Intended for healthcare professionals


Exodus of medical staff strains Iraq's health facilities

BMJ 2007; 334 doi: (Published 26 April 2007) Cite this as: BMJ 2007;334:865
  1. John Zarocostas
  1. Geneva

    The exodus of Iraqi doctors fleeing the escalating violence—including targeted threats, kidnappings, and murder of medical staff—is threatening the country's strained health infrastructure, say humanitarian relief experts.

    “Health facilities are stretched to the limit as they struggle to cope with daily emergencies caused by mass casualties,” said Angelo Gnaedinger, director general of the International Committee of the Red Cross (ICRC).

    Mr Gnaedinger told a recent conference in Geneva on the needs of refugees and internally displaced persons in Iraq and in neighbouring countries, “Patients and medical staff are threatened or targeted. As a result, medical personnel are fleeing the country in large numbers, leaving health facilities short of staff.”

    A report by the ICRC published this month on the situation of civilians in Iraq says, “According to the Iraqi Ministry of Health, more than half the doctors have left the country.”

    At the end of last year, 18 000 of the 34 000 doctors had left the country, according to reports confirmed by Iraq's Ministry of Health, say ICRC officials.

    The UN Refugee Agency (UNHCR) estimates that about 1.9 million Iraqis are displaced within the country, and that as many as two million have fled abroad—mainly to neighbouring countries, such as Syria and Jordan.

    A 2006 study by the Washington based Brookings Institution, cited by an International Federation of the Red Cross and Red Crescent Societies report on Iraq, estimated that 2000 doctors had been killed and 250 kidnapped.

    The Iraqi Red Crescent Society, which cooperates closely with the ICRC, has had 14 of its staff and volunteers killed and 45 abducted, 12 of whom remain unaccounted for, and has witnessed numerous attacks on its offices, warehouses, and convoys, says Mr Gnaedinger.

    But some senior UN officials say that the Brookings Institution estimate is rather conservative and that the numbers are probably much higher but difficult to quantify.

    Some WHO officials believe substantiation of the various estimates of the number of health professional who have left Iraq or been killed is difficult “because of the lack of accurate data.” They say that although the situation “remains grave,” the information available points to lower figures.

    The ICRC report says, “There have been frequent reports of armed men storming hospitals and forcing doctors to give their companions priority treatment at the expense of other more urgent need.”

    Road blocks and check points sometimes stop doctors and patients reaching healthcare centres in time, says the report, which adds that the insecurity “also hampers the distribution of medical supplies in many parts of Iraq.”

    Similarly, Ala Alwan, assistant director general at the World Health Organization, told the BMJ that in the past couple of years the health situation had deteriorated “particularly in relation to human resources, with a massive brain drain taking place.”

    Dr Alwan, a former education minister and health minister in Iraq in 2003-5, pointed out that many medical specialists had left and said, “Postgraduate training programmes in many specialties are currently seriously hampered because of lack of adequately qualified faculty staff.”

    Earlier, in a speech to the conference, Dr Alwan emphasised that large numbers of casualties “are impeding access to health care for a large sector of the Iraqi population. The health system is frequently overwhelmed by the large number of seriously injured [people].”

    He said that a substantial proportion of critically injured people—almost 70%—die in emergency departments because of shortages of medical staff, essential supplies, and equipment.

    The management of dead bodies was also “seriously hampered by capacity problems in hospital morgues,” Dr Alwan noted.

    Iraq “can't afford to lose its medical professionals,” said Andrew Harper, head of the UN Refugee Agency's Iraq support unit.

    To improve the situation, WHO has trained about 4000 health professionals in and outside the country, and, as of December 2006, had awarded 550 fellowships, said Dr Alwan.

    Despite the hardships, a WHO official said, the progress achieved in controlling communicable diseases such as cholera and malaria has been largely preserved, and Iraq is polio free for the sixth consecutive year.

    But the agency is concerned about the low coverage of routine immunisation, said Dr Alwan. The potential for outbreaks of diseases preventable by vaccination in childhood was rising, he said.

    “With access to health and other services increasingly limited, displaced children are far less likely to go to school and they are far less likely to be immunised,” cautioned Daniel Toole, Unicef's deputy executive director.

    On April 22 Iraq with the support of WHO, Unicef, and the European Commission, launched a two week immunisation drive to bring the measles, mumps, and rubella (MMR) combined vaccine to as many as 3.9 million Iraqi children aged between 1 and 5 years.


    • Civilians without Protection: the Ever-Worsening Humanitarian Crisis in Iraq is available at

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