WHO/

Brief Description of Health Situation and WHO Activities

Dear Dr. Jama,

As discussed over the telephone, kindly find below a brief description of health situation in and WHO activities for kind consideration and advice of the Regional Director.

Best regards,

Ghulam.

1. General Present Situation

· Lack of law and order/insecurity

- Security to health facilities (50% of facilities in ) is guarded by armed militias who established a parallel system to MOH. - All MOH main warehouses guarded by armed militias who are interfering in the distribution of supplies and making distribution to newly opened, non authorized centers. - Hospitals PHCs are guarded by militias, Laying off important staff and recruiting new staff, appointing new directors and removing old ones is going on. - Security of distribution network, warehouses, cold chain, transportation, etc. - Security of population at large. § Restricted movement during the day particularly for women and children. § No movement after the dark as looting, kidnapping, hijacking and killing is going on at a large scale until now.

· Vacuum of power (no relevant national authority). · Damaged health facilities (war and looting). · No salaries for the health personnel for the last 3 months. · No operation cost for the health programmes/facilities · Complete collapse of communication network within Baghdad and between Baghdad and other governorates. · Badly affected transportation (Lack of security, looting in addition to shortage of fuel) · Lack of power (electricity) only two hours/day for Baghdad. · Poor quality/quantity of drinking water and poor sanitation. · Garbage collection and disposal system completely collapsed all over the country. · Insufficient quality/quantity of food/short in proteins. · Loss of all health related data including historical epidemiological information and others. · Victimized and demoralized civil servant. · Shortage of fuel.

2. HEALTH SECTOR

· Absence/breakdown of leadership, control, supervision by national authority. · Complete breakdown of disease control and surveillance. · Complete breakdown of drug distribution system including cold chain. · Complete breakdown of all public health programmes. · Breakdown of all public laboratories with few exceptions. · Potential for outbreak, of communicable diseases particularly water born vector born diseases.

3. Action Taken by WHO, Before, During , and After the War

A- Before the war

- Coordination with relevant agencies and preparation of WHO contingency plan and health sector contingency plan, and inter- sectoral contingency plan. - Training of trainers for disaster management/control of outbreaks during complex emergency/surveillance and control/rapid assessment. - WHO trained at least one team in each district all over Iraq to manage emergencies. Trainees were supplied with the tools for data collection. - Decentralization of MOH stocks in order to deal with the emergency. All hospitals and PHCs were supplied with buffer stock for 3 months just before the war. - Stockpiling of emergency medicines /supplies inside and outside Iraq in the neighboring countries. - Emergency Polio NIDs in January and February in anticipation of war. - Emergency measles catch up house to house campaign for children 9 – 59 months of age during the month of March. The attained coverage of more than 95% was confirmed by independent monitoring. - Formation of Rapid Health Assessment Teams in Baghdad and 3 NGs, from the WHO national staff. - Relocation of international expertise in the neighboring countries to support cross border activities.

B- During War

- Rapid assessment of situation / particularly war related causalities displaced population and disease outbreaks. - Distribution of emergency supplies during the war * For example: 24000 blood bags were distributed to different hospitals during the war * Distribution of Health Emergency Kits - Prevention of outbreaks of diseases. (Measles outbreak in Sulaimania). - Collection of information from other sources and urgent reply to the needs. - Shipment of urgent supplies to Baghdad during the war.

B- After War

- At present, WHO has one main office in Baghdad, 3 sub-offices in the 3 NGs, and WHO national staff in , Kirkuk, , Diala, Babyl and Basrah.

- Baghdad:

· Main Office: WHO Representative Office in Baghdad has been fully rehabilitated after the severe looting and burning. The Office has now recovered its pre-war operational capacity. Seven international staff covering different areas of expertise are now in place. Also, all national staff (117) is reporting to their duty on regular basis. Nine assessment teams are collecting information on the health situation, war damage to the health facilities as well as the reactivation of health services and rehabilitation of the health infrastructure. WHO has also established 14 sentinel surveillance sites in representative geographical locations (6 main hospitals and one sentinel site in each of the 8 districts of ) within the existing health facilities in order to collect on daily basis information on 27 health conditions. · Diyala. WHO appointed a focal point. It has also dispatched two national medical officers to launch the assessment process and brief the DOH staff on how to conduct such activities. Almost all health facilities are reportedly to be intact and this governorate appears to have been less affected by the war and the subsequent looting.

- Three Northern Governorates:

· There are a total of 200 national staff and a total of six international staff. · The health information system is functioning normally. · Nine assessment teams are covering various activities · Drug distribution from WHO warehouses to the health facilities is continuing · All preventive and curative activities are ongoing (i.e. malaria control including spraying, EPI, water quality control, health education, diarrhea disease control and others) · Urgent needs of health facilities during the war were met by local procurement

- Centre (Ninewa (Mosul), Kirkuk and Salah-Al Addin): · The preparation for setting up the coordination office in Mosul to cover the governorates of Ninewa, Kirkuk and Salah-Al Addin governorates has been completed. Three international staff who has been assigned to this office is currently operating from and will soon move to Mosul as soon as security and other logistic arrangements are in place. · For Ninewa governorate (Mosul), a national WHO staff serving as focal point assisted by three national WHO staff from Dohuk Office (two engineers and a data entry clerk) have been attached to the Mosul Office on full time basis. Five assessment teams, seven teams for house keeping and hospital waste collection and disposal, seven sentinel surveillance sites and one team for water quality control have been established. Reports indicate that the following was achieved: (a) A weekly average of 39 tons of garbage and hospital waste have been disposed using rented cars, (b) 400 oxygen cylinders are being daily refilled and supplied to all hospitals in Mosul, (c) The two pharmaceutical plants in Mosul have been assessed and were found severely damaged and looted. (d) Urgently needed life saving drugs and medical supplies valued at $10,852 have been sent from Dohuk to Mosul. (e)Assessment of all 12 hospitals, 25 health centers inside the city and 40 HC in the rural areas were completed. · In Tikrit: A focal point has been appointed and is actively supported by two WHO national medical officers and one national pharmacist from Suleiymaniyah Office. 7 hospitals and four specialized centers, six warehouses, the main pharmaceutical plant of Samara Drugs Industries (SDI) and 29 primary health care centers were assessed. With the exception of the SDI severely damaged and closed and two hospitals mildly damaged, other facilities were found intact. · In Kirkuk: A focal person point has been appointed and is actively supported by two WHO national medical officers and one national pharmacist from Suleiymaniyah Office. WHO teams assessed 21 out of 22 hospitals and specialized centers. 13 were found intact, two mildly damaged and six severely damaged. WHO also assessed 54 primary health care centers of which 32 were found intact,9 mildly damaged and 13 severely damaged. Also, malaria, Kala-azar, diarrhea and water quality control programs are now in place. This is in addition to the provision of urgently needed inputs to maintain basic health care services, including food, fuel and drugs.

- Upper South (Babil, Kerbala, , Wassit and Qaddisiya) · A WHO focal point has been recently appointed, given the necessary orientation and provided with the needed tools including transport and thuraya phone. The focal person will supervise these 5 governoates.

- Lower South (Basrah, Thi-Qar, Missan and Muthana) WHO office has been fully established and five international and three national staff have been appointed. Assessment reports from local health officials, NGOs, DART have been regularly done. Also a WHO daily consolidated OVL (Outbreak Verification List) has been produced since 22 April 2003. A cholera task force led by WHO has been put in place to coordinate all activities aimed at containing, control and managing any outbreak. Sufficient quantity of drugs and medical supplies have been moved to Basrah and pre-positioned in and Amman to be mobilized on short notice if needed. Also WHO has accepted the offer from the British coalition forces to provide drugs and supplies.

Summary 1. Assessment of the drug supply situation and the status of the main warehouses in Basrah has been conducted and the results indicate that all vital essential drugs are available to last for two months. 2. The Assessment report indicate that out of the four warehouses assessed, one was severely damaged while others were either intact or mildly damaged. 3. Comprehensive assessment of health situation and health facilities showed the following:

v 25 WHO health assessment teams are in places all over the country. v Assessment of 32 hospitals in Baghdad is completed and the report will be submitted by Monday. v Assessment of 7 main/MOH warehouses in Baghdad is completed and the report will be finalized by Monday. v Assessment of all public health laboratories is going very extensively. For Mosul, Tikrit and Kirkuk all health facilities including DOH, WHS, hospitals, HCs, other has been completed. The report will be ready by Monday. v For , Diala and other governorates the assessment is going on. v Assessment of disease surveillance system is going on. v Establishing more than 35 sentinel reporting sites, in Mosul, Kirkuk, Tikrit, Baghdad, Basra, by WHO. v Critical information on morbidity and mortality has been collected, in order to monitor the health situation and take immediate corrective measures. v Malaria, Leishmaniasis and diarrheal disease control programmes in Mosul and Kirkuk have started. This will be expanded to other governorates. v Support to vital activities of hospitals /HC is on going. v Delivery of urgently needed medicines, medical supplies, etc. is ongoing. v 14 truck loads of emergency items delivered to Baghdad, 3 trucks load of emergency items from Dohuk to Mosul, 2 trucks loaded of emergency items from Sulaimania to Kirkuk. v Cholera kits from Kuwait to Basra. v One truck from Baghdad to Basra. v Water quality control activities are going on in Kirkuk and Mosul and parts of Diyala. v Coordination with ORHA and others NGOs. v WHO/Baghdad Office is fully rehabilitated after the looting.