News Communication was one of the problems, the report recommended Expert Committee finds little main failings outlined in the report. the creation of a Centre for Health fault in Hong Kong’s response The Department of Health (a govern- Protection (CHP) with responsibility, to SARS ment department reporting to the authority and accountability for the Health, Welfare and Food Bureau which prevention and control of communi- A panel of international experts has overall policy responsibility for health cable diseases. commissioned by the Chief Executive matters), only became aware of the first Whilst the report has received some of the Hong Kong Special Administra- major outbreak through news media criticism from Hong SAR’s media for tive Region found shortfalls in the reports. This was a result of an initial not naming individuals, WHO has government’s handling of the outbreak failure in communication between Hong welcomed the commissioning of the in China, Hong Kong Special Adminis- Kong SAR’s Hospital Authority (an report. “It is a reflection of Hong Kong trative Region (Hong Kong SAR), but independent body responsible for the [Special Administrative Region]’s praised its response overall. The 172 page provision of all public hospital services), continuous willingness to be transpar- SARS Expert Committee report was the Department of Health and university ent, even of its flaws,” said Dick published on 2 October and highlighted health experts. Guangdong, where the Thompson, Communications Officer in weaknesses in Hong Kong SAR’s health disease originated, was singled out for WHO’s Department of Communicable system but did not single out any officials having withheld information about the Diseases. “What is important,” he for individual criticism. disease from Hong Kong SAR and the added, “is that these assessments are “Overall the epidemic in Hong rest of the world. “If it had been avail- done and that Hong Kong [Special Kong [Special Administrative Region] able,” the report said, “we believe the Administrative Region], and WHO, was handled well, although there were epidemic might have been ameliorated.” learn from SARS so that we are prepared clearly significant shortcomings of system Lack of contingency planning was for SARS II, whatever that might be.” performance during the early days of also highlighted as a major weakness in The full report and its summary the epidemic when little was known the system. Referring to the outbreak at can be viewed on the Committee’s web about the disease or its cause,” said the the Prince of Wales Hospital on 10 March site at www.sars-expertcom.gov.hk. O report, which also went on to praise in which 11 staff were infected, the Sarah Jane Marshall, Bulletin “the extraordinary hard work of people committee noted the “absence of a pre- at all levels of the system in very determined hospital outbreak control difficult circumstances.” It also pointed plan and the inadequate involvement of Iraq health minister plans out that the shortcomings in the territory’s Department of Health staff in critical health system were aggravated by key decisions about outbreak control measures future Iraqi health system personnel succumbing to the disease. at the Prince of Wales Hospital were Iraq’s interim health minister Khudair Hong Kong SAR was the second not conducive to the management of Abbas is working on plans to transform worst hit area after the mainland itself the outbreak.” Inadequate infection his country’s public health system that with 299 deaths and 1755 infections. control and poor environmental once favoured Saddam Hussein’s allies However, the fatality rate in Hong Kong conditions were also cited as contribut- to one that is more equitable and SAR was much higher, showing 17.1% ing factors to the outbreak at the Prince primary health care-based and reflects compared with the mainland’s 7%. of Wales Hospital and other outbreaks in the dual burden of noncommunicable The Committee was established on Hong Kong SAR. The absence of and communicable diseases. 28 May following criticism by Hong comprehensive laboratory surveillance Dr Abbas has been working closely Kong SAR’s community of its was listed as another important gap in with WHO, the Coalition Provisional government’s handling of the outbreak the system. Authority in Iraq (CPA), several UN during the initial stages of the crisis. The report made 46 recommen- agencies and the World Bank to identify The Committee comprised 11 experts dations presented under 12 strategic Iraq’s immediate health needs and draw from Australia, China including Hong themes with the overall aim of making up a long-term plan for public health. Kong SAR, the United Kingdom and sure Hong Kong SAR is better The plans, which were due to be the USA and was co-chaired by two prepared for future disease outbreaks. presented at a donor’s conference in British doctors, Sir Cyril Chantler and A major recommendation was a review Madrid on 23–24 October, require about Professor Sian Griffiths. Their task was of the organizational structure US$ 1.6 billion in funds from 2004 to to conduct a review of the management including the relationship between 2007 in addition to the US$ 1 billion and control of the epidemic and to the Health, Welfare and Food Bureau already raised by the US Government identify lessons to be learned to better and the constituent government and Iraqi oil revenue. prepare Hong Kong SAR for any departments. Ambiguities in the “Our chief priority is to jump-start future outbreak. The Committee relations between and roles of the the Iraqi health system so that it can formed two groups to focus on hospital departments had led to a breakdown provide basic functions again like disease management and administration, and in coordination and policy-making surveillance, provision of medicines and public health. during the epidemic. To address these basic hospital services,” said David 848 Bulletin of the World Health Organization 2003, 81 (11) News of Kuwait recently made a US$ 3 million donation to a Basrah hospital. Dr Nabarro was optimistic that the Iraqi health bid would get a positive response from donors in Madrid but he said there was no guarantee. “I think there is a good chance that the Health Sector will get support from investors – some conventional donor assistance through the Health Ministry, some as proposed partnerships between companies outside Iraq and the health authorities within the country, and some as support for local initiatives and NGO’s,” he said. O Fiona Fleck, Geneva Malnutrition leading cause of David Nabarro death in post-war Angola Health facilities in Basrah, Iraq, destroyed during the 2003 war. Malnutrition replaced violence as the Nabarro, the senior WHO official The US-led war in Iraq triggered a main killer of displaced children and appointed by the UN and the World complete collapse of the country’s health adults at the end of Angola’s bloody civil Bank to help prepare the health side of system. Outward signs were looted war, says the medical relief organization, Iraq’s needs assessment for Madrid. hospitals and violence against health Médecins Sans Frontières (MSF). A Building a health system virtually workers, especially female staff. survey (BMJ 2003;327:650-5) by the from scratch is a formidable challenge But the system was “already badly organization documents the disastrous amid continued violence, tension and run down” due to previous wars, health impact of armed conflict on an uncertainty and is expected to cost sanctions, drastically reduced spending isolated population that has been billions. WHO has already helped — some estimates suggest the Iraqi health largely ignored by the outside world. Afghanistan, East Timor and, many years budget was cut by 90 per cent during The survey focused on the families ago, Cambodia, rebuild their health the 1990s — as well as an inequitable of former members of the rebel move- systems from the ashes of war. After Iraq, health treatment policy. ment UNITA (União Nacional para a the next such project will be to help Decades of weak primary health Independência Total de Angola), which Sudan create a public health system, care have resulted in high rates of was defeated after a 27-year civil war. Dr Nabarro said. maternal and child mortality, and of A ceasefire was signed in April 2002. But humanitarian agencies in Iraq malnutrition. Diseases like malaria and In the last four years of the war, an say the dire security situation there is cholera are endemic in certain parts of international embargo prevented relief making their mission difficult and Iraq and there is a drastic shortage of organizations from reaching UNITA-held dangerous. After the bomb attack on nurses, epidemiologists and public areas so that by the time of the ceasefire, UN headquarters in Baghdad on 19 health administrators. some three million people were judged August, many — including Médecins One of the first projects was to to be in need of immediate help. Sans Frontières (MSF), the International vaccinate all Iraqi children of five years MSF says that death rates among Committee for the Red Cross (ICRC), and younger against measles, diphtheria, the displaced UNITA families during Oxfam, Save the Children, Merlin and tetanus, whooping cough, tuberculosis, the survey period, between mid-2001 the United Nations High Commis- hepatitis B, and polio by the end of and mid-2002, were about three times sioner for Refugees — scaled back their the year. The National Vaccination Days as high as expected for a population in a operations, withdrew international project is being sponsored by WHO, low-income country. Some of the deaths staff and moved their headquarters to UNICEF, the US Government and the could have been avoided if humanitarian neighbouring Jordan or Kuwait.