UN/IRAQ: UN agencies in post-war Iraq are trying to cope with the dramatic deterioration in the country since the US military operation was launched on March 20th.
The World Health Organisation is the leading the campaign to provide medical care to Iraq's 24 million people.
Dr Ghulam Popal, WHO representative in Iraq, says that before the imposition of sanctions in 1990 and the 1991 Gulf war, Iraq had "one of the best health systems" in the region.
"A comprehensive network providing primary, secondary and tertiary care was in place. There were efficient communications and transportation, including ambulances. There was an excellent public health programme. Medical personnel were well paid. Water, electricity and sanitation were in very good shape.
"Because of this system, the Iraqi population enjoyed a high level of health and social wellbeing."
This is no longer the case, he says. Due to sanctions and war, the system had deteriorated to close to collapse.
The oil-for-food programme, introduced in 1997, reversed this process, he says, but the situation did not return to the 1990-91 level.
"The recent war has had severe consequences for the health system and infrastructure," Dr Popal adds. "Some facilities were damaged during the war and many others were looted, partially or completely. The health information system has completely broken down, disease-control measures have collapsed, all public-health programmes and activities have ceased to function."
Drug warehouses are looted, he says, and distribution had been halted "for the time being" due to insecurity, vehicle theft, the breakdown in communications and the shortage of electricity.
International UN staff are permitted to move round only in guarded convoys while local staff have limited mobility. A WHO driver was shot in Baghdad this week while all UN staff were temporarily withdrawn from the northern town of Kirkuk due to fighting between Kurds and Arabs. Security is deteriorating in the southern city of Basra.
Rating 1990 as 100 per cent, Dr Popal says Iraq's health system was operating at 60 per cent just before the war and 20 per cent now. "This is not a scientific assessment, just figures off the top of my head," he adds.
His greatest concern is the lack of information. "WHO has sentinel reporting sites in different health facilities all over Iraq, trained people who provide information on morbidity and mortality. There were 14 sentinel sites in Baghdad. Our coverage is not as comprehensive as before."
Dr Popal is worried about the outbreak of cholera in Basra."There are only one or two laboratories remaining which can test instances of diarrhoea to see if it is cholera," he said.
There are 36 confirmed cases in the city, a startling increase over the annual average of 39. Many more cases are under investigation. "These are just the tip of the iceberg."
The shortage of water for makes it likely that the incidence of cholera will rise during Iraq's long, simmering summer.