THE DISMAL STATE OF HEALTHCARE IN BASRAH

C O N F I D E N T I A L SECTION 01 OF 03 BASRAH 000119

SIPDIS

SIPDIS

E.O. 12958: DECL: 7/19/2016
TAGS: PGOV SOCI IZ
SUBJECT: THE DISMAL STATE OF HEALTHCARE IN BASRAH

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CLASSIFIED BY: Mark Marrano, Deputy Regional Coordinator, REO
Basrah, DOS.
REASON: 1.4 (b)


1. (U) Summary: The hospitals and clinics in Basrah suffer
from a shortage of the most basic supplies and equipment. There
are a total of 17 hospitals and numerous clinics in Basrah
province. Most of the citizens of Basrah go to the public
hospitals and clinics to receive free healthcare, the private
hospitals and clinics are better equipped but most people are
unable to afford their services. The most immediate needs
facing the healthcare system in Basrah are blood bags, x-ray
film and drugs. The hospitals also lack basic medical
equipment, for example, there is only one MRI machine in the
entire province and the wait can be up to six months. Poor
infrastructure requires the hospitals to run their generators an
average of 12 hours per day, lack of proper disposal of
hazardous medical materials and sewage is also a problem. The
consensus among healthcare professionals is that little is being
done by either the local or central governments to help,
however, the Director General for Health does feel that he
receives cooperation and support from the local government. The
medical field is also seeing migration of its doctors and
nurses, especially Sunnis, out of Basrah. All of these elements
contribute to the dismal state of healthcare in a province
currently coping with security and political instability,
healthcare is just one more problem in a long list that faces
Basrah. End summary.

AVAILABILITY OF HEALTHCARE IN BASRAH


2. (U) There are a total of 12 public hospitals, 18 Primary
Health Centers (public clinics),five private hospitals and
numerous private clinics that provide health care services to
the residents of Basrah. Healthcare procedures, treatments and
medicines are provided completely free of charge in public
hospitals and clinics, however, some institutions have a nominal
registration fee of 500 Iraqi Dinars (US 50 cents). Facilities
and availability of equipment and drugs is better at private
hospitals and clinics but few people can afford to pay for
services.


3. (U) The largest public hospital in Basrah is the Basrah
General Hospital. The hospital was built in 1926 and currently
has 696 beds, which according to the current Director of the
hospital, Dr. Ahmed Theyab Abdullah, is typically at 85%
occupancy. The hospital consists of five departments including
surgical, medical, pediatric, obstetric and gynecologic and
technical. The hospital employs 150 specialist doctors, 512
resident doctors and 512 paramedical staff. Approximately 2000
patients come through the hospital's doors each day and the
surgical department performs an average of 1000 surgeries per
month.


4. (U) There are an adequate number of doctors in Basrah but
there is a severe shortage of nurses, especially females,
according to all of the healthcare contacts poloff spoke with.
There is a medical college at Basrah University and the dean of
the college, Dr. Thamer Hamdan, summarized the education of
doctors as good in view of resource constraints. There is no
degree granting program for nursing in southern Iraq, however,
medical college offers a six-year vocational program in lieu of
secondary education. Dr. Thamer, who is also an orthopedic
surgeon at the Teaching Hospital, told poloff that to his
knowledge there are only two nurses at the hospital that have
nursing degrees.

LACK OF ESSENTIAL SUPPLIES AND POOR INFRASTRUCTURE


5. (U) There is a critical shortage of medical supplies and
drugs in all of the hospitals in Basrah. An issue that was
raised in every discussion that poloff had with health sector
contacts was the dire need for blood bags for the province's
blood bank. All hospitals rely on a single blood bank to
provide them with the needed blood for procedures. There are
more than enough people willing to donate blood but no means
with which to store the blood. According to Dr. Ahmed of Basrah
General, requests to the blood bank are for an average of 1000
bags of blood per month, however, only 75 bags are received from
the Ministry of Health (MoH),if supplies are received, per
month. This acute shortage in blood has led to a cessation of
non-emergency surgeries at all of the hospitals. Dr. Ahmed said
that the MoH has promised 3000 blood bags for Basrah but they
have yet to arrive.


6. (U) Other critical shortages include x-ray film and all
types of drug supplies. Dr. Jenan Ghalib, Head of the Pediatric
Oncology department at the Bin Gazwan Children and Maternity
Hospital, told poloff in a meeting on July 13 that she had
recently informed the Director General of Health that if drugs
were not received soon, the department would have to shut down
and turn patients away. (Note: The department is the only
Pediatric Oncology department in all of the south and services

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patients from all four southern provinces. End note.)


7. (U) There is also a lack of medical equipment in the
hospitals and few technicians that can service and maintain the
equipment that is available. According to Dr. Muyed Jumah
Lefta, Director of the Basrah Teaching Hospital, technicians
normally must be sent from Baghdad through a contractor or the
central government. Dr. Muyed expressed frustration to poloff
during a meeting saying that he and his staff must continually
press the MoH in order to get a response for repair work for
their equipment. The Teaching Hospital has the only Magnetic
Resonance Imaging machine in southern Iraq and there is a
six-month waiting list for exams. Basrah General Hospital, the
largest in the province, has only one functioning x-ray machine
and one sonogram machine.


8. (U) The most serious problems posed by lack of essential
services and infrastructure to hospitals are shortage of
electricity, inability to adequately dispose of hazardous
medical waste and no sewage treatment. Basrah General has only
two electricity lines that provide electricity for the entire
hospital complex (a 500 square meter area) and there are
problems with the transformers that carry the electricity in
when it is available. The hospital has two generators but only
one is functional, this generator provides enough power to only
half of the hospital's buildings. During a visit to the private
al Moosawi Surgical Hospital, the director, Dr. Zain al Moosawi,
told poloffs that his hospital runs an average of 16 hours per
day on generators. Dr. Jenan told poloff that the Bin Gazwan
Hospital runs an average of 12 hours per day on their generators.


9. (U) Very few hospitals have the means to dispose of their
hazardous medical waste. The Pediatric Oncology department uses
an incinerator that was donated to them by an NGO, Basrah
General only has one of two incinerators that functions and it
is in use virtually 24 hours a day. The Teaching Hospital on
the other hand does not have an incinerator and all of the trash
is taken away and burned or simply dumped in one of the many
unofficial landfills all over Basrah. Neither of the sewage
systems at Basrah General or the Teaching Hospital are connected
to the city system. Basrah General has septic tanks that are
emptied and maintained by a hired company, the Teaching Hospital
simply dumps their sewage into the Shaat al Arab River as most
residents of Basrah do.

LITTLE HELP FROM THE LOCAL OR CENTRAL GOVERNMENTS


10. (U) All of the healthcare professionals that poloff spoke
with lamented the fact that they receive very little assistance
from the Basrah Provincial Council (BPC) or the MoH. Most
doctors and directors told poloff that they often solicit help
and donations from the private sector and various NGOs. For
example, Dr. Thamer of the Teaching Hospital told poloff that he
would be traveling to Kuwait in the coming days to request
assistance from the Kuwaiti Ministry of Health for blood bags
and x-ray film. The hospital also recently received a donation
of medical supplies from the University of California, Irvine.
Dr. Jenan from the Bin Gazwan hospital also told poloff about a
trip she recently took to Kuwait to solicit help in obtaining
cancer treatment drugs.


11. (U) However, the Director General (DG) of Health, Dr.
Kathim al Timimi, said that he has a good relationship with the
BPC and there is cooperation and coordination on numerous
projects. He cited the recent approval by the BPC of a grant
for ten million ID (US$ 7,500) in order to purchase x-ray film.
He added that turning to the BPC for help has only recently been
done in order to compensate for the severe shortage of supplies.
The DG stated that 31 million ID (US$ 23,255) was needed per
month for medical supplies. According to the DG, the problem
did not lie with the MoH but with the Ministry of Finance (MoF).
He said that the MoH asked for a four billion ID (US$ 3.1
million) budget and the MoF only approved one billion ID (US$
750,000). Dr. Kathim added that Basrah usually only receives
20-25 percent of its requests for supplies and equipment from
the MoH.

INTIMIDATION OF LOCAL HEALTH CARE PROFESSIONALS


12. (C) As with all Sunnis in Basrah, there is also
intimidation and assassinations against Sunnis in the medical
profession. The DG of Health estimated that 60 percent of
doctors in the al Zubair areas of Basrah have left and 30
percent of doctors in central Basrah have left as well. To
highlight the problem, Dr. Jenan called the head nurse of her
department in to a meeting with poloff. The nurse explained
that she was Sunni and her brother and sister, after receiving
threats had already fled Basrah. She said that the reason she
was still in Basrah was because Dr. Jenan convinced her to stay
through the end of July. She lamented that she had over 25
years of experience and loved her job but feared for her life
and wanted to leave as soon as possible. Salaries paid to
doctors and nurses, approximately 200,000-650,000 ID per month

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(US$150-400) to doctors and 150,000-400,000 ID per month
(US$112-300) for nurses are not enough incentive for them to
stay against all of the intimidation and violence they fear.
All of the doctors that poloff spoke with said that the poor
security situation prevented them from coming to the hospitals
after hours.

COMMENT


13. (C) Comment: As with all things in Basrah, the lack of
essential services and poor security situation permeate every
aspect of life. The state of perpetual fear that even the
medical community lives under cripples the amount and type of
care that they can offer the citizens of Basrah. The hospitals
make do with what they have and with whatever resources come
from the MoH but it is clear that more help is needed. As with
everything else in Basrah, from security to politics to the
environment, the state of healthcare is just one more problem in
a long list that the citizens of Basrah must cope with on a
daily basis. End comment.
MARRANO