16-30 September 2003
Health budget for 2004
The Coalition Provisional Authority (CPA) has proposed a budget of $20.3 billion for rehabilitation and reconstruction activities in Iraq in 2004. Of that amount, approximately $ 850 million is specifically for health, including the construction of a new paediatric hospital, refurbishment of hospitals and clinics, and replacement of medical equipment.
According to data from the US Government and information published by the media, allocations include:
Health Coordination Meetings
Health Coordination Meetings have resumed in Amman under WHO’s chair as requested by NGOs and other UN agencies currently stationed in Amman. The first meeting took place on 29 September. Participants representing NGOs, UNOPS, UNICEF, WFP and WHO shared information on health issues and activities being carried out by the different partners in Iraq. It has been decided to hold such meetings weekly, on Mondays.
Health Needs Assessment
Two follow-up meetings on the Health Needs Assessment for Iraq on 18-19 and 29-30 September took place in Amman. The participants included officials from the Ministry of Health and the Coalition Provisional Authority, World Bank, UNFPA, UNICEF and WHO. The purpose of the meetings was to discuss the current health situation in Iraq and to draw the map of available assets and financial resources needed to achieve the overall goal of providing Iraqi people with health services that are accessible, equitable, affordable and of adequate quality.
Spraying, fogging and anti-larvacide activities are being carried out in various parts of the country as part of the vector control programme for leishmaniasis and malaria.
Visceral leishmaniasis is endemic in Iraq. The highest risk-group of the population are children below five years of age. The reservoir of infection is believed to be the domestic dogs, foxes and rodents. The annual number of reported cases varies from 700 to more than 3,000. Visceral leishmaniasis is reported mainly in Wassit, Diyala, Baghdad, Thiqar and Basra governorates.
Malaria is another endemic disease in Iraq. During the 1940s there were about 1,000,000 cases registered. A malaria eradication programme was established during the 1950s. The programme succeeded in reducing malaria from the south and central regions of the country; only scattered focuses remained in the three northern governorates of Dohuk, Erbil and Suleymaniya.
Following the First Gulf War malaria re-surged at wide scale in the north and then spilled to the adjacent governorates and later other parts of the country. During 1994 and 1995 about 100,000 cases were reported. From 1996 the situation was progressively brought under control and at the end of the year 2002 the total reported cases were 953 cases.
Number of malaria cases reported in the last three years:
*Until the end of June.
During September and October a defaulter vaccination campaign is taking place across the country. Vaccination teams from primary health centres carry out visits to identify and vaccinate children who were missed out in previous immunization campaigns.
There have been reports of unavailability of vaccines in various areas of the country. At Baghdad level there were shortages of MMR (mumps, measles and rubella), DPT(diphtheria, polio and tetanus), as well as anti scorpion, anti snake and rabies sera. The Ministry of Health has requested UNICEF to urgently purchase one million doses of MMR vaccine. In the south, WHO reported that 200,000 doses of polio vaccine are now available in Basrah to cover the needs of all the four Lower South governorates.
NORTH (Dohuk, Erbil, Suleymaniya)
No disease outbreak has been reported in this area during the reporting period.
Three cases of acute flaccid paralysis (AFP) have been diagnosed, samples have been sent to Amman and Cairo for testing.
Antimalarial drugs and primaquine have been reported on shortage in the area. For the first time in years health facilities have received morphine and pethidine (analgesics).
CENTRE (Ninewa, Salah al-Din, Tameem)
There are some 1,500 internally displaced persons (IDPs) in Tikrit (Salah al-Din Governorate). In Kirkuk (Tameem Governorate) there are approximately 10,000 IDPs and 15,000 returnees from the northern governorates. Most of them are living in very poor conditions with inadequate water and sanitation facilities; health services are not always available. Less than 40% of children under five year of age are immunized. A mobile team has been sent to carry out vaccination.
In the Centre Area whooping cough has reportedly decreased in September. Only 7.4 % of the cases had received three doses of DTP vaccine. Seventy per cent of the mumps cases registered were not immunized.
One case of acute flaccid paralysis (AFP) in a two-year-old girl was diagnosed. Laboratory tests are being carried out.
BAGHDAD (Anbar, Baghdad, Diyala)
One case of AFP has been reported. Laboratory investigations are being conducted.
The health situation of pockets of IDPs in Diyala Governorate are being monitored.
UPPER SOUTH (Nafaj, Kerbala, Babil, Qadissiyah, Wassit)
In September five cases of cholera were confirmed by laboratory testing; all are Inaba type. Four of them were children below five years and one was an adult. Samples were taken from relatives and all tested negative. Samples from water supply also tested negative. No deaths reported.
One case of AFP was diagnosed in a four-year-old child. Samples were sent to the laboratory for testing. Reportedly there is a high density of anopheles mosquito (500/room) and sand flies in Mahweel district Babil Governorate). The Communicable Diseases Centre at the Ministry of Health was requested to spray the area.
Twelve cases of visceral leishmaniasis were reported in Babil (5), Kerbala (2) and Qadissiya (5). Pentostan, the drug of choice for the treatment of the diseases was available.
Reportedly, a 12-year-old boy died of rabies in August. Antirabies vaccine is in shortage in the area. Other items in shortage include intravenous sets, anaesthetic drugs and laboratory supplies and test kits.
LOWER SOUTH (Muthanna, Thi Qar, Basrah, Missan)
The last confirmed case of cholera was registered on 13 September 2003. The cholera outbreak is well under control. There has been a gradual decrease in diarrhoea cases, both watery and bloody.
There are sporadic cases of measles. Thirteen samples collected from all reported suspected measles cases from Basrah Governorate were sent to the Kuwait Central Public Health Laboratory for serological testing of measles and rubella.
One case of AFP in a two-year-old child from Thiqar was registered in Wassit. Samples were sent to Baghdad for laboratory investigation.
CPA has provided enough fuel to hospitals and clinics in Lower South governorates.
CALENDAR OF FORTHCOMING ACTIVITIES