War cripples Iraq's health care system
For months, Americans have obsessively focused on the state of their health care system and what is the best way to reform it. For other countries, problems with heath care and public health often have a much more dire urgency. Zaryab Iqbal, an assistant professor of political science at Pennsylvania State University, charts the impact of war on a country’s public health in her book “War and the Health of Nations,” recently released by Stanford University Press. War attacks the health of a nation in direct and indirect ways: from battlefield casualties and the destruction of infrastructure to the creation of refugees and forced migration. Here Iqbal examines what war has done to public health in Iraq.
By Zaryab Iqbal
One need look no further than Iraq’s life expectancy for a strong measure of the war’s health ramifications. The World Bank’s World Development Indicators, published in 2009, shows that life expectancy in Iraq was 65 years in 1990 and rose to 71 years by 1996, only to decline to 67 years in 2007.
This decline cannot be attributed only to casualties of war. It also reflects the numerous ways in which the conflict has weakened the country’s health care system. Consider Iraq’s fertility rate, another key measure for assessing public health. Higher fertility rates are associated with lower levels of health, as they indicate lack of access to contraception and health education, as well as health challenges for both mothers and infants. Between 2000 and 2007, the adolescent fertility rate rose from 0.63 (63 per 1000 women) to 0.86.
The war’s impact on the nation’s medical infrastructure can be seen in the trend in vaccinations against key diseases, which is a good indicator of preventive health care provisions. The percentage of the population that has been immunized against DPT, polio, and measles has steadily declined, according to the World Health Organization and UNICEF. The percentage immunized against measles dropped from about 90 percent in 1999 to less than 70 percent in 2005. Over the same period of time, immunization against polio declined from 86 percent to 66 percent, and the DPT vaccination rate fell from about 78 to 62 percent. This trend of reduced immunization rates could lead to serious repercussions for the population’s health and the prevalence of disease in the future.
The deterioration of other parts of the nation’s infrastructure also has important implications for public health. For instance, the percentage of Iraqis with access to improved water sources declined from 82 percent in 1995 to 77 percent in 2006, according to the World Bank.
The Iraq war has also caused the displacement of a large number of people. The total “population of concern” to the UN Refugee Agency (including refugees and internally displaced persons) originating in Iraq increased from 466,000 in 2002 to 4.8 million in 2008. This tenfold increase in displacement could lead to health consequences not just in Iraq but in refugee-recipient states such as Jordan, Syria, and Saudi Arabia.
Public health clearly suffers from armed conflict, but it will be many years before we can begin to get a clear idea of the extent to which Iraqi society has been affected by this war.
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