Rebuilding health care in Iraq

The effects of three wars within 25 years,1 a decade of international sanctions,2 and a brutal regime have had tragic consequences on Iraq’s health system and on the health of the Iraqi people.3 While the scale of these problems is becoming clearer, it has been difficult in the current security situation to know how best to respond to requests for help.

A workshop organised by the International Committee of the Faculty of Public Health (FPH) in November 2003 has now addressed this very issue.4 This paper describes the health service needs presented at the workshop by representatives from the Department for International Development (DFID), World Health Organisation (WHO), International Non-Governmental Organisations (INGOs) and, most importantly, Iraq’s Ministry of Health. We will also consider current responses and how professional public health bodies from around the world might contribute to the development of Iraq’s health sector.

The priority health service needs of Iraq where professional public health organisations could usefully contribute fall into four broad areas: communicable diseases, primary care development, health management, and public health training. These areas were identified as being of key importance by the participants at the workshop with recent experience in Iraq and concur with the assessment of the Iraqi Ministry of Health5,6 and findings of the donor meeting in Madrid.7

The potential for the outbreak of infectious diseases is clear and immediate. The cold chain for the delivery of vaccines has broken down in many parts of the country.8 Primary care facilities are often not administering the immunisation programme in an efficient manner—and even where facilities are functional staffing remains variable.9 Such disruption will also affect other communicable disease control programmes such as that for tuberculosis. …