Humanitarian Disaster – That’s Iraq

(Things just keep getting better and better. That’s the return on “success” – promoted by ek hornbeck)

In light of the new numbers calculating the Iraq civilian death toll to be 1 to 1.2 MILLION people out of a total pre-US invasion population of what I thought to be 31 million, but is more likely to have been 24 to 26 million I wrote a comment last evening on the inestimable nightprowlkitty’s post about us needing to do THE MATH to make some sense of that number.

What was the original Iraq population? 

I’m thinking perhaps around 31 million?

Let’s compare – California has what, 37 million citizens?

What cities in Cal. have a population of 1.2 million (the same percentage of 1 million out of 31 million)?

San Jose is at 950,000, and San Diego is at 1,200,000. San Francisco is at about 750,000.

Can you imagine San Francisco gone?  San Diego a memory?  San Jose just a cinder pile?

On a national basis, the number would climb to 10 million dead.  No New York AND Boston AND Hartford?

The numbers aren’t real because we don’t translate them into what we know.  Time to do – as Karl Rove says – THE MATH.

This morning, the NY Times’ Bob Herbert speaks to what is being termed a humanitarian crisis.

When the U.S. launched its “shock and awe” invasion in March 2003, the population of Iraq was about 26 million. The flaming horror unleashed by the invasion has since forced 2.2 million of those Iraqis, nearly a tenth of the population, to flee the country. Many of those who left were professionals marked for death – doctors, lawyers, academics, the very people with the skills necessary to build a viable society.

The Iraq Ministry of Health reported that 102 doctors and 164 nurses were killed from April 2003 to May 2006. It is believed that nearly half of Iraq’s doctors have fled. The exodus of health care professionals in a country hemorrhaging from the worst kinds of violence pretty much qualifies as nightmarish.

While more than two million Iraqis have fled to other countries, another two million have been displaced internally. According to the Global Policy Forum, a group that monitors international developments:

But a crisis is not a permanent condition.  It is, by its definition, a critical point in time which requires resolution.

cri·sis  (krss)
n. pl. cri·ses (-sz)
1.
a. A crucial or decisive point or situation; a turning point.
b. An unstable condition, as in political, social, or economic affairs, involving an impending abrupt or decisive change.
2. A sudden change in the course of a disease or fever, toward either improvement or deterioration.
3. An emotionally stressful event or traumatic change in a person’s life.
4. A point in a story or drama when a conflict reaches its highest tension and must be resolved.
[Middle English, from Latin, judgment, from Greek krisis, from krnein, to separate, judge; see krei- in Indo-European roots.]
Synonyms: crisis, crossroad, exigency, head, juncture, pass

I believe that what is occurring in Irzq has gone well beyond a crisis and is a full-on disaster – of genocide.

I’ll let the facts of the actions speak for themselves in that argument.

But for now, I’d like to share with you a bit about how it is to try to be a nurse in Iraq.  I posted this during the week in May which is celebrated – sort of – in the US as “Nurses’ Week”. I tried to give a flavor for the difference in nursing between military nurses at a CSH in Iraq and their native Iraq civilian counterparts.  I haven’t been able to connect with any nurses in Iraq directly, so if you have contacts, please share or forward this so they know they aren’t forgotten.

Nurses at the CSH (Combat Surgical Hospital – receiving facilities for combat injuries) in Mosul were feted and footed.  A military news web site reported on the activities for the registered nurses and support nursing staff.  The festivities included appreciation for and by nurses, professional education and professional grooming.

Blackanthem Military News, FOB DIAMONDBACK – The 28th Combat Support Hospital celebrated Nurses’ Week in May with events planned by the junior officer council. The celebration began with a cake-cutting ceremony. Traditionally, the oldest and youngest nurses are chosen to cut the cake symbolizing the past and future of the Army Nurse Corps.

The second day, head nurses treated Soldiers to a continental breakfast to thank them for their hard work.

The clinical nursing staff donned “nursing excellence” t-shirts to display their nursing pride and spirit.  Nursing Week concluded with a discount beauty day provided by AAFES.
A couple officer professional development sessions were given during the week.  In addition, the JOC trained AAFES personnel on first aid and cardiopulmonary resuscitation. 

A good time was had by all.  And that’s only all good since the CSH staff deals with unending combat injuries of incredible magnitude and complexity.  But while the American nurses were celebrating, what were their Iraqi civilian counterparts doing during Nurses Week 2007?

Well, in 2003, the US was crowing about Iraqi nursing and nurses:

National Iraqi Nurses Conference Convenes in Baghdad

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Baghdad, Iraq — The National Iraqi Nurses Conference convened today at the Baghdad Convention Center. The two-day conference, sponsored by the U.S. Agency for International Development (USAID) in conjunction with the Coalition Provisional Authority (CPA), attracted more than 200 of Iraq’s senior leadership of nursing and healthcare professionals to address the future of nursing in Iraq. They joined together for an Iraqi-led dialogue on standards and curriculum, continuing education, how to educate and train current nurses in a new system, bylaws and regulations, a nursing code of ethics, nursing specializations, a national library of nursing, and a nursing research institute and council.

–snip–

The conference participants will review, discuss and revise a ten-year plan of action drafted by the Ministry of Health, non-government organizations, the College of Nurses, nurse managers and floor nurses. The plan takes a holistic approach to begin to rectify the years of substandard training and professionalism in Iraq’s nursing community. Due to the steep cuts in budget allocations by the former regime, the entire Iraqi health sector suffered from a lack of equipment, supplies, training, operation and maintenance funding since the 1980s. Much of the equipment is old and Iraqi health professionals have had little technological contact with new developments in the international health field.

Nursing plays a key role in maintaining the health of a country.

What about this year -May 2007?

Funny – the Google turns up nothing.  But in 2006, nurses were looking for a little bit of this , courtesy of Yale University’s School of Nursing:

Nurses in Iraq listed building new hospitals, English language training and creating more autonomy and respect for their profession as priorities in reconstructing a healthcare system in the war ravaged country, according to a study by researchers at Yale School of Nursing.

A total of 744 surveys were collected from nurses in the Dohuk and Erbil regions of northern Iraqi Kurdistan by field researchers working on the project with Yale. The region has remained stable with only sporadic violence because of creation of the “no-fly” zone in 1991. “However, a functioning economy does not mean that the reconstruction is complete,” said Allison Squires, R.N., doctoral candidate and lead author of the study in Advances in Nursing Science. “It will be an ongoing process. Including input from nurses will be important for ensuring the success of the policy choices made there.”

Squires and co-author Ali Sindi, M.D., who is in Iraq, developed the survey. After the survey was translated into Arabic and Kurdish field coordinators distributed it to nurse participants at their place of work and the data was emailed to Squires.

In addition to new hospitals, language training and leadership development, nurses reported the need for new equipment and furniture for patient care, financial support for student nurses, more access to nursing and medical journals and improved laboratory services.

“Nurses repeatedly wrote down that they wanted more respect, not only in the workplace, but in society as a whole. They suggested that this could be accomplished through recognition for quality of performance,” Squires said. “They also wanted respect from physicians, administrators and the public but did not offer solutions in this area.”

The nurses also called for assistance with housing, child care and transportation to and from work and risk allowances to cover health benefits such as vaccinations. “We might assume from this that many nurses have not been properly vaccinated against infectious diseases, which increases their risk of contracting easily preventable illnesses on the job,” Squires said.

The nurses’ comments reflect the low public status of nursing and the lack of consistent authority. “We have more than one manager.” “We are insulted and every guilt of the hospital eventually comes upon nurses.” “We should be paid more than police and teachers because teachers have four days off each month and they are not tired like us.” Currently nurses in Iraq earn an average of US$150 per month.

Diseases nurses listed as priority concerns were childhood illnesses, cancer and sexually transmitted diseases other than HIV/AIDS, of which the incidence rate remains low. Squires said cancer rates are high in the region due to a variety of factors including chemical warfare used by the previous authoritarian regime for ethnic suppression. Malnutrition was also a serious concern. It stems from both prolonged political sanctions in the region and mismanagement that impeded the success of the United Nations’ oil-for-food program in the country during the 1990s.

Still, surely there must be nurses celebrating Nurses Week in 2007, right?

Here’s this little snippet demonstrating American concern:

BAGHDAD, Iraq, Feb 21, 2007 (AFP) – Few countries have a more dire need of brave and skilled nurses than war-torn Iraq, and few countries make it harder for women to train and work outside the four walls of their family home.
Now, however, a determined group of young women have defied daily threats and dangers to take part in a pioneering US-led training programme that could soon serve as a model for isolated women in other conflict zones.
“You are now leaders, teachers, and role models for women of Iraq to help bring healing to a hurting nation,” US army Major Darrin Frye told a ceremony where grinning graduates received stethoscopes and white blouses.
The 17 women, aged between 18 and 45, have completed a six-week training course at a clinic on the sprawling grounds of Camp Victory, a US military complex on the western edge of the battle-scarred Iraqi capital.
One was not able to attend the entire Preparatory Iraqi Nursing Course in person.
She was warned off by thugs in her community, who threatened to beat her bloody in order to set an example to other women who dared have contact with the training team — US and Iraqi doctors, and female military officers.
But friends brought course materials back from the base and she worked hard at home, allowing her to graduate this week along with her classmates.
“Our neighbours were against us because it was an American programme,” said another graduate, Amal Hadi Abbas, who scored 28 out of 29 on the final exam.
The taster course does not turn out qualified professional nurses but covers a variety of skills so graduates can assist doctors or midwives.
The women learn to take temperatures and blood pressures, control infections and give artificial respiration or cardiac massage. They study medication safety, female and community health issues and primary micro-biology.
Most of the women on the course left formal schooling at 13 or 14, and as the city plunged into sectarian carnage in the aftermath of the fall of Saddam Hussein much of the country’s educational infrastructure collapsed.
“They defied the odds on the outside” to get a taste of what nursing really is, said Air Force Captain Samantha Elmore, who with Turki and Frye was one of the volunteer programmes’ pillars.
They also had to overcome a stigma in Iraq, where nurses are considered by some as women of loose moral character. Executed dictator Saddam Hussein was quoted in a programme brochure as saying he would “do without nurses.”
The country now needs an estimated 60,000 of them to staff new and refurbished clinics being built across Iraq, providing a job opportunities for many women and healthcare for deprived communities.
Most here wanted to earn nursing credentials, including some who already worked as US interpreters, while a few sought skills to care for elderly relatives or friends.

That’s right.  Six weeks of training to form the new nursing base of unskilled and intimidates health care worker.  Not a single mention of professional nursing.

But here’s the LA Times reporting at the end of May how healthcare looks in Iraq after four years of American occupation and reconstruction (you know – post Saddam):

U.S. and Iraqi medical personnel say it was a typical turnout. The adults looked older than their years, the children younger – in both cases, the result of poor diet and a lack of healthcare.

The problems of Iraq’s medical system since the 2003 toppling of Saddam Hussein are well-documented: doctors fleeing the country, graft, supply shortages, and civilians dying for lack of care or because their hospital came under attack.

The International Committee of the Red Cross this month issued its most dire assessment yet about the foundering system (pdf links). The report concludes that Iraqi healthcare has all but collapsed and that deaths and suffering, already widespread, are increasing.

In Al Anbar, military and health officials say, the deep-rooted alienation between the Sunni Arab population and the Shiite Muslim-led government in Baghdad has made the problem even more acute.

Wounded Iraqi soldiers and police officers tremble at the prospect of being sent to a Baghdad hospital, where they fear they’ll be killed.

“I’ve had some of them almost get off the operating table and try to run away rather than go to Baghdad,” said Navy Cmdr. George Dyer, a senior nurse at the trauma hospital at Taqaddum air base.

The same is true at the hospital at the U.S. base at Al Asad. At both facilities, about 60% of the patients are Iraqis, many of them security personnel injured by roadside bombs. Once a patient’s condition is stable, the goal is to get him or her to an Iraqi facility.

“We try to get them to a place where Sunnis are accepted,” said Army Maj. Kenneth Grundy, a critical-care nurse at Al Asad. “Sometimes we just can’t and we end up holding on to them.”

After the clinic in Abu Fleiss, a tribal sheik and an Iraqi general pleaded with three visiting Marine generals to do something about the Baghdad government’s alleged indifference.

U.S. officials, military and civilian, are concerned that the government’s estrangement from Al Anbar could make it easier for foreign insurgents to recruit there.

Sheik Ali Hatem Suleimann Dulaymi said he feared that Islamic fundamentalists, opposed to the alliance between the tribal sheiks and the U.S. military, could gain political power in Al Anbar if the Baghdad government isn’t responsive to health needs and other issues. Provincial elections are set for this fall.

Iraqi Gen. Tark Abed-Alwab Jassim said that though “enemy activity is decreasing day after day,” there could be a resurgence of violence “if we do not keep our promises to the people.”

Chief among those promises was the rebuilding of the healthcare system, ravaged in the decades of Hussein’s rule and during the U.S.-led invasion and ensuing Sunni-led insurgency.

But promises have been difficult to keep amid the violence. Building projects have been abandoned or scaled back. Doctors Without Borders, an international aid group, left the country because of security concerns. Iraqi doctors have been killed or intimidated, including a female physician in Haditha whose hands were chopped off by insurgents.

An internal U.S. document says that coalition forces remain “the only source” for food, clothing, and school and medical supplies in much of Al Anbar. Hospitals in the cities of Ramadi and Fallouja have reopened but are swamped with patients.
“Our people have so many problems – epilepsy, diabetes, heart, tumors, eye diseases, everything,” said Ibrahim Khalidy, a doctor and colonel in the army.
Flanked by dozens of Iraqi soldiers, who were themselves backed by Marines, Khalidy tried to give each of the patients at the clinic a few minutes’ attention. Though other doctors have fled Iraq, Khalidy has decided to stay.

“I love my country too much to run,” he said.

Along with a quick medical checkup, the adults received anti-insurgency fliers. “This aid is made possible through the efforts of the Iraqi security forces,” said one.

The U.S. military and the Iraqi army try to hold a clinic in the region at least one day a week.

Only female corpsmen and nurses are allowed to interact with female patients. Children stand in the women’s line, sometimes for hours.

Youngsters Ayai and Moham med both have chest pains and are wheezing. They are small for their age, possibly a sign of what doctors call a “failure to thrive.”

“These people are really hurtin’,” Navy corpsman Tiffany Sharkey said. “It’s a tough life in Iraq.”

So are the nurses, Tiffany.  If there are any left, that is.