Why are there shortages of essential medicines in Iraq?
On December 16th, I received the following information from a confidential source in USAID:
"USAID's role in the health sector in Iraq is now limited to completing construction of the Basra hospital/pediatric facility. The funds appropriated by Congress in the Iraq Relief and Reconstruction (IRRF 2) supplemental (the $18B) are primarily under the control of and have been contracted out by DOD. Under the first IRRF supplemental, USAID did program some $3.5B in funding, including for the health sector; however those activities have been completed or are now winding up. The activities described below were carried out with that initial funding. "WHO's grants with USAID have supported immunization programs but not the cost of vaccines. However, using USG funds under its grant, UNICEF has contributed to the cost of some vaccines in 2003 and 2004. UNICEF has also used USAID grant funds to bring in some supplies of other essential medicines for use at the primary health care center level. It should be noted, though, that UNICEF grant funds in health are spent down, with final activities underway.
"The Iraqi Ministry of Health (MOH) is responsible for the procurement and distribution of all medicines. There are significant problems associated with this process and accordingly shortages of drugs around the entire country, not just in Basrah. At present, governorate level Directorates of Health follow an established process of working with the central MOH to request drugs and indicate when there are problems of shortages. That said, there are continuing shortages of some drugs. The Ministry is attempting to resolve these issues but it will take some time and considerable resources to improve drug procurement, distribution and logistics management systems."
In other words, the first supplemental included funds for essential medicines (via UNICEF and the WHO), but the second supplemental did not. The second supplemental included $784 million to reconstruct 19 hospitals and 142 clinics, and these funds included $75 million to be disbursed in April 2006 for equipment. Exactly zero was set aside for essential medicines. Why? Because it's now the responsibility of the Iraqi MOH to procure and distribute all medicines. Yet, the MOH has neither the resources nor the infrastructure to distribute these medicines. The Minister of Industry and Minerals, Usama Abdulaziz, estimates that Iraq's pharmaceutical companies meet 50% of the country needs.
As a consequence, hospitals and clinics throughout Iraq are experiencing critical shortages of basic medicines. The following was recently reported in the Guardian Observer: "'Government is not functioning in so many sectors,' says Oliver Burch of Christian Aid, which has several partner organisations working across Iraq. 'The health budget for last year was $1bn, but out in the provinces, doctors in hospitals and clinics are appealing to everyone they can find, because they can't get the place painted; they can't get the toilet fixed; they can't get basic drugs.'" In August 2005, I received a list of essential medicines needed at a children's clinic in Basra. This list--which included drugs for leukemia and solid tumor treatment, anti-nausea medications, rehydration agents, and pneumonia antibiotics--was passed to two members of the Washington State Congressional delegation. Normal political channels proved to be useless; in the end, an Austrian NGO provided the Basra clinic with a shipment of medicines. However, that shipment has now run out, and the Basra children's clinic is out of everything. A colleague recently passed me the following from the clinic's director:
"Dear Amy In other words, the clinic can't even treat dehydrated children with a saline drip. And with potable water now available to only about 32% of the population, water-borne diseases could reach epidemic proportions among children.
How many children must die in Iraq before one member of Congress stands up and says, "Enough!" Is there no one in Congress who cares?
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