Focus on maternal and infant healthcare in Baghdad

As paediatrician Tala al-Awqati stands in the middle of a hospital room of incubators filled with premature and low birth-weight babies, it’s obvious that she is passionate about her work. One baby is crying, surrounded by three nurses with plastic gloves checking his vital signs. But the other six babies are silent and peaceful in sealed plastic incubators in the children’s wing of the al-Jermuk hospital in the Mansour district of the Iraqi capital, Baghdad, unaware that they are the lucky few who are born in the hospital. Iraq has a high infant mortality rate, driven by the poor healthcare system and compounded by low water and sanitation standards in the country. “We’re doing our best with what we have,” al-Awqati said, after listening to some hurriedly whispered comments about the crying baby’s welfare. “The conditions here are good, relatively speaking, after more than 10 years of sanctions.” Along with food, medical equipment and drugs were brought into the country under the former UN Oil-For-Food Programme put in place to help a population suffering under international sanctions against former president Saddam Hussein. Recent reports, however, cite possible corruption, keeping some of the equipment from its intended use. After Baghdad fell to US-led coalition forces one year ago, infant mortality rose, according to NGOs working on health issues in Iraq and health officials, including Dr Naeema al-Gasseer, the World Health Organization (WHO) representative for Iraq who is currently based in Amman, Jordan. Other NGO workers who declined to be named, gave anecdotal evidence that because the health care system was in turmoil when the war ended, pregnant mothers who needed care often didn't seek it, or didn't get what they needed soon enough. A worker at one health-oriented NGO said people were often afraid to go to a hospital or a clinic if there were problems with a pregnancy because of the unstable situation in the streets. Many hospitals and clinics were looted last April as doctors and nurses struggled to deal with the unexpected violence. These recent events along with the sanctions paint a very grim picture of maternal and infant mortality rates in Iraq. According to a report by United Nations Population Fund released in November 2003, maternal deaths in Iraq had tripled since 1990 due to a crumbling health system. The study found that bleeding, ectopic pregnancies and prolonged labour were among the causes of the reported 310 deaths per 100,000 live births in 2002. This figure had risen from 117 deaths in 1989. Miscarriages had also risen, partly due to stress and exposure to chemical contaminants, the report said. While there are no current specific figures available, al-Gasseer pointed to health indicators compiled by the Iraq's Ministry of Health in 2002 as evidence that at-risk pregnancies and infant mortality were already reaching chronic levels. In 2002, almost 40 percent of pregnancies were described as "at-risk," with an infant mortality rate of 108 deaths for every 1,000 live births, she said. According to statistics recently compiled by the ministry and WHO workers, almost 300 out of every 100,000 pregnant women died in 2002 while giving birth. In addition, WHO and other health workers returned to their jobs soon after the war ended, but many fled outside of Iraq following an August truck bombing at the UN headquarters in Baghdad that killed 22 people. Al-Gasseer and many of her staff are "managing from exile," in Amman. "We have 100 WHO national staff working in Iraq on life-saving measures," al-Gasseer said. "They don't go to the main office, but they are working on things like preventing the spread of diseases and looking at the blood banks." Iraq had relatively low infant mortality rates in 1989, the latest comparison period for which statistics were available. At that time, about 40 babies died for every 1,000 live births, according to WHO statistics. These days, financial support, equipment and medical training is lacking, not only for women’s health care, but all health care in Iraq - especially in rural areas, al-Awqati said. "International organisations such as the WHO and the UNICEF are taking a special interest in women, from the Ministry of Health on down, but the support is not enough,” she said. No matter how much health workers focus on improving care for pregnant mothers, poor water and sanitation standards means more babies are born prematurely or have lower birth weights, said Ann Trenelone, a US administrative spokeswoman for the Ministry of Health. "That's why the infant mortality rate is so high," she said. Under the old regime, no one cared about poor populations in the country and pregnancies, Trenelone said. “The ministry is working on it. One thing we’re going to do is certify midwives, for example. But it can’t be fixed overnight,” she added. A maternal child health strategy workshop is being held at the end of April to establish how to best address the problems, al-Gasseer said. And several key Ministry of Health slots are now filled by women who have an understanding of some of the issues, al-Gasseer said, including a new director of HIV/AIDS and sexually transmitted diseases. In Baghdad, international agencies have set up breast-feeding clinics, a family planning clinic and a mammogram breast screening centre, said Ban Sami Basheer, who trained as a dentist, but works as an administrator at al-Jermuk hospital. In addition, families pay less than US $1 for visits to the doctor and medicine needed at the publicly funded hospital, she said. Those who can afford it however, go to private hospitals, said Dr Nasareen Farat, who trained in England and now works in a maternity hospital sponsored by the Iraqi Red Crescent Society about a mile away from al-Jermuk. Many women still go to midwives to deliver babies, both in urban and rural areas, because they’re afraid they’ll be charged a lot of money to come to the hospital, Farat said. “Before the birth, we don’t have proper care for women like you would in England, so the patient goes to the hospital if she has any problem, from a headache to bleeding,” she maintained. “Health education here is very bad.” And though Farat said she had heard there was plenty of medicine flowing into the country, there’s a major shortage of basic medicines needed in the hospitals. In addition, a colleague said there weren’t enough doctors in Baghdad, pointing to the line forming at the door as she stopped her work to talk to a reporter. Probably 50-60 patients per day come to the hospital to give birth, said gynaecologist Annal Shaker, with up to 12 per day needing a Caesarean birth. “This hospital is well-known because it has good services," she told IRIN. "But this is the question now - where did our money for health care go before under Saddam Hussein?” she asked. “We want our hospital to have up-to-date equipment.”