Suffer the Children

Child mortality in Iraq has spiralled because of the tense security situation, deteriorating health services and lack of medical supplies, say experts.



According to a report released in May 2007 by aid agency Save the Children, “Iraq’s child mortality rate has increased by a staggering 150 per cent since 1990, more than any other country.”



The report, entitled State of the World’s Mothers 2007, said that some 122,000 Iraqi children - the equivalent of one in eight - died in 2005, before reaching their fifth birthday. More than half of the deaths were among newborn babies in their first month of life.



“Even before the latest war, Iraqi mothers and children were facing a grave humanitarian crisis caused by years of repression, conflict and external sanctions,” said the report.



“Since 2003, electricity shortages, insufficient clean water, deteriorating health services and soaring inflation have worsened already difficult living conditions.”



The study listed pneumonia and diarrhoea as major killers of children in Iraq, together accounting for over 30 per cent of child deaths.



“Conservative estimates place increases in infant mortality following the 2003 invasion of Iraq at 37 per cent,” it said.



In the capital of Baghdad, there are four paediatric hospitals and three gynaecological hospitals, as well as individual children’s wards in other medical institutions.



The city’s central paediatric hospital is in the capital’s Islam neighbourhood - a volatile area which is hard for families and medical staff to reach.



The hospitals fall short in providing quality care because they do not have enough medical supplies or staff - who, in many cases, have fled to other countries.



Experts draw parallels between the dire state of Iraq’s health care system today and the way it was when the country was under sanctions during the 1990s, when there was a similar limited supply of drugs and other medical resources.



The UN Security Council imposed economic sanctions against Iraq in 1990, following the Iraqi invasion of Kuwait and these continued until 2003.



In 2000, the UN children’s agency UNICEF published a survey which showed the mortality rate among Iraqi children under five had more than doubled in the government-controlled south and centre of Iraq during the sanctions.



At the time, Anupama Rao Singh, a senior UNICEF official, said in an interview with Reuters that around half a million children under the age of five had died in Iraq since the international embargo was imposed.



“In absolute terms, we estimate that perhaps about half a million children under five years of age have died, who ordinarily would not have died had the decline in mortality that was prevalent over the 70s and the 80s continued through the 90s,” she said.



Mohammed Zahraw, a paediatrician with the ministry of health’s inspector-general’s office, said that similar threats to children’s health exist today – and that these are compounded by the lack of security which now prevails in Iraq.



"In the past [infant deaths] were caused by the economic sanctions and the lack of medicine and medical supplies. The same problem exists now, in addition to the deteriorating security situation. This is particularly true in Baghdad, where it’s difficult to access hospitals," he said.



Fahima Salman, the head of the inspector-general’s monitoring force, said the primary reason for high infant mortality in Iraq is a lack of drugs and medical supplies.



The inspector-general’s office at the health ministry is tasked with inspecting hospitals and reports back to the ministry on the sanitation, performances and needs of health facilities.



Salman said that poor security and a lack of transport meant that it was hard to transfer drugs and supplies to hospitals and clinics. This means that families of patients usually buy basic medicine, such as antibiotics and hydrocortisone, on the black market and bring the medicine to the hospital or clinic.



"We, as the inspector general's office, visit health facilities to determine the level of shortages and note the difficulties,” said Salman. “We try to provide what we can…but we still face major challenges."



Sometimes, drug deliveries fail to reach the ministry of health’s warehouses, and go missing en route.



Amal Abdul-Amir, a paediatrician at the Yarmook Teaching Hospital in Baghdad’s Karkh area, said that infants were also dying because paediatricians and gynaecologists had fled the country in droves, resulting in a lack of skilled staff.



“People are turning to midwives who do not necessarily have experience with births or emergency cases,” she explained. “This is causing the number of infant mortalities to rise."



In hospitals throughout the country, it is not uncommon to hear the wails of grieving mothers, such as 30-year-old Zaineb Mohammed, whose two-month-old baby died after she failed to get him to hospital in time.



She told IWPR that en route to the hospital in the impoverished Baghdad suburb of Sadr City, her family was repeatedly stopped at roadblocks and checkpoints erected to combat security problems there.



The delays caused the child’s condition to worsen and when they finally arrived there weren’t paediatric specialists to treat her.



Mohammed has vowed not to have another child. "I don’t think that I can bear to lose another baby to the poor health and public services in Iraq," she said.



Hind al-Safar is an IWPR contributor in Baghdad.