LoomingWarCripplesNOTonlyKurdish HealthCare

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Posted by andreas from dtm2-t7-1.mcbone.net ( on Saturday, January 04, 2003 at 3:14AM :

Looming War Cripples NOT ONLY Kurdish Health Care ...

but also Assyrian-Chaldean-Syriac, I suppose ...

Any confirmation or actual reports?

Thank you in advance.




January 3, 2003

A Doctors' Dilemma Hits Kurdish Patients


RBIL, Iraq, Dec. 30 The surgeon looked at a radiologist's images of the tumor in Mustafa Othman's brain. He spoke gently, telling the patient that only one thing could be done.

The tumor was treatable, he said, just not in the Kurdish-controlled regions of northern Iraq. Mr. Othman, 70, would have to travel to Baghdad to find a specialist. But with war perhaps looming, it is a trip the old man is unwilling to make. He does not want to be bedridden in the Iraqi capital if bombs begin to fall.

"Now is not a good day to go," Mr. Othman said.

Throughout northern Iraq, doctors and patients are confronting shortages and difficult choices in a health care system they worry might soon collapse.

After years of struggle and sanctions, hospitals are short of equipment, drugs, training, staff and supplies. The possibility of war makes matters worse. If war comes, doctors say, this strained system, responsible for roughly four million people living in Iraqi Kurdistan, as the de facto independent part of Iraq calls itself, will be overwhelmed.

"The situation is unpredictable," said Dr. Jamal Abdulhameed, health minister in the western half of the autonomous region. "But we are expecting a disaster."

Signs of hard choices abound.

Some are individual, like Mr. Othman's decision to delay treating the tumor growing in his brain. Others are institutional, a mix of policies or shortages that restrict medical care. Since mid-December in Erbil, for example, government hospitals have been cutting back on surgery and X-rays, denying nonemergency procedures to patients in hopes of preserving medical supplies for war.

It is a triage in anticipation of a triage, driven by shortages taking almost every form: blood bags, catheters, X-ray film, sutures, antibiotics, anesthesia and reagent kits, which are used to determine blood types to ensure safe transfusions.

Ambulances in northern Iraq, themselves an uncommon sight, carry little more than gurneys, and have no first-aid kits on board. Only a few have oxygen bottles.

On Dec. 24, the blood bank in Sulaimaniya had 65 pints of blood for more than one million people enough to handle victims of road accidents on a normal day. The shortage of reagents means there is little chance that a rush of donors would produce stores of useful blood.

"As a surgeon I cannot say this more clearly," said Dr. Giorgio Francia, a manager for Relief International, a Los Angeles-based health aid organization that is assessing the region's medical needs. "If someone goes to a hospital, and he needs a transfusion and they do not have reagent, he will die. Period."

There is also a shortage of specialists. There is no local neurosurgeon to remove Mr. Othman's brain tumor, and in a war patients with neurological injury would not receive specialized care, said Dr. Mothafar Habib, director of the 400-bed Rezgary Teaching Hospital here.

"Can we have a war without head injuries?" he asked. He said that he would like help from the United States, in the form of training, staff, equipment and supplies, but that "there is no sign yet of this."

It is impossible to say with any certainty how a war in Iraq would affect civilians in its path. But medical professionals here see several possibilities, and say war planners should take them into account.

First, if it becomes apparent that war will begin, the officials said, large numbers of civilians will probably flee Kurdish cities to the mountains, where they would be vulnerable to exposure and waterborne disease. Health officials also expect Saddam Hussein's Iraq, which regards the Kurdish-controlled region of the north as an enemy, to bombard Kurdish cities with conventional artillery and rockets, mixed with chemical or biological munitions.

Moreover, they predict a second exodus, this one of non-Kurdish Iraqi civilians, fearful of American bombs, fleeing from Iraqi cities under Mr. Hussein's control.

Between the expected bombing and the dislocated people wandering across regional lines, health officials anticipate an influx of victims suffering typical war traumas, including bullet, shrapnel and burn wounds, and complicating infections.

"It will be a catastrophe," said Dr. Rajan Ezzat, deputy director of the teaching hospital in Sulaimaniya.

An official for the International Committee of the Red Cross said the committee has stockpiled emergency materials and surgical kits in Iran, and these will be brought to Iraqi war zones if fighting begins. Kurdish officials said this effort, while welcome, would not be enough.

Moreover, the attacks they fear most chemical or biological strikes are the attacks for which they are least prepared, and against which the Red Cross has said it could provide little help.

Government hospitals have no gas masks and no wash-down stations to bathe victims as they arrive, a step necessary to prevent contamination of emergency rooms with toxic agents, which might quickly render hospitals useless.

Officials also say that their labs are not equipped to sample and identify toxic agents that could be used against them, and that doctors, nurses and ambulance drivers have not received training on chemical agents.

Many Kurds, while supportive of efforts to change Iraq's central government in Baghdad, view war as optional. The United States, they say, can choose when to start a war, and how to wage it. In this circumstance, they regard medical preparation as a moral obligation.

"It would be a shame for humanity to allow Kurds to be exposed to chemical weapons again," said Dr. Habib. "The U.S.A. should protect us, just as they do in Kuwait and other places, and in Israel."

The Kurds are also frustrated because American trade restrictions, imposed to enforce sanctions against Iraq, also prohibits the transfer of money and many forms of aid to the Kurdish region.

On a tour of northern Iraq last month, two members of the Senate Foreign Relations Committee Senator Joseph R. Biden, Democrat of Deleware, and Senator Chuck Hagel, Republican of Nebraska expressed support for providing relief for the Kurds.

"I view what is about to happen in Iraq with some trepidation," Mr. Biden said. "There has not been a lot of thought and preparation to try to deal with the humanitarian situation, and what could be a tremendous crisis."

Upon returning to Washington, the senators met with senior State Department officials to relay this concern, and were told that the department was reviewing possible solutions, according to an aide who attended the meeting. No decision had been made before the holidays, the aide said.

So the Kurds wait. In Sulaimaniya, Dr. Kamal Ahmed Saeed, a general surgeon, opened the door to a hospital pharmacy. He explained its nearly bare shelves the simplest way. "We need everything," he said.

Copyright 2003 The New York Times Company

-- andreas
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