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Iraqi doctors return to work, but patients still face acute shortages of drugs

BMJ 2003; 326 doi: (Published 03 May 2003) Cite this as: BMJ 2003;326:952
  1. Owen Dyer
  1. London

    A week of steady improvement in Iraq's humanitarian situation has seen doctors returning to work across the country and the partial restoration of electricity and water supplies in many areas. WHO has warned, however, that patients with chronic diseases face acute shortages of medicines, and many hospitals are providing emergency care only.

    WHO said that a survey of Iraq's health infrastructure showed that there were 1447 medical facilities throughout the country, including 160 hospitals, of which 33 are in Baghdad, and 1285 health centres. There are more than 26 000 hospital beds, which the WHO considers adequate for the population.

    Rather than sending field hospitals, WHO said, donor countries should help fund Iraq's existing hospitals. Praising the efforts of Iraqi medical staff to stay at work despite danger and a lack of pay and equipment, WHO said a time would nevertheless come when staff who had to support their families would be forced to look elsewhere for work. The organisation asked for a minimum of $3000 (£1900; €2700) to $5000 a month for each of Baghdad's hospitals.

    The International Committee of the Red Cross said the functional capacity of hospitals fell into three categories: a few hospitals whose staff had devised coping mechanisms allowing them to work, but at reduced capacity;, hospitals providing only emergency care (most hospitals); and “quite a number” of hospitals not functioning at all.

    Some of the medical equipment looted from Baghdad's hospitals was returned over the weekend, mostly through the intervention of mosques and religious leaders. But stocks of all drugs remain low, and it is reported that antibiotics are being given in half doses, increasing the dangers of resistance. The major Yarmouk Hospital in Baghdad ran out of insulin last Thursday, prompting the WHO office in Jordan to send 600 vials by taxi.

    Hospitals continue to take in wounded patients, despite the apparent cessation of hostilities. Cluster bombs, mines, and other unexploded ordnance claim new casualties every day. An explosion at an ammunition dump in Baghdad recently killed six and wounded at least 50 people. The main hospital in Kirkuk, in northern Iraq, reported 52 people killed and 63 injured by landmines and unexploded ordnance in just one week. Most were children.

    British soldiers returning from the Gulf will be offered urine tests for depleted uranium, after the Royal Society rejected defence secretary Geoff Hoon's assurances that depleted uranium posed no risk. The Ministry of Defence also said it would publish details of where uranium munitions had been used. The Pentagon has yet to make a similar offer, although the Ministry of Defence said that it was hopeful that the United States would follow Britain's example.

    Brian Spratt, chairman of the Royal Society's working group on depleted uranium, said: “The soil around the impact sites of depleted uranium penetrators may be heavily contaminated and could be harmful if swallowed by children, for example. In addition, large numbers of corroding depleted uranium penetrators embedded in the ground might pose a long term threat if the uranium leaches into water supplies.”

    No plans have been announced to test Iraqi civilians for exposure to depleted uranium. Most estimates of its use in this war range from 1000 tonnes to 2000 tonnes, compared with about 350 tonnes in the last Gulf war.

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