Views: Health and Politics
by Dr Ismail Jalili
Arabs can be defined as a group of people who share a common heritage and culture and who have evolved over the millennia with dynamism and the wheel of history. Their roots, like Aramaic, the source of the Arabic language, have grown not only deeper and deeper, but have spread wider and further than any other civilisation and in so doing, absorbed extensive cultural feeds throughout the generations. Nourished by the richness of its environment, its geopolitics with its cultural interactivities, it has resulted in a well-anchored, solid, gigantic tree made up of people, history and civilisations. Its infinite number of branches and seedlings has produced a fascinating mosaic of features, faiths and subcultures that have all contributed to the wheel of civilisation and produced rich fruit. Their dynamism, vitality and thirst for knowledge and learning has produced the very essence of civilisation but also, at times of difficulties, led to diversities and divisions.
The Arab identity, therefore, is a sense of belonging and heritage rather than a rigid racial code, which in this multicultural era is a positive concept with all the merits to flourish in a democratic multicultural Britain. The current Arab, from the anthropological, social and cultural aspects therefore, is a rich amalgam of vast numbers of elements that makes impossible to distinguish their genetic make up. Started before recorded history, and running throughout the millennia from the Sumerian, through the Assyrian (from the province of Assyr, Arab peninsula), and the Canaanites, throughout history till present times although that the word Arab was first documented only about 840 BC.
Migrants, even in large waves tend to assimilate in their host community, let alone when the majority of such migrants came from the same origin i.e. the current southern Arabia. The increasing fragmentation of Arabs is the result on the \one hand of political expediency and on the other a symptom of the despair felt because of the sata of the region..
The way forward is to renew and re-cultivate the vitality and dynamism of the Arabs and revive their faith in themselves and for the sake of the future generations in their new land. Our endurance throughout history, and the evidence of our great civilisation is proof that we can do this.
On the aftermath of the previous regime
Letter from Dr A Barnouti, physician, Baghdad. Summer 2003
The medical services has been devastated by three wars during the last 25 years plus 13 years of sanctions, and the negligence of the previous regime, the infrastructure including hospitals and medical clinics were damaged or destroyed, the medical services almost collapsed, the standards of medical schools deteriorated, the morale and scientific standard dropped, this dehumanization and insult was reflected on Patients, and patient care declined to near zero standards, many young doctors suffered from poverty and had to leave the medical profession and work in another job that pays money to live, many left the country. The young doctors suffered the most (house officers, senior house officers, registrars) they had no wrights as human beings, as doctors, or citizens, their salary was about 2 dollars a month!! the conditions in the medical residence were appalling , the food was terrible , the air Conditions were not working, the working hours were exhausting, all this was reflected on the patients which were treated badly, and they victims number one. The policy of the previous regime destroyed the scientific, moral, ethical, humanitarian, side of the medical profession,
Now after the regime has changed and the Security Council has approved lifting sanctions, we Iraqis are trying to rebuild our country. British Doctors were in Iraq and their contribution in establishing hospitals and medical colleges will never be forgotten,
We need help
We need help in all aspects, including medical journals, CD-ROMs, medical books, open internet access to the medical journals and libraries, refreshing training courses to update the senior doctors, jobs and possibly scholarships for junior doctors and post graduate studies, we will be honoured to invite lecturers to come to Baghdad, we also will look forward of having the part one of the MRCP FRCS MRCOG exam in Baghdad, as it was in the late seventies, when the security conditions are established .
In the future would it be possible to consider to look into the prospect of establishing a new medical school and hospital (may be private sector) like the one in Lebanon (AUB) or the gulf.
We know that security must be established to start reconstruction of our medical social and economic infrastructure, and we hope that it will improve gradually in the future
We are confident that you will participate actively and dynamically
Iraq Health Care Under the Occupation
200 Children Die Every Day. December 1, 2004
By Ghali Hassan
Since the US military invasion and occupation of Iraq, Iraq's health care system has deteriorated as a result of deliberate destruction by the US administration. The most vulnerable victims of this destruction are the Iraqi children, particularly children under the age of five.
A detailed new study by the British-based charity organisation (Medact) that examines the impact of war on health, revealed cases of vaccine-preventable diseases were rising and relief and reconstruction work had been mismanaged. Gill Reeve, the deputy director of Medact who released the report said, "[t]he health of the Iraqi people has deteriorated since the 2003 invasion ... The 2003 war not only created the conditions for further health decline, but also damaged the ability of Iraqi society to reverse it".
A second report, to be released soon, revealed that acute malnutrition among Iraqi children between the ages of six months and 5 years has increased from 4% before the invasion to 7.7% since the US invasion of Iraq. In other words, despite the 13-years sanctions, Iraqi children were living much better (by 3.7%) under the regime of Saddam Hussein than under the Occupation.
The report, which was conducted by the Norway-based Institute of Applied International Studies, or Fafo, in cooperation with the Iraq's Central Office for Statistics and Information Technology, Iraq's Health Ministry, and the UN Development Program (UNDP), shows that about 400,000 Iraqi children are suffering from 'wasting' and 'emaciation' conditions of
chronic diarrhea and protein deficiency.
A recent UNICEF report shows that, "[b]efore 1990 and the imposition of sanctions, Iraq had one of the highest standards of living in the Middle East". Now UNICEF reports, "at least 200 children are dying every day. They are dying from malnutrition, a lack of clean water and a lack of medical equipment and drugs to cure easily treatable diseases". The
UNICEF report shows that, child mortality was not getting any better since the conflict started in 2003 and that the death rate among children was rising.
UNICEF estimates that there are about 6,880 deaths of children under the age of five every year in Iraq, with an under-fives mortality rate of 125 per 1,000 live births. Furthermore, the mortality rate of Iraqi women during
pregnancy and childbirth has reached three times the rate reported during the period between 1989 and 2002, a study by the United Nations Population Fund reported.
A medical delegation from the American Friends Service Committee found that years of sanctions "have had their severest impact on families and children there, producing a generation of young people weakened by disease, isolated from the outside world and left to feed on feelings of bitterness and injustice". In its report, the delegation noted that, "the
consequences of the sanctions fall most heavily on children. While adults can endure long periods of hardship and privation, children's physiological immaturity and vulnerability provide them with less resistance. They are put at greater risk and are less likely to survive persistent shortages" of food and health care.
Earlier report by the UN stated that before the first US war, "Iraq had an extensive national health care network. Primary care services were available to 97% of the urban population and 71% of the rural population". Every Iraqi citizen had the right to free health care provided by the government. In 1991, Iraq had 1,800 primary health centres, according to
the UN children's agency UNICEF.
As a result of US war and sanctions, a decade later that number had fallen to 929, of which a third require serious rehabilitation, one of the most pressing needs to date.
The US-British sponsored sanctions and wars against the Iraqi people have killed more than 2 million Iraqi civilians, a third of them were children under the age of five. Iraq's health care and education systems were deliberately targeted for destruction.
Under the US-UN imposed sanctions, Iraq's public health care system has eroded at every level. Life-saving medical supplies such as chemotherapy drugs, antibiotics, vaccines etc., are either banned or delayed under the dual-use policy. Medical equipments that Iraq was allowed to import were either blocked from delivery by US-Britain or the shipments were almost invariably incomplete and of unusable quality.
Using the usual mask of the UN, "the US had prevented the normal importation of indispensable items of equipment for more than a decade" wrote Tom Nagy of George Washington University. In his research on the effect of sanctions on Iraq's water and the health care system, Nagy found that the US "intentionally destroying whatever had remained of
Iraq's water system within six months by using sanctions to prevent the import of a mere handful of items of equipment and chemicals" that are vital for the treatment of water.
During the US assault on Fallujah, US forces cut off water and electricity to the city of 300,000 people. US air strikes have destroyed hospitals and medical centres. The US took over the Fallujah General Hospital and converted to a military hospital, thus denying the citizens of Fallujah any health care service. On 09 November 2004, US warplanes attacked the
Nazzal Emergency Hospital in the centre of the city and completely destroyed it. Thirty-five patients were killed, including five children under the ages of 10 years. According to Amnesty International, "20 Iraqi medical staff [doctors and nurses] and dozens of other civilians were killed when a missile hit a Fallujah clinic on 09 November 2004". The air strike also destroyed the hospital medical supplies warehouse. The destruction of Fallujah is a crime against humanity.
As of today, the exact number of civilians killed by the US assault on Fallujah is not known. According to an official in the Allawi's puppet "government", "more than 2085" Iraqis have been killed. US forces used internationally banned weapons such as napalm, phosphorous weapons and jet fuel, which makes the human body melt, to attack the city in
violation of international law. Medact has also called on US forces to re-evaluate the use of these illegal weapons in populated areas, given the high rate of civilian casualties.
The Iraqi Red Crescent Society was prevented by US forces from entering the city to provide supplies to the wounded civilians, and called the health conditions in and around Fallujah "catastrophic". Eyewitnesses say most
of the victims are civilians, including, women, children, and unarmed men between the ages of 14-60 years old, who were prevented from leaving the city before the US onslaught. Furthermore, many children have died as a result of starvation, dehydration and outbreaks of diarrheal infections.
UNICEF Executive Director Carol Bellamy said that the death of was "an unconscionable slaughter of innocents". "The killing of children is a crime and a moral outrage", Bellamy added.
Medact says: "The war is a continuing public health disaster that was predictable - and should have been preventable". It added that, "[excess deaths and injuries and high levels of illness are the direct and indirect results of ongoing conflict". According to the Medact, Iraq had also experienced an alarming recurrence of previously well-controlled communicable diseases, including acute respiratory infections, diarrhoea and typhoid, particularly among children.
The Medact study found that, "[one in four people in Iraq were now dependent on food aid, and there were more children underweight or chronically malnourished than before the US invasion". The near disappearance of immunisation programmes had contributed to the recurrence of death and illness from preventable disease, and infant mortality rose due to a lack of access to skilled help in childbirth, as well as to violence, confirming the Fafo report.
The Fafo report paints a catastrophic picture of Iraq's health care under US Occupation. "It's in the level of some African countries", Jon Pedersen, deputy-managing director of the Norway-based Institute told The Associated Press. "Of course, no child should be malnourished, but when we're getting to levels of 7 to 8 percent, it's a clear sign of concern", he added.
Like the Fafo report, the Medact study specifically blames the US Occupation for the deteriorating conditions in Iraq's health and the tactics of the US-led occupying forces for exacerbating the country's health problems, particularly the decision to sideline the UN. Unreliable supplies of electricity have made it hard to boil water for safe drinking. The
destruction of Iraq's infrastructure, including the sewage and water systems has exacerbated the problem and led to increase in outbreaks of virulent diseases such as hepatitis. More that 20% of urban residents and 60% of rural Iraqis don't have access to clean water, as a result of the destruction of Iraq's infrastructure. According to the Medact report:
"twelve percent of Iraq's hospitals were damaged during the war and the country's two main public health laboratories were also destroyed".
In order to foster the sale Iraqi assets and resources, the US must render them useless first. The deliberate targeting of Iraq's health care system for destruction is part of the illegal armed conquest of Iraq. The objective is quite clear: the cheap sale of Iraqi assets and resources to US corporations.
The US is unable to provide all Iraqis with acceptable and equal health care. Health care in the US is worse than any of the developing countries, with appalling statistics. The US is one of the few countries in the world that does not provide universal health care for children and pregnant women. Infant mortality, low birth weight, and child deaths under five are
ranked among the highest in the U.S. as compared to Western industrial nations and Japan.
According to Gill Reeve, of Medact: "Immediate action is needed to halt this health disaster". The best and lasting solution to the humanitarian catastrophe in Iraq is for the US to stop the violence against the Iraqi people, withdraw its forces from Iraq, and restoration of Iraq's sovereignty. The current interim US-appointed "government" is illegitimate.
Iraq's sovereignty should be restored to ensure the peaceful rehabilitation of Iraq's infrastructure and health care system.
Ghali Hassan lives in Perth Western Australia: He can be reached at e-mail: G.Hassan@exchange.curtin.edu.au
(1) Medact study: http://www.medact.org/
Health Crisis in Palestine
Letter by Dr Ismail Jalili, FRCS, FRCOphth, NABA Chairman
Last week, Derek Summerfield addressed the health issues in Palestine, as part of Israeli genocide of the Arabs in Palestine. Those who did not have a chance to read it, can access it by clicking the following link.
NABA's chairman, Dr Ismail Jalili, also wrote about the subject and his letter was included on the same site entitled: Palestine: a state of despair (included at the bottom of this page). We also appreciate the many positive responses we received following the circular we sent.
This week, the issue of Arab genocide in Iraq is addressed in the Lancet in a major article by Les Roberts and colleagues and in a Comment by Richard Horton. The article estimates the human losses to be in the region of 100,000 with the majority of these deaths being in women and children. (You can access them on the web through the following link):
This state of affair has been ongoing with very little outcry from the 'democratic world', let alone the non-democratic world. The current spate of such publications in reputable medical journals is to be applauded, particularly if we are to keep the level of public awareness in the west regarding these appalling situations.
Back to Top
Institute of Psychiatry, London firstname.lastname@example.org
BMJ 2004;329:924 (16 October),
Does the death of an Arab weigh the same as that of a US or Israeli citizen? The Israeli army, with utter impunity, has killed more unarmed Palestinian civilians since September 2000 than the number of people who died on September 11, 2001. In conducting 238 extrajudicial executions the army has also killed 186 bystanders (including 26 women and 39 children). Two thirds of the 621 children (two thirds under 15 years) killed at checkpoints, in the street, on the way to school, in their homes, died from small arms fire, directed in over half of cases to the head, neck and chest—the sniper's wound. Clearly, soldiers are routinely authorised to shoot to kill children in situations of minimal or no threat. These statistics attract far less publicity than suicide bombings, atrocious though these are too.
Amnesty International has called for an investigation into the killing of Asma al-Mughayr (16 years) and her brother Ahmad (13 years) on the roof terrace of their home in Rafah on 18 May, each with a single bullet to the head. Asma had been taking clothes off the drying line and Ahmad feeding pigeons. Amnesty noted that the firing appeared to have come from the top floor of a nearby house, which had been taken over by Israeli soldiers shortly before. Amnesty suspects that this is not "caught in crossfire," this is murder.
Israeli military reoccupation of the West Bank and Gaza—a system of military checkpoints splitting towns and villages into ghettos, curfews, closures, raids, mass demolition and destruction of houses (more than 60 000), and land expropriations—has made ordinary life impossible for everyone, and is driving Palestinian society and its institutions towards destitution. Moreover, Israel has been constructing a grotesque barrier that, when completed, will total over 400 miles—four times longer than the Berlin Wall. Extending up to 15 miles into Palestinian territory, the real purpose of the wall is permanently to lock more than 50 illegal Israeli settlements into Israel proper. This is expansive, aggressive colonisation, in defiance of the International Court of Justice in The Hague and the United Nations General Assembly resolution of last July.
Last year a UN rapporteur concluded that Gaza and the West Bank were "on the brink of a humanitarian catastrophe." The World Bank estimates that 60% of the population are subsisting at poverty level (£1.12; $2; 1.6 per day), a tripling in only three years. Half a million people are now completely dependent upon food aid, and Amnesty International has expressed concern that the Israeli army has been hampering distribution in Gaza. Over half of all households are eating only one meal per day. A study by Johns Hopkins and Al Quds universities found that 20% of children under 5 years old were anaemic, 9.3% were acutely malnourished, and a further 13.2% chronically malnourished. The doctors I met on a professional visit in March pointed to a rising prevalence of anaemia in pregnant women and low birthweight babies.
The coherence of the Palestinian health system is
being destroyed. The wall will isolate 97 primary health clinics and
11 hospitals from the populations they serve. Qalqilya hospital,
which primarily serves refugees, has seen a 40% fall in follow up
appointments because patients cannot enter the city. There have been
at least 87 documented cases (including 30 children) in which denial
of access to medical treatment has led directly to deaths, including those
of babies born while women were held up at checkpoints. The
checkpoint at the entrance to some villages closes at 7 pm and not
even ambulances can pass after this time. As a recent example, a man
in a now fenced in village near Qalqilya approached the gate with his
seriously ill daughter in his arms, and begged the soldiers on duty
to let him pass so that he could take her to hospital. The soldiers
refused, and a Palestinian doctor summoned from the other side was
also refused access to the child. The doctor was obliged to attempt a
physical examination, and to give the girl an injection, through the
There are consistent reports of ambulances containing gravely ill people being hit by gunfire, or detained at checkpoints while drivers and paramedics are interrogated, searched, threatened, humiliated, and assaulted. Wounded men are abducted from ambulances at checkpoints and sent directly to prison. Clearly marked clinics are fired on, and doctors and other health workers shot dead on duty.
Physicians for Human Rights (Israel) have
lambasted the Israeli Medical Association (IMA) for its silence in
the face of these systematic violations of the Fourth Geneva
Convention, which guarantees the right to health care and the
protection of health professionals as they do their duty. Remarkably,
IMA president Dr Y Blachar is currently chairperson of the council of
the World Medical Association (WMA), the official international watchdog
on medical ethics. A supine BMA appears in collusion with this farce
at the WMA. Others are silenced by a fear of being labelled
"anti-semitic," a term used in a morally corrupt way by the
pro-Israel lobby in order to silence. How are we to affect this
shocking situation, one which to this South African-born doctor has
gone further than the excesses of the apartheid era.
Back to Top
Palestine: the state of despair
Letter to the BMJ by Dr Ismail Jalili, FRCS, DO, FRCOphth
Consultant Ophthalmologist, UK.
Summerfield's article 1 on Palestine adds to the previously
documented health crisis in this population 2-5 and demonstrates the
scale of this human tragedy. Indiscriminate obstruction damages an already vulnerable medical infrastructure resulting in increased morbidity, degraded health, premature deaths, and non-fulfillment of basic human needs 2. Repeated invasions cause extensive destruction, food shortages, internal civilian displacement and psychological distress 3. Poor socio-economic, demographic and environmental health conditions lead to over-crowding, affects drinking water sources and play a major role in the occurrence of intestinal parasites and diarrhoea with under 5s at highest risk.
Endemic parasitic infestations were found in 29.8% of women4, 24.1% in
1-4 years old; and 13.7% of diarrhoea admissions with 10.6% mainly in <1
Injuries rose sharply, a staggering 32 and 9-fold increases in the first and second Intifidas respectively. Before the Intifida, victims were men, there were no <10's; during the Intifida 9% were women and 12% under 14 years; injury patterns changed with 65% due to firearms or explosives, 19% to beating and 6% to gaseous substances. Among children, most firearm injuries involved the head, including eye injuries and brain damage 5.
After the 1967 war, Israel's labour market opened to workers from the Occupied Territories, with jobs in construction, agriculture etc; conditions were poor and exploitation rife6. By 1984, 87,000 Palestinians were employed in Israel - 36% of the total workforce. Since 1991, there has been a sharp decline, with Romanian and Thai workers recruited instead. Girls and young women increasingly risk illiteracy and families are marrying their daughters at younger ages for security 6.
Before 1987, the author witnessed the failure to provide treatment for 2
children with retinoblastoma; neglect and bureaucracy led to advanced,
metastasised presentation, causing excruciating pain and agony. They
were failed by a lack of initial treatment but also by denial of
terminal care 7, reflecting the neglect of poor and deprived pointed out
by Summerfield's and others 1,8.
1. Summerfield D. Palestine: the assault on health and other war
crimes. Br Med J 2004;329:924.
2. Quato D. The politics of deteriorating health: the case of
Palestine. Int J Health Serv 2004; 34:341-64.
3. Giacaman R, Husseini A, Gordon NH, Awartani F. Imprints on the
consciousness: the impact on Palestinian civilians of the Israeli Army
invasion of West Bank towns. Eur J Public Health 2004;14286-90.
4. Abu Mourad TA. Palestinian refugee conditions associated with
intestinal parasites and diarrhoea: Nuseirat refugee camp as a case
study. Public Health 2004;118:131-42.
5. Helweg-Larsen K, Abdel-Jabbar Al-Qadi AH, Al-Jabriri J,
Bronnum-Hansen H. Systematic medical data collection of intentional
injuries during armed conflicts: a pilot study conducted in West Bank,
Palestine. Scand J Public Health 2004;32:17-23.
6.Diamond J. Demography of the Arab World. Lecture. ST203, 21.10.02.
7. Jalili IK. Childhood visual impairment in the West Bank and Gaza
Strip. Thesis - in preparation.
8. World Health Organisation. Health conditions of, and assistance to,
the Arab population in the occupied Arab territories, including
Palestine. The 54th World Health Assembly, Agenda item 17, 22 May 2001.
Published on line: http://bmj.bmjjournals.com/cgi/eletters/329/7471/924?ehom#81170
by Richard Horton. The
NW1 7BY, UK
present conflict in Iraq signals a contrast of paradoxical proportions. The
Iraqi people, their interim government, and their largely US and British
occupiers are preparing for landmark elections early in the new year. Yet a
ruthlessly violent insurgency is successfully destabilising these arrangements,
murdering foreign civilians and Iraqi law enforcement officers in the most
brutal ways imaginable, and exploiting the world’s media in doing so. Amid
this deep national uncertainty, it is hard to judge what is happening among
Iraqis themselves. This week The
the first scientific study of the effects of this war on Iraqi civilians.
a unique US-Iraqi collaboration, Les Roberts and his colleagues report
substantially more deaths in Iraq since the war began than during the period
immediately before the conflict. Much of this increased mortality is a
consequence of the prevailing climate of violence in the country, and many of
the civilian casualties that are described were attributed to the actions of
coalition forces. These findings—and the tentative countrywide mortality
projections they support— have immediately translatable policy implications
for those charged with managing the aftermath of invasion.
research we publish today was completed under the most testing of
circumstances—an ongoing war. And therefore certain limitations were
inevitable and need to be acknowledged right away. The number of population
clusters chosen for sampling is small; the confidence intervals around the point
estimates of mortality are wide; the Falluja cluster has an especially high
mortality and so is atypical of the rest of the sample; and there is clearly the
potential for recall bias among those interviewed. This remarkable piece of work
represents the efforts of a courageous team of scientists. To have included more
clusters would have improved the precision of their findings, but at an enormous
and unacceptable risk to the team of interviewers who gathered the primary data.
Despite these unusual challenges, the central observation—namely, that
civilian mortality since the war has risen due to the effects of aerial
weaponry—is convincing. This result requires an urgent political and military
response if the confidence of ordinary Iraqis in the mostly American-British
occupation is to be restored.
and his colleagues submitted their work to us at the beginning of October. Their
paper has been extensively peer-reviewed, revised, edited, and fast-tracked to
publication because of its importance to the evolving security situation in
Iraq. But these findings also raise questions for those far removed from
Iraq—in the governments of the countries responsible for launching a
pre-emptive war. In planning this war, the coalition forces—especially those
of the US and UK—must have considered the likely effects of their actions for
civilians. And these consequences presumably influenced deployments of armed
forces, provision of supplies, and investments in building a safe and secure
physical and human infrastructure in the post-war setting.
the admitted benefit of hindsight and from a purely public health perspective,
it is clear that whatever planning did take place was grievously in error. The
invasion of Iraq, the displacement of a cruel dictator, and the attempt to
impose a liberal democracy by force have, by themselves, been insufficient to
bring peace and security to the civilian population. Democratic imperialism has
led to more deaths not fewer. This political and military failure continues to
cause scores of casualties among non-combatants. It is a failure that deserves
to be a serious subject for research.
But this report is more than a piece of academic investigation. A vital principle of public health is harm reduction. But harm cannot be diminished by individual members of society alone. The lives of Iraqis are currently being shaped by the policies of the occupying forces and the militant insurgents. For the occupiers, winning the peace now demands a thorough reappraisal of strategy and tactics to prevent further unnecessary human casualties. For the sake of a country in crisis and for a people under daily threat of violence, the evidence that we publish today must change heads as well as pierce hearts.