The State of Iraq's Public Health: a Ground's Eye View from Baghdad

On July 24, EPIC had the pleasure of hosting a discussion with Doctor Kadum Al Hilfy, an Iraqi physician visiting the United States for two months (he returned to Iraq in late July). The gathering was an intimate group NGO community at Amnesty International USA. Dr. Al Hilfy, the 2006 Middle East Doctor of the Year, presented the findings of the World Health Organization’s Iraq Family Health Survey (2007) and shared his firsthand perspective on the state of public health in Iraq.

To collect data, the survey was administered to 9,345 households, including surveying 14,675 women of reproductive age, in over 1,000 neighborhoods and villages in Iraq between 2006 and 2007. It is the first family Health survey to cover all governorates in Iraq by regions and by urban and rural residence.

View Dr. Al Hilfy's PowerPoint Presentation (PowerPoint 5.6MB)

The IFHS was conducted to update and expand the Iraqi national health database through health indicators, such as women’s morbidity and mortality; and measures of disparities in health. The major concern that Dr. Al Hilfy communicated to the group was the accessibility of healthcare, which is strongly influenced by the security situation. According to the doctor, “the main health indicators will deteriorate if the security situation does not improve in the near future…the use of health facilities will decrease as the security situation gets worse, preventing access to preventative and curative healthcare.” It is important to keep in mind that this survey was first administered in 2006, before we started seeing security improvements. However, as the doctor reiterated, access to healthcare remains a huge concern.

How do Iraqis pay for healthcare? The report finds that about one third, 29.8%, said that they had to borrow the money from relatives, friends, or from other sources, while 7.6% relied on selling items and 5.5% used savings to pay for health services. In Kurdistan, the numbers are similar: 24.9% borrowed from relatives or friends, 12.3% used savings, and 5.4% depend on selling items.

A household becomes impoverished when a high proportion of its money is allocated for healthcare payments. The IFHS survey shows that this process occurred in 7.6% of households. Furthermore, about 10% of the non-poor households will become impoverished because of healthcare payments. More often those living in rural areas are impoverished because of healthcare payment (9.2%) than those living in urban areas (6.8%). Dr. Al Hilfy also spoke about the prevalence of domestic violence in Iraq and the difficulties faced in determining the true level that exists:

Collection of data on domestic violence is challenging due to a culture of silence that surrounds the topic. Asking about violence, especially in households where the perpetrator may be present at the time of the interview, also carries the risk of further violence. The IFHS therefore adhered to rigorous ethical and safety standards related to the investigation of domestic violence. It was possible to obtain privacy in 95.6% of the interviews conducted. In the remaining 4.4% of the interviews privacy could not be secured.

In total, 33.4% of women report at least one form of emotional violence. The acts of emotional violence reported by the greatest number of women are the husband belittling or insulting her (22.3%), humiliating her in front of others (21.7%), and scaring or intimidating her (18.3%). The youngest age group report the lowest levels of emotional violence, with 29.2% of 15 to 24 year olds reporting at lest one act of emotional violence. The age group with the highest percentage of women who report having experienced at least one or more attack of emotional violence is the oldest age group, with 26.8% reporting at least one act.

For more information on women’s health I explored Women for Women’s 2008 Stronger Women Stronger Nations report. According to the report, “63.9% of respondents stated that violence against women in general was increasing. In central Iraq and Baghdad, this number jumps to 91.9% and 72.0%, respectively.”

Dr. Al Hilfy also discussed mental health in Iraq, which is a serious concern: roughly 40% of males and 30% of females report high emotional distress. However, Dr. Al Hilfy noted that there is an increasing emphasis in the health community on mental health, and Post Traumatic Stress Disorder (PTSD). PTSD is defined by the American Psychological Association as a psychological condition experienced by a person who had faced a traumatic event which caused a catastrophic stressor outside the range of usual human experience (an event such as war, torture, rape, or natural disaster). Due to the conditions in Iraq, many citizens have been exposed to conditions that are completely beyond the scope of average life. The intense changes made to their society coupled with the breakdown of structure and peace in communities has greatly impacted the mental and physical health of Iraqi populations.

Over half of the respondents had felt nervous, tense or worried in the previous 30 days. A large proration of the respondents also indicate that they are easily tired, often have headaches, and also feel tired all the time. 3.5% of the respondents stated that they thought of ending their own life, while 7.8% thought that they were a worthless person at some point in the month before the survey.

We would like to thank Dr. Al Hilfy for sharing his expertise and unique perspective of the public health sector in Iraq with us and commend him for his efforts to improve healthcare for all Iraqis.

Photo Caption: Dr. Thamer Kadum Yousif Al Hilfy discusses the current state of the public health sector in Iraq.