Baghdad hospitals need urgent improvements, survey says

The situation in Baghdad's hospitals is critical, particularly in terms of unhygienic and unsafe working conditions, according to a recent survey by the US-based Medicine For Peace (MFP) NGO. The MFP reported that most hospitals were unclean and unhygienic and lacked an infection control programme. The sanitation system was practically non-existent and, according to the survey, as much as 60 percent of toilets were not working. The survey was carried out in 90 percent of the capital's hospitals and 60 percent nationwide. Infective materials could be seen in open boxes, easy for anyone to be in direct contact with them, the survey found. Potable water was rarely seen in hospitals, with most patient's families bringing water to them. Dr Youssef Abdul Kader of Yarmouk Hospital in Baghdad told IRIN that most hospitals in the capital were running low on ways to control the spread of infection and that a disease outbreak could happen at any time. He also complained that most health workers did not have gloves or masks to wear and had become part of the groups at risk. "After the last war the country became open for blood-transmitted diseases such as HIV and the lack of these essential materials for protection can bring unexpected diseases to medical staff. I bring gloves with me because the hospital cannot afford them," Kader added. According to the MFP study, all hospitals were suffering from a sporadic or persistent shortage of essential medicines and disposable supplies, including basics such as detergents, hand washing disinfectants, sterile needles and gloves, masks, antiseptics and soap. The survey added that clinical laboratories and radiology services in the majority of hospitals were unable to support demand, especially because of old and malfunctioning clinical laboratory and imaging equipment, as well as poor instructions on how to use it. Dr Michael Viola, who directed the MFP study, told IRIN that hospitals in Iraq were not nearly as good in terms of providing quality care as they were before the 1991 Gulf War. The hospitals struggled during the 1990s, mainly due to the sanctions implemented following Iraq's invasion of Kuwait and bad management by the Baathists, the report said. According to Viola, from 1999 hospitals went into a decline. The former regime stopped putting money into health care at that point. A key point in the report is that the "brain drain" of Iraqi physicians and academics during the 1990s, made worse by the recent violence, has had a devastating effect on the performance of hospitals in Baghdad. "Whether a similar problem exists all over Iraq is difficult to say. Since the Ministry of Health (MoH) has not instituted standards of care for all of Iraq, I would suspect the problem in this case is for all the country. In the past, health care was best in Baghdad," Viola added. A doctor from a public hospital in the capital, who preferred not to be named, told IRIN they had to use the same needles many times for more than three patients. "I know that it is something very wrong, but sometimes you want to save a life and you don't have any other choice," the doctor explained. Viola noted that there were three main needs of the health system in the country: leadership by the MoH to develop, implement and monitor an appropriate level of care in hospitals; education of physicians on best practices in terms of an infection control programmes; and resources for supplies, drugs, equipment and repair of facilities. MoH officials told IRIN that the health care system deteriorated during Saddam Hussein's regime and was compounded by looting during the 2003 conflict, but they had been working hard to repair it, which might take longer than expected. However, the MFP study team did note a number of improvements since the 2003 war, including an increase in the number of hospital staff and a 30-fold increase in salaries for doctors and nurses, as well as improvements in security in some areas, but that all these developments could be nullified by the poor and unsafe working conditions, it warned. Dr Viola added that urgent intervention was required by the government but that after two wars and years of UN sanctions, it was a good sign to see that at least hospitals were still operating in the country. "Improving security for hospital staff, particularly physicians, and instituting professional education programmes with the goal of upgrading the standard of care delivered in public hospitals is an important step that should be taken urgently by the government," Viola stressed.