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Irak - Rapport om sundhed
IRAQ: Briefing paper on health
IRINnews.org, 18. maj 2004
Helt op gennem 1980'erne var Irak kendt for at have et af Mellemøstens bedste sundhedssystemer. I 1991 fandtes omkring 1800 sundhedscentre, men blot 10 år senere var antallet halveret. I 2003 blev det vurderet at omkring en trediedel af alle børn i det centrale og sydlige Irak var fejlernæret, fødselsvægten var faldende og børnedødeligheden stigende.
After having one of the best health care systems in the region in the 1980s, Iraq's health care has deteriorated substantially in recent years owing to economic sanctions and war. In 1991, Iraq had 1,800 primary health centres, according to the UN children's agency UNICEF.
A decade later that number had fallen to 929, of which a third require serious rehabilitation, one of the most pressing needs to date. The country's fall on the United Nations Development Programme's (UNDP) Human Development Index from 96 to 127 reflects one of the most rapid declines in human welfare in recent history.
By 2003, almost a third of the children in southern and central Iraq were malnourished. Low birth weight is a particular problem, as are diarrhoea and acute respiratory infections. An estimated one in eight children dies before his or her fifth birthday, according to the World Health Organisation (WHO).
The three biggest child killers in Iraq are acute respiratory infection, diarrhoeal diseases and measles. Almost half of the country's 24.5 million people are children, and their future depends on a massive and rapid improvement in the country's health and infrastructure.
In a recent report by the NGO, Medical Aid for the Third World, the medical infrastructure was deemed outdated with patients not able to receive optimal treatment. "Everything is lacking, including medicines for acute as well as chronic ailments," the report said.
UNICEF has spent more than US $17 million on emergency health projects in the last year, focusing on distributing special health kits to reduce the impact of diarrhoea. UNICEF and the US Agency for International Development (USAID) also bought 30 million vaccination kits and immunised three million children under five in the last year.
However, the situation could rapidly improve if oil revenues over the next year are directed to boosting health care. In addition, the 2004 budget for health care is now $950 million ($40 per person), compared to $16 million (less than 75 cents per person) in 2002.
For the whole country, the WHO estimates that $20 million per month is all that is needed to keep the health system functioning. Without this small initial investment, much more will be needed to repair the damage that will inevitably result. In the aftermath of the war that toppled Saddam Hussein, many hospitals and clinics were looted, leaving thousands without access to adequate medical care, while medicine is also reported to be in short supply.
According to WHO statistics, the infant mortality rate in Iraq is 108 per 1,000 live births, the under-five mortality rate is 28 per 1,000, and maternal mortality is 294 per 100,000. This data is very telling when compared to neighbouring countries such as Syria. Its infant mortality rate is 23 per 1,000, the under-five mortality rate is 28 per 1,000 and the maternal mortality ratio is 110 per 110,000 (source, UNDP Human Development Report published in 2003).
Some 4,000 health workers and 124 supervisors were trained over the past six months to help continue the immunisation campaign. Some $1.8 million in small grants will be given by USAID to Iraqi aid agencies to undertake health care projects this year.
The national polio laboratory was repaired this year with funds from USAID. About $5 million in laboratory equipment and supplies re-established the Central Public Health lab in Baghdad, the National Centre of Drug Control and Research, and the Nutritional Research Institute. High-protein biscuits were given to more than 240,000 pregnant and nursing mothers and malnourished children by World Food Programme (WFP) workers in a monthly distribution project.
A national health conference held in Basra brought together 150 health professionals from across the country earlier this year to discuss how to reform medical education and how to create a medical coverage and distribution plan. USAID repaired the sanitation system at the al-Majar
al-Kabir medical facility near the border with Iran, which serves about 800 outpatients every day along with 70 inpatients. However, the imminent fear is that with the summer months approaching and continuing electricity cuts, poor water and sanitation, there could be an increase in communicable diseases, according to WHO.
A joint UNICEF-Ministry of Health survey in 2001 concluded that Iraq's mortality rate for the under fives had increased since 1991 by more than 150 per cent to 56 per 1,000 live births. In the north, the figure was half that. And with 466 primary health centres for a population of 3.5 million, according to WHO, northern Iraq is better provided than the rest of the country - 1.3 per 10,000 inhabitants compared to 0.5 for the country as a whole. By comparison, Iran and Jordan in 2002 had 3.6 and 2.4 PHC units per 10,000 inhabitants respectively.
Across the country, teams funded by USAID repaired 49 hospitals and clinics. Another 131 will be repaired this year. Medical supply kits holding basic clinical supplies are also being distributed to 600 clinics. The Ministry of Health also spent $40 million to purchase 128 generators and repair another 10.
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