Iraqi Women's Health Care Needs Urgent Attention
Physicians for Human Rights
Update: 11 May 2003
The overall situation regarding general medical supplies has improved,
however, maternity hospitals remain left out of distribution routes in
many areas of the country. Many of the gender specific supplies PHR identified
as necessary have arrived in An-Nasiriyah. WHO emergency kits, oral rehydration
salts and women’s health medications have been provided to the only
maternity and pediatric hospital in the province of Dhiqar by International
Medical Corps. PHR representatives in Iraq gave lists of essential gender-specific
medications and supplies have been given to the military civil affairs
medical teams, UN agencies, the Iraqi Ministry of Health and many humanitarian
aid agencies.
Bulletin #3: 18 April 2003
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.
From the FieldFor Immediate Release
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.