NOTE: This is a guest post from Matt Willingham, Press Secretary for the Preemptive Love Coalition.
Last week I went to a local teahouse here in Iraq with a local friend, and the conversation inevitably turned to politics: “If we could just fix the healthcare system!” my friend hissed from across the table. “Then maybe the hospitals would be better and people could be healthy.”
“Fixing the system,” “improving quality of life,” and “healthy children” are hot topics around here, and not just among my aid/development worker friends. Iraq’s healthcare system was once envied by much of the Middle East, and families from all over came to Iraq for medical treatment.
Unfortunately, the opposite is now true. Iraq has fallen far, and the people here know it and discuss it often. Also unfortunately, despite these conversations being well-intentioned (because we all want people to be healthy, right?) much of the talk is focused on symptoms rather than root causes–fish handouts rather than fishing lessons.
As development workers living in a place like Iraq, my team has seen plenty of people come to help, and we’ve seen most of them leave. And I believe one reason they don’t last is because they never really answered this question: how did medical care here get so bad?
Again, they focused on easing symptoms rather than doing the difficult work of getting to the root of the problem.
And that’s exactly why so many didn’t last: the real, root reasons for these problems are incredibly complex, difficult to talk about, and, to be frank, dealing with symptoms is easier and sexier than talking about a problem’s ugly and confusing root-underbelly.
So, using Iraq’s recent history as a case study, here are 3 ways to obliterate a nation’s healthcare system:
1. Cripple a country’s ability to operate politically and economically.
In 1990, the United Nations passed Resolution 661, which placed economically violent restrictions on Iraq’s ability to trade with members of the UN. The resolution was originally passed to “limit the aggressors” in Iraq (read: Saddam Hussein’s government), but ultimately led to widespread poverty and malnutrition among Iraqis.
Because Iraq’s economy is so dependent on foreign imports and exports, the limitation of trade by the UN caused the economy to crash. In 1989, annual income per household was $3,510 and by 1996 had fallen to less than $500.
Before sanctions, 93% of the population had ready access to healthcare institutions that were staffed primarily by Iraqi physicians who had been trained in Europe or the United States. After Resolution 661 passed, the Iraqi government was unable to sustain this level of healthcare for its citizens nor were they able to keep hospitals adequately supplied.
These sanctions, and the economic collapse they caused, primed the country for the health crisis it is in today.
In 2006, at the height of the sectarian conflict in Iraq, insurgents directed their attacks against medical professionals, ambulances, and hospitals. They stole medical supplies, necessary to treat the populace, or forced the staff to treat wounded comrades or family members.
The number of professionals was further reduced as doctors and nurses began fleeing the country in order to escape kidnapping or death. Today, many of America’s best doctors are Iraqis who once lived in Baghdad, and without their mentorship, expertise, and knowledge, generations of students from Iraqi universities and teaching hospitals will continue to receive inadequate educations.
3. Overburden the healthcare system by creating too many patients.
Decades of strife left many water and sewage treatment plants demolished, causing illness-rates to soar. In 1989, there were no cases of cholera per 100,000 people; just 5 years later there were 1,344 cases per 100,000 people.
Saddam Hussein’s destructive efforts during the Iran-Iraq war were no less devastating. Gene-mutating mustard gas was used on the opposing soldiers, and innocent bystanders were also exposed. The damage caused then spread to the next generation of Iraqi children.
In subsequent wars, American munitions tipped with depleted uranium contaminated the environment (and, inevitably, the people as well) causing untold damage to the parents and their children. Doctors in Fallujah are reporting 1 our of every 10 children born at Fallujah General Hospital are born with a birth defect–that’s more than ten times the global average!
In areas where these munitions were used, reports also indicate a 400% increase in birth defects, and hospitals are encountering certain rare defects that were previously unheard of in Iraq. All told, these factors left Iraq with a growing backlog of sick people and, as we’ve seen, hospitals that are largely incapable of treating them.
If youʼre feeling overwhelmed, that’s normal. These are 3 enormous problems, and they’re just the tip of the iceberg! But that doesn’t mean we can’t do our part to help “fix the healthcare system.” It does mean, however, that we have to approach Iraq’s medical infrastructure with humility and a desire to effect root causes rather than symptoms.
What did I miss? What else do you think led to Iraq’s current healthcare crisis? Leave your comments below!
Photos courtesy of Lydia Bullock, Matt Willingham, and Kendelyn Ouellette.