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Special Report: Under sanctions, simple diseases turn deadly

The Hartford Courant
Basra, Iraq

The cranky ring of the old telephone startles Dr. Faris Abdul Abbas awake. He glances at his watch. It’s just past midnight, the dark beginning to a new day at Basra Maternity and Pediatrics Hospital.

The chief resident picks up the receiver. A 30-year-old woman has suffered a cervical tear during childbirth. Now she is in shock from loss of blood. Abbas is wanted in the delivery room.

He is preparing to leave his cramped office when the phone rings again. Four-year-old Nawris Khatan, a favorite of the hospital staff, has arrived at the trauma center in cardiac arrest. A cherubic little girl whose name is Arabic for “seagull,” Nawris is severely anemic. Her parents have been scouring the hospitals and blood banks of Iraq’s second-largest city for more than a week in search of blood for her monthly transfusion. They have had no success.

Woman and child both need type B-positive blood immediately.

Abbas dials the number for the hospital blood bank, but he is not hopeful. With plastic blood bags scarce under U.N. sanctions, the hospital canceled all elective surgery months ago. For all other procedures, blood -- when it’s available -- is rationed sparingly.

The hospital blood bank has just one unit of B-positive, barely enough for one patient. Abbas will decide who will live and who will die.

The 33-year-old pediatrician walks the darkened hallway to the trauma center. He will not tell Nawris’ young parents that he is giving the blood to the woman, an otherwise healthy mother of three. Instead, he tells them there is no blood, and asks them to pray with him. Fighting back tears, he begs God to spare the child until morning, when some might become available.

Back in his office, Abbas lays his head on his desk and cries. Dawn is still distant when Nawris dies.

“It is very difficult to work in these disaster conditions,” Abbas says softly, as another hot morning breaks over Basra. “This is just one instance. There are many, many instances like it all the time.”

The U.N. embargo has devastated all of life in Iraq. But nowhere is the deprivation more evident than in the once-modern health care system, where sanctions deny doctors the medicine and equipment they need to save patients dying of the curable diseases burgeoning amid the wreckage of war. U.N. officials estimate more than 1 million Iraqis have died in the last decade as a direct result of the sanctions.

The embargo is harvesting children. Before the Persian Gulf War, when food was plentiful and clean water readily available, the greatest pediatric health problem in Iraq was obesity. Now, with widespread food shortages and contaminated drinking water, undernourished children are stalked by cholera and typhoid. UNICEF blames the sanctions for the deaths of more than 500,000 Iraqi children under 5 since 1991.

Officials in the United States, the strongest supporter of the sanctions, blame the suffering on Iraqi President Saddam Hussein. They say Saddam can end the sanctions by allowing U.N. inspections to ensure Iraq is not developing nuclear, chemical or biological weapons.

But the embargo does not appear to be affecting Saddam or his friends, who have billions of dollars in hard currency, access to high-quality health care and a history of indifference to the suffering of the people. The regime stopped cooperating with weapons inspections in 1998. The United Nations withdrew its inspectors; the regime says they will not be allowed to return.

It is the people who are being punished. UNICEF says thousands are dying every month.

“This is unacceptable in medicine, to have patients die because of a shortage of drugs and supplies that are readily available everywhere else,” Abbas says. “It is a crime against humanity.”

Basra, wedged between Iran and Kuwait, bore the brunt of the gulf war. Now it is bearing the brunt of the embargo. Sanctions have kept the city from repairing sanitation facilities and power plants bombed during Operation Desert Storm. Now the canals that made this port the Venice of the Middle East bubble green with raw sewage. The public water supply is contaminated with human waste. Electricity flickers off for hours every day, leaving precious food and medicine to spoil in the desert heat. There are not enough trucks to haul away the garbage that rots in the streets.

Dysentery and gastroenteritis are epidemic. Chronic malnutrition leaves children more vulnerable to pneumonia, bronchitis and other infections. Polio and meningitis are making comebacks. Cholera and typhoid are thriving.

“Before 1991, these problems were out of our minds,” says Dr. Ali Faisal Jawad, president of Basra Maternity and Pediatrics Hospital. “We have had to go back to the textbooks to learn how we should treat them.”

Jawad’s 320-bed hospital, the largest children’s medical facility in southern Iraq, was among the best equipped in the country when it opened in 1986. It had CT scan and ultrasound machines, incubators to nurture premature babies and centrifuges to separate blood parts.

Over the years, much of the equipment has worn out, and spare parts are unavailable. The hospital’s emergency generator, in constant use since the gulf war, can power only the operating room and the trauma center. Without consistent electricity to run air conditioning or transfer systems in other parts of the hospital, windows are left open. Mothers brush flies from sick children lying two and three to a threadbare mattress on rusting iron beds. The halls reek of the gasoline with which orderlies clean the floors -- it is the cheapest solvent in this oil-rich, food-and-medicine-poor nation.

Doctors here, many of whom have studied in Britain or the United States, earn the equivalent of $4 a month. They share worn photocopies of decades-old textbooks. They have little access to current research and no access to the Internet.

Nurses earn less than doctors. Many have abandoned the profession, leaving mothers and grandmothers to care for their sick children, administering medicines and watching for changes.

The hospital needs scalpels and clamps for surgery, antibiotics for infections and cytotoxins for chemotherapy. There is not enough specialized formula to treat underweight babies. Syringes and surgical gloves are washed and reused.

“I do not think Americans would accept this for their children,” Jawad says. “What is the difference between a sick American child and a sick Iraqi child?”

Visitors entering the hospital must step over a crude graffito. “Down USA,” someone has painted in sickly yellow across the flagstones of the courtyard.

The mothers line up in the main hallway of the pediatrics wing, cradling their underweight children in the folds of their traditional black robes as they wait for the attention of Dr. Hussein Mohammed.

Marium Talib cries in dry rasps as she hangs limply across her mother’s arms. At 6 months, she weighs 10 pounds, little more than half her healthy weight. The skin around her eyes is brown and scaly; her arms and legs and belly are swollen. A needle protrudes from her head, the only place doctors could find a vein large enough to take nourishment.

Her mother, 21-year-old Sajida Naim, explains that the family lives in the al-Moufakia Flats, a notoriously squalid housing development that has no drinking water. The water the family draws from a neighborhood nearby is contaminated with sewage. Marium now suffers from gastroenteritis. Mohammed says the hospital is giving the baby medicine to clear up her diarrhea and protein to improve her weight, but he expects the problem to recur when she returns home and resumes drinking the water.

It may be too late to help Aleah Mohammed. The 1-year-old, who is no relation to her pediatrician, weighs less than 15 pounds and has stopped feeding. Weakened by gastroenteritis, she has developed a bronchitis that is not responding to the simple antibiotics Mohammed has prescribed.

The future is even bleaker for 11-month-old Abbas Abed al-Hussein. The brown skin of his face has turned a pale yellow, and his dark hair has taken on a reddish tint. His swollen arms and legs stick out from his body.

Abbas is one several babies at the hospital with kala azar, a disease transmitted by flies now flourishing because sanctions prevent Iraq from importing an effective insecticide. The hospital does not have the drug to treat kala azar or the separated blood parts to make treatment effective. Mohammed expects little Abbas to die within days.

“This is not a difficult disease,” he says. “But under sanctions, there is nothing we can do.”

Amid such conditions, more than one in eight children in southern and central Iraq dies before reaching his or her fifth birthday.

Before the gulf war, Iraq boasted a free public health care system that was among the most advanced in the Arab world.

“This was a well-developed system, a well-funded system, and there was a high level of skill among Iraqi specialists,” says Richard Garfield, a Columbia University epidemiologist who studies public health under sanctions. “It was never the healthiest place in the world, but medical care standards probably were not that far from Western Europe, which made it look less like a Third-World country.”

Under the embargo, Iraqi hospitals now are limited to the equipment, medicine and supplies that may be purchased through a U.N.-monitored oil-for-food exchange. The Security Council blocks orders that could also have military uses.

In 1989, the last full year before Iraq invaded Kuwait, the Ministry of Health spent $500 million on medicines and medical supplies for the nation’s public hospitals.

In the four years since the oil-for-food program began, the committee has allowed Iraq to import $980.4 million in health-related goods and is holding requests for $189 million more. The committee has held up orders for heart and lung machines, syringes and thermometers, ambulances and refrigerated trucks.

The United States, which leads the 15 council members in placing “holds” on contracts, has drawn criticism for undermining humanitarian aid to Iraq.

“The United Nations has always been on the side of the vulnerable and the weak, and has always sought to relieve suffering, yet here we are accused of causing suffering to an entire population,” U.N. Secretary-General Kofi Annan said during a Security Council session in March. “We are in danger of losing the argument, or the propaganda war -- if we haven’t already lost it -- about who is responsible for this situation in Iraq -- President Saddam Hussein or the United Nations.”

U.S. officials defend the holds as necessary to ensure that Iraq is not obtaining military equipment. They accuse the regime of hoarding medicine and equipment to increase the suffering of the people in order to gain support for lifting the sanctions without dismantling its weapons programs.

“There is enough food and enough medicine to care for and meet the needs of the Iraqi people,” National Security Council spokesman P.J. Crowley says. “It is a manipulation by Saddam, using the suffering of the Iraqi people that he could solve if he wanted to. ... We care more about the Iraqi people than he does.”

U.N. officials say they have not seen credible evidence that the regime is withholding humanitarian goods. They say an exodus of experienced managers and the deterioration of storage and transportation systems -- themselves effects of the sanctions -- sometimes slow distribution.

“I think the Iraqis want to be helpful and cooperative,” says Tun Myat, the U.N. coordinator for humanitarian aid to Iraq. “At the higher levels I have met with people who are clearly very sincere in saying that they want to be cooperative and collaborative and which they try to be within the limits of their own constraints.”

“The State Department has done a very good job at figuring out what images and sound bites will work to demonize the leaders of Iraq, but it doesn’t do very much justice to what’s actually happening,” says Garfield, the Columbia epidemiologist. “It may play in Peoria, but it doesn’t help fix the situation in Iraq.”

The large stainless-steel box in the morgue at Basra Maternity and Pediatrics Hospital is called a refrigerator, but without power, it keeps no cooler than room temperature, which has risen to more than 100 degrees. The stench of decay fills the dusty, tiled room.

Dr. Abed al-Kareem Hussein opens the doors and pulls out the trays. Cardboard boxes made to ship packets of cereal and rolls of aluminum foil now hold the bodies of babies.

This is where the hospital keeps the corpses of children whose parents are unable to pay the $3 required for burial. The hospital will keep each for a few weeks before burying them in a pauper’s field.

Hussein has counted 13 tiny corpses when an orderly arrives with another box. This one is marked “Tiffany Milk Biscuits.” Inside is the body of a newborn who died after delivery, the fourth death in the hospital today.

The cause? Hussein, who was not the attending physician, shrugs.


This story, the second part of a four-part series, first appeared in the Hartford Courant on Oct. 23. It is reprinted here with permission. The full series can be found at www.ctnow.com

National Catholic Reporter, November 10, 2000