Health services overwhelmed in northern Iraq

Abstract

Iraq's health services are struggling to meet the needs of millions of Syrian refugees and internally displaced Iraqis in the north of the country. Sharmila Devi reports. Northern Iraq is facing its worst humanitarian and health crisis of recent years as the needs of refugees and internally displaced people overwhelm medical supplies and personnel, said Jaffar Hussain, WHO's representative to Iraq. “This is the worst I've seen in terms of the scale and magnitude in my 4 years here”, Hussain told The Lancet from Dohuk, Iraqi Kurdistan. “There are between 1·2 million to 1·4 million internally displaced people mostly in the Kurdistan region. We are trying to deliver more resources into existing health-care clinics, secondary hospitals, the surveillance system, pharmaceutical procurement, and increase the number of doctors and nurses so they can see patients into the evenings.” Tens of thousands of minority Yazidis, Christians, and other Iraqis have fled their homes since June when armed insurgents of the Islamic State (IS) swept across northern Iraq, pushing back Kurdish forces. Ongoing US air strikes seemed to have halted the advance of the IS but western military involvement beyond aid drops and military supplies appeared unlikely and fighters of Iraq's semi-autonomous Kurdish region were struggling to push back the IS. Although the crisis on Sinjar mountain, where tens of thousands of men, women, and children had sought safety, seemed to have abated with most of the people leaving the rocky terrain, many overall health needs remained, said Hussain. A great number of surgical procedures needed to be done because of injuries caused by the ongoing war. Also of particular concern was providing health-care access to small groups of people who had scattered across the region in search of safety. “There might be 30 families in a park, 50 in a school, ten under a bridge, or 100 in a still under-construction apartment building”, said Hussain. “It's very difficult for them to access health care.” Ten mobile medical teams—each consisting of a doctor, a nurse, a pharmacist assistant, and a driver—were being supported by WHO in Dohuk to provide curative and preventive treatment. “The team can provide medicine and papers if they need follow-up treatment a few days later”, said Hussain. “If hospital treatment is needed, for example 1 or 2 days in hospital to stabilise hypertension, the mobile clinic can arrange admission.” Medical and pharmaceutical procurement, usually done centrally by the federal government in Baghdad, was another challenge and WHO was working with international and local suppliers to ensure a stable supply chain. The current crisis has exacerbated long-standing problems. Political wrangling in Baghdad has meant that no general budget has been passed for this year although in theory the oil-rich country should be able to cover its costs. Conflict and war has also led to the physical degradation of health infrastructure. WHO has been working to strengthen the surveillance and early warning system and had 500 sentinel reporting sites across the region. “If cases of diarrhoea, fever, hepatitis, measles, etc go beyond a normal range, it triggers a response”, said Hussain. “So far, with the grace of God, we've had no epidemics.” Together with UNICEF and the Iraqi Ministry of Health, WHO had just concluded a 4-day polio vaccination campaign. “We vaccinated 4 million children across 12 [of 19] governorates in Iraq and included Syrian refugee children. This will be repeated next month and every month until December.” Around 250 000 Iraqi children and 125 000 Syrian children have taken refuge in the Kurdistan region. Polio was discovered in October, 2013, in Syria and it spread to Iraq in March. One of the two Iraqi children found to have polio was confirmed to have been paralysed by the disease in April and hundreds of other Iraqi children are believed to have been exposed. WHO and other agencies are working on a detailed assessment of their monetary and supply needs that is expected to be completed by the end of September when donor countries and Baghdad would be informed. Saudi Arabia recently donated US$500 million out of which WHO received $50 million. “This is enough only for the next 3–4 months”, said Hussain. “The conflict is ongoing and we see the situation going beyond 2015. We estimate that to deal with this crisis for a year, we will need a total of $150 million, meaning an extra $100 million has to be found.” “The needs are enormous given the sheer size of the crisis. In these conditions, people are vulnerable to acute viral and bacterial diseases and we need a lot of resources.”