Iraq's Shortage of Medicine May Worsen

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Posted by Lilly from ? ( on Thursday, December 19, 2002 at 12:17PM :

December 19, 2002
Washington Post

Iraq's Shortage of Medicine May Grow More Severe
U.S. Proposal to Tighten Sanctions Would Restrict Antibiotics, Other Goods With Potential Military Use

by Peter Baker

BAGHDAD, Iraq -- The infant lay sleeping on a bed, an intravenous tube disappearing beneath the worn gray blanket as her mother dabbed at tiny bubbles around the baby's mouth.
The mother, Saadiya Saif, had rushed to the hospital with her 40-day-old daughter, Zahraa, because of the baby's cough and fever. Doctors diagnosed a chest infection. As they do nearly every day for some patient, they prescribed the antibiotic ciprofloxacin. Within a few days, the doctors said soon after she was admitted Tuesday morning, Zahraa should be well enough to go home, where she will continue to take ciprofloxacin in syrup form.

But antibiotics such as ciprofloxacin, commonly known by its brand name Cipro, may soon become harder to obtain here under a new U.S. proposal to tighten international sanctions on Iraq. Because ciprofloxacin can be used to counter anthrax exposure, the U.S. government wants to keep President Saddam Hussein's government from stockpiling it, fearing such a supply would make it easier for him to launch a biological attack while protecting his own troops.

Similarly, doctors at the Saddam Teaching Hospital for Pediatrics here use gentamicin to treat urinary tract infections, doxycycline to help those with cholera or diarrhea, and streptomycin in cases of tuberculosis. All three would be added to the list of restricted items if the U.N. Security Council agrees to the U.S. proposal.

"We're a developing country and infections are common diseases here, not like in Europe or the United States, so antibiotics are vital," said Mohammed Hassan, the 28-year-old chief resident presiding over wards of children at the pediatrics hospital. "There's no thinking of humanity, there's no thinking about the patients in our hospital."

Around Baghdad, word of the possible new restrictions has drawn a mixture of outrage and resignation. Few really question adding high-tech navigation systems, missile testing equipment, radio intercept devices, night-vision technology and communications jammers to the U.N. list. And many shrugged at the idea of more shortages of everyday items. After more than a decade of privation, many Iraqis have adopted a weary acceptance of reality.

Others, though, saw the effort to impose new restrictions as more evidence of American hostility. At the Mishin complex in south Baghdad, a rollicking bazaar where automotive parts are sold, Hisham Ali bristled at the idea that the large tires he sells might be restricted.

"This is oppression," he exclaimed. "They're trying to affect my living. They're trying to destroy the whole economy."

"Why do they focus on tires?" asked Jasim Sadiq, 35, a farmer who was buying some tires. "Do they think they're weapons?"

U.S. officials put certain large tires on the list because of concern they could be used for military equipment. Yet Mohammed Fadhil needs them for his truck, so he can bring potatoes to the city. After each harvest, he loads 16 tons of potatoes and makes the journey to Baghdad, turning around to do it again a half-dozen times. In preparation for the January harvest, Fadhil, 40, spent his afternoon roaming through the market looking for new tires imported from such places as Turkey, China and India.

The sanctions have long embittered Iraqis, who consider them a chokehold on their lives. But now, at a moment of confrontation with the United States, the proposed changes strike many as even more punitive.

Beyond the antibiotics and tires are a host of other products that would be restricted, including atropine, organophosphate pesticides, activated charcoal, large hydraulic lifts, meteorological equipment, satellite dishes, full-motion flight simulators and even speedboats. U.S. officials came up with the 36 categories of items in their proposal this month after concluding that Hussein's government has been exploiting the U.N. oil-for-food humanitarian program to buy products with the ability to enhance his military power.

Over the last five years, for instance, Iraq has imported more than 3.5 million vials of the drug atropine, which can be used to treat cardiac arrest, but also is an antidote for nerve agents. With his own army inoculated, Hussein might be less inhibited in unleashing chemical weapons on enemy troops, U.S. officials fear.

If the 36 items are added to the restricted list, they would not necessarily be banned for import. But the United States would be able to block them on a case-by-case basis, or at least impose a monitoring system before they are approved. Negotiations on the U.S. proposal are supposed to be wrapped up by the end of the month, but Russian and French diplomats have raised objections.

As a practical matter, the most modern and effective medicines already are hard to come by here, even some of those used to treat routine illness. At the Hanoudi Pharmacy on Yasser Arafat Street, most shelves long ago were emptied of drugs and stocked instead with shampoo, toothpaste, shaving cream and deodorant. On back shelves that still contain medicines, some bottles date to 1980 or earlier, according to the owner, J. Hanoudi.

"If you go to a drug store in America, you see everything available. Here we have nothing," said Hanoudi, 60, the image of an old-time pharmacist with dwindling gray hair and a red sweater who has been behind the counter here since 1969. "Every day, every time, we can't help people. What can we do?"

Even without the new restrictions, Hanoudi said he cannot get atropine or inhalers for asthmatics or insulin for diabetics. What he can get, he said, he cannot get enough of. "If I need 1,000, there is 10," he said.

Just then, a man walked in and asked for capsules with fusidic acid to treat a bacterial infection.

"I haven't got it," Hanoudi said.

"Could you get it for me?" the man asked.

"I can't. It hasn't been available for a long time."

The Ministry of Health disburses medicines to hospitals and pharmacies each month depending on what it receives through the U.N. program.

In November, Shatha Edward Harak, another pharmacist, received a two-month allotment of 300 packages of acetaminophen, 200 vials of ampicillin, 30 iron injections for those with anemia, 14 vials of procaine penicillin, 12 doses of thiamine and two packages of the laxative Sennalax. She got 24 packages of ciprofloxacin from Syria and eight from India, and sells them for as little as 10 cents, depending on the dose.

Harak said supplies are somewhat more available than they were in the years immediately after the Persian Gulf War, before the U.N. Security Council revised the sanctions program to allow more humanitarian goods into Iraq.

The U.N. Children's Fund, or UNICEF, reported recently, for instance, that the child malnutrition rate fell from 32 percent in 1996 to 23 percent this year. But Carel de Rooy, the UNICEF director for Iraq who announced the improvement, also noted that the numbers mean nearly 1 million Iraqi children still suffer from chronic malnutrition.

The Iraqi government has said 1.7 million children have died from disease, lack of food or other causes linked to the U.N. sanctions, which were imposed after Hussein's troops invaded and occupied Kuwait in August 1990. Western health specialists have contested that figure, putting the number closer to 500,000.

Whatever the count, the notion of further restrictions on ciprofloxacin and other inexpensive, commonly used antibiotics has left Harak and her customers baffled. "Is this for rockets or bombs?" said Mohammed Ibrahim, a 39-year-old driver who came by for some ciprofloxacin to recover from bronchitis. "I just want to take my medicine to get well. I just want to breathe."

Harak picked up the theme. "This is not for war. This is for people to live. Let the people live."

2002 The Washington Post Company

-- Lilly
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