Iraqi Women's Health Care Needs Urgent Attention
Physicians for Human Rights (PHR) urges the United States and coalition forces in Iraq to immediately address the dire state of health care, particularly for women. PHR researchers, returning from a three day health and human rights investigation to An-Nasiriyah in southern Iraq, found that an already compromised healthcare system is much worse than it was before the recent hostilities. Women's health is in even greater jeopardy, because for more than a decade women's heath needs have not received priority within the Iraqi health care system.
According to PHR researchers, the maternity hospital in An-Nasiriyah has no prenatal vitamins, iron tablets, birth control pills, estrogen, progesterone and medications to address the complications of pregnancy and childbirth. Scalpels to make incisions are re-used and tubing for IVs and catheters have been used for an entire month. Essential medicines for maternal health and for pregnancy complications are virtually nowhere to be found, and apparently have not been available for years.
The war has severely exacerbated the health crisis for women in An-Nasiriyah. Before the war, the city had four family planning clinics. One was bombed during the war, while the other three were forced to close when the war began. They have no running water, and electricity from generators is intermittent at best. Since the war began, the clinics have been unable to obtain basic life-saving drugs and supplies. They remain closed.
"Women's health services in An-Nasiriyah that were severely compromised are now in crisis," said Dr. Lynn Amowitz of Physicians for Human Rights, one of the researchers.
PHR researchers visited the single maternity and pediatric hospital in the province of Dhiqar. Women from around the province and within the city are referred by their local clinics to this hospital for all types of women's health issues. This hospital performs more than 600 deliveries a month. Approximately 150-200 of these deliveries are caesarean sections. Electricity in this hospital is provided by two generators. Due to short fuel supply, however, generator power is now reserved for emergency cases or for night-time use when needed. There is currently no source of water at the hospital. Not only can the floors and walls not be cleaned, but obstetricians and midwives have no water to wash before a delivery.
Labor and delivery take place in the dark. Slivers of light reach the ward from hallway windows. Women labor on metal spring beds without mattresses. There are no towels, sheets or supplies. Fetal monitors do not exist. If an episiotomy is needed, this is done with a non-sterile, re-used scalpel or with old surgical scissors and without anesthesia. The use of non-sterile medical supplies not only invites life-threatening infection, it is also a source of infectious disease transmission, including hepatitis and HIV/AIDS.
On the maternity wing of the hospital, the windows are without glass, floor tiles are not intact, and trash litters the hallway. Family members have been collecting water from swamps and rivers for the patients, and this water has been used without treatment. The single incubator noted was non-functional and was serving as a crib. There were no cradles, sheets or mattresses on the beds, so mothers and their babies sat on blankets on the floor. Swarms of flies are fanned away from newborns by new mothers and grandmothers.
The PHR research team also expressed concern about the aid shipments to Iraq that include infant formula. The use of infant formula contradicts the World Health Organization's breastfeeding guidelines. For mothers who need formula, there are UNICEF-run therapeutic feeding centers.
Women's health in the region has also suffered because for over a decade, the Iraqi Ministry of Health, which will reportedly remain an Iraqi-run institution, has controlled the contraceptive choices for women. Women who are healthy and able to bear children have been restricted from choosing their form of birth control. In particular, tubal ligation has been regulated by the Ministry of Health and subject to the approval of the male head of household.
Physicians for Human Rights urges the United States and other entities involved in the reconstruction of Iraq to focus attention on women's health care needs, especially the urgent needs of women who are at grave risk:
1) The United States and coalition forces must immediately provide round-the-clock security for all hospitals and clinics, both to prevent looting and re-looting and to permit hospital personnel and patients to come and go in safety.
2) The United States and coalition forces must make the provision of clean water and dependable electricity to all hospitals and clinics, including maternity hospitals, an urgent priority.
3) Lifesaving medications and supplies ensuring safe childbirth should be provided. The humanitarian aid community should procure and supply, on an urgent, emergency basis, an immediate infusion of medical equipment, supplies, and medicines, including sterile instruments and single-use syringes. In addition, shipments of infant formula should be limited to supplying UNICEF therapeutic feeding centers.
4) As quickly as possible, the United States and other donors should provide other supplies and medications related to women's health, including adequate supplies of contraceptives, medications for reducing maternal mortality, pre-natal vitamins, iron tablets, folic acid, as well as other gender-specific supplies and medications.
5) As planning for reconstruction moves forward, Physicians for Human Rights also recommends that donors be guided by best practices in addressing women's health, including the following:
* Primary health care centers should be supplied separately from urban hospitals with essential medications and supplies, and distribution should be monitored.
* In keeping with UNICEF/WHO recommendations, the donor community should provide basic equipment needed for normal and complicated births to local clinics and regional health centers in order to meet criteria at Essential Obstetric Care (EOC) Facilities. None of the primary health care centers in the Dhiqar governorate have even the most rudimentary supplies, such as intravenous medications to control seizures, bleeding or infection; clean water; or vacuum extractors. This basic package of materials and equipment at every facility, combined with the proper training, could save the lives of tens of thousands of women and children every year.
Contact:
John Heffernan 617.413-6407 jheffernan@phrusa.org
Barbara Ayotte, 617.695.0041 x210 bayotte@phrusa.org
For more information on PHR's work in Iraq, visit: http://www.phrusa.org/research/iraq/index.html
Physicians for Human Rights (PHR) promotes health by protecting human rights. As a member of the steering committee of the International Campaign to Ban Landmines, PHR shared the 1997 Nobel Peace Prize.