq's U.S.-backed government, which by many accounts is infested with corruption and incompetence.

Another problem Iraq is facing is a lack of anti-venom for snake bites.

Snake are leaving their normal habitat because of a drought in southern Iraq. People are bitten while sleeping and while awake.

The medical centers in these areas also lack the simplest means to take care of those besieged people. There was no anti-venom. No one asks after them. No one really cares.

In Afghanistan, the health care system never was in great shape (by a long shot), but the number of Afghanis without health care is growing.

Growing number of Afghans lack health care - Ministry

Over 600,000 Afghans lack basic healthcare services due to attacks on healthcare facilities and health workers - a figure that has doubled since 2007, Abdullah Fahim, a spokesman for the Ministry of Public Health (MoPH), has said. About 32 health centres were torched, destroyed and/or closed down due to insecurity in 2007, and 28 health facilities were shut down or attacked in 2008, MoPH said.

They are calling on all warring parties to respect the neutrality of health centers. The number of attacks are increasing, per UN Integrated Regional Information Networks, with the decrease in security. The article further states:

Afghanistan has one of the highest maternal and infant (0-12 months) mortality rates in the world, according to WHO. Every hour at least two Afghan women die from obstetric complications due in part to the lack of health services. In each batch of 1,000 live births, at least 125 infants die, and one in five children die from mostly preventable diseases before their fifth birthday, the UN Children’s Fund and the MoPH said in 2008.

Polio is still a problem in Afghanistan, although there have been efforts at immunization over the last seven years. In 2001, about 32% were immunized and today it is over 80% immunized. In 2008, there were 31 cases of polio in Afghanistan. So far this year, there are 10 reported cases. Access to children is one factor in the lack of immunization, usually due to the bad security situation.

Fighting a stubborn poliovirus

About 200,000 children miss out on polio drops every time the vaccinators conduct a nationwide immunization drive, it said.

“Three things impede polio immunization in Helmand Province: First the insecurity, second a lack of public awareness, and very low payments to vaccinators,” said Jan Agha, a local health worker.

“The Taliban often oppose vaccinations. They threaten and beat vaccinators and break their vaccination kits… so people don’t want to risk their lives for 150 Afghanis [US$3] a day,” said a vaccinator in Kandahar Province who declined to be named.

Some Afghans are turning to travel to India to get medical treatment. It is rather expensive, and therefore limited to Afghans who are relatively well-off. Going to India has the advantage of advanced medical technologies like MRI, CT scans and dialysis facilities.

Patients turn to India for treatment
The lack of quality health services at home is prompting thousands of Afghan patients to travel to India for medical treatment despite the high costs.

The Indian embassy in Kabul said it had issued 5,224 medical visas in 2008 - up from 4,658 in 2007 and 3,844 in 2006.

The real number of Afghans going to India for treatment is higher than these figures suggest, as visas are also issued by four Indian consulates dotted around the country, and some who travel to India as tourists seek medical treatment on arrival.

So, the health care system in Iraq has been seriously damaged, with some signs of recovery in the last year or so…… while the situation in Afghanistan is deteriorating in the last couple of years.

This is just a brief survey of the health care systems of these countries. There has not been a lot of reporting on what is going on with the doctors, hospitals and public health systems. All the articles cited above come from McClatchy’s or from the UN Integrated Regional Information Networks. No one else is reporting on it.

And while we were busy spending money to destroy the health care system of Iraq (and not improve the health care system in Afghanistan) our own health care system deteriorated. It’s a lose-lose situation.

UPDATE: Two more articles

Just noticed this article from 2006:

Afghanistan, Iraq Near Top Of Infant Mortality Table

A new study says Afghanistan, Pakistan, and Iraq are among the countries with the highest death rates for newborns in the world. The study by the U.S.-based independent charity Save the Children says the African nation of Liberia has the world's highest newborn mortality rate, with 65 out of 1,000 babies dying.

The report says Liberia is followed by Afghanistan, where 60 out of every 1,000 babies die. Behind them come Iraq and Sierra Leone, with 59 of 1,000 newborns dying, and Pakistan, which has a rate of 58 deaths. The report says illiteracy, poverty, malnutrition, poor hygiene, and crippled health-care systems are among the factors contributing to the high rates of death among infants and mothers during or soon after birth.

And this report on the health care system collapse in Pakistan. They have a budget of $150 million/year for health care and $3.45 billion/year for wars. They are as messed up as the USA.

In Pakistan, Refugees Push the Health System Toward Collapse

Hospitals have been overwhelmed by more than 2 million refugees from the northwest, where the army is battling Taliban insurgents.

"To tell you honestly, health is not our national priority. It is very unfortunate," says physician Arshad Khan, the health ministry's top official in Mardan, which borders the battle zone. "And now, with this crisis, every smaller hospital is overloaded with displaced people, and our district hospital in Mardan is collapsing."

If you support the continued occupation of Iraq or Afghanistan, or the bombing of Pakistan, then you support WHAT WAR BRINGS: the destruction of health care.

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