International Community Works to Rebuild Iraqi Health System
By Kathleen T. Rhem
American Forces Press Service
WASHINGTON, Aug. 11, 2004 When the United States and international aid organizations began to look closely at Iraq's health-care network, they found a system in ruins after decades of neglect and misuse, the man now responsible for that health-care system said here today.
Dr. Alaadin Alwan, health minister for Iraq's interim government, explained that in the 1970s and '80s, Iraq's health care was among the best in the Middle East, then went into a rapid decline.
"Following more than two decades of major wars, disastrous military adventures and irrational policies, the health system went into a steady decline driven by a combination of negligence, poor management, severe lack of resources and more than 12 years of sanctions," he said, during a symposium at the U.S. National Academies' Keck Center.
"The result is an almost collapse of the health system, with health indicators becoming one of the worst in the region, in less than 10 years," said Alwan, who is a Baghdad native and has held several high-level positions with the World Health Organization.
"Health care was used as a tool to manipulate the will of the Iraqi people by the ruling party. Basic medical needs went unmet," Dr. William Winkenwerder, assistant secretary of defense for health affairs, said at the symposium. "The physical medical infrastructure was crumbling from years of neglect. Medical equipment was inoperative, outdated by any modern standard. Distribution of needed drugs was wracked by corruption and inefficiency."
Of particular concern, Alwan said, were the mortality rate for mothers, infants and children, which tripled between 1990 and 2000, and the deteriorating physical infrastructure of primary health centers and hospitals "to the degree that they are now incapable of delivering basic health services of acceptable standards."
Today, improving health care for the Iraqi people is a major goal of the United States and several international organizations. "There is no doubt that security, transition to democracy, and economic recovery emerge today as crucial challenges," Alwan said. "But we cannot make any long-lasting progress in meeting these challenges without addressing health and education, the two major prerequisites to sustainable development."
Winkenwerder said the need for quality health care is universal. "The international health community is committed to improving the health-care situation of those in need, regardless of national interests," he said. "Improving health care transcends geopolitical borders; it really is a powerful force for bringing people together to do good things and for common goals."
Winkenwerder, DoD's top health expert and the man tasked to jump-start the reconstruction process for Iraq's health-care system, explained the process through which experts have been working to resolve some of Iraq's medical woes.
In June 2003, Winkenwerder sent a team of health experts from across disciplines and across agencies to Iraq to assist the country's fledgling health ministry. Jim Haveman, a former director of Michigan's Health Department, led the team of 30 to 35 experts from across the Defense Department, U.S. Agency for International Development and the Department of Health and Human Services.
An immediate priority was to ensure there was no pending public-health disaster following the fighting there. "They found that the stabilization efforts that were under way at that time, led by the U.S. and coalition forces and the international community and the nongovernmental agencies around the world had stabilized the situation," Winkenwerder said.
He offered high praise for the dedication of the Iraqi doctors and other health-care professionals who were working under arduous conditions. "What our team found when they arrived in Baghdad was a proud and strong Iraq health-care community absolutely dedicated to improving their situation for their people," Winkenwerder said. "It was evident that those serving in the Ministry of Health as well as Iraqi doctors and hospital staff were steadfast in this commitment, at many times serving at great personal peril."
After addressing immediate concerns, the international team set out to assess needs and plan long-term solutions. "Using the intellectual power of this group, (they) assisted the Iraq minister of health in setting the strategic course for Iraq's future," Winkenwerder said. "A strategic plan was developed. The organization was aligned for improved governance, which was an issue, and attention to strengthening the areas of preventive medicine, community health and maternal-child care."
Winkenwerder's staff in Washington worked closely with the U.S. Agency for International Development and other international organizations to ensure the team in Baghdad was getting all the support it needed.
Today, significant planning for rebuilding Iraq's medical system has been accomplished. "For Iraq, this is a new beginning, a rebirth if you will," Winkenwerder said. "The people of Iraq are now able to choose their future without the yoke of a brutal dictatorship but with the knowledge that wise and responsible decisions need to be made on behalf of all of the people of Iraq."