The state of health in Iraq has fluctuated during its turbulent recent history. During its last decade, the regime of Saddam Hussein cut public health funding by 90 percent, contributing to a substantial deterioration in health care.[1] During that period, maternal mortality increased nearly threefold, and the salaries of medical personnel decreased drastically.[1] Medical facilities, which in 1980 were among the best in the Middle East, deteriorated.[1] Conditions were especially serious in the south, where malnutrition and water-borne diseases became common in the 1990s.[1] In 2005 the incidence of typhoid, cholera, malaria, and tuberculosis was higher in Iraq than in comparable countries.[1] The conflict of 2003 destroyed an estimated 12 percent of hospitals and Iraq’s two main public health laboratories.[1] In 2004 some improvements occurred.[1] Using substantial international funds, some 240 hospitals and 1,200 primary health centers were operating, shortages of some medical materials had been alleviated, the training of medical personnel had begun, and the inoculation of children was widespread.[1] However, sanitary conditions in hospitals remained unsatisfactory, trained personnel and medications were in short supply, and health care remained largely unavailable in regions where violent insurgency continued.[1] In 2005 there were 15 hospital beds, 6.3 doctors, and 11 nurses per 10,000 population.[1] Plans called for US$1.5 billion of the national budget to be spent on health care in 2006.[1]
In the late 1990s, Iraq’s infant mortality rates more than doubled.[1] Because treatment and diagnosis of cancer and diabetes decreased in the 1990s, complications and deaths resulting from those diseases increased drastically in the late 1990s and early 2000s.[1] The collapse of sanitation infrastructure in 2003 led to an increased incidence of cholera, dysentery, and typhoid fever.[1] Malnutrition and childhood diseases, which had increased significantly in the late 1990s, continued to spread.[1] In 2006 some 73 percent of cases of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in Iraq originated with blood transfusions and 16 percent from sexual transmission.[1] The AIDS Research Centre in Baghdad, where most cases have been diagnosed, provides free treatment, and testing is mandatory for foreigners entering Iraq.[1] Between October 2005 and January 2006, some 26 new cases were identified, bringing the official total to 261 since 1986.[1]
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Infant mortality rates fell from 80 per 1,000 live births in 1974, to 60 in 1982 and 40 in 1989, according to government statistics. A similar trend characterized under-five mortality rates which halved from 120 per 1,000 live births in 1974 to 60 in 1989.[2]
In the eight months following the 1991 war, mortality rates for children under five shot back up to 120 per 1,000 live births, the highest recorded increase for any country in the world in the 1990s. The war and the sanctions destroyed the capital-intensive model of free and sophisticated care.The war damaged hospitals, foreign nurses left the country; and the health budget was slashed. Spending per capita fell from a minimum of US$86 to US$17 in 1996.[2]
Iraq had developed a centralized free health care system in the 1970s using a hospital based, capital-intensive model of curative care. The country depended on large-scale imports of medicines, medical equipment and even nurses, paid for with oil export income, according to a “Watching Brief” report issued jointly by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) in July 2003. Unlike other poorer countries, which focused on mass health care using primary care practitioners, Iraq developed a Westernized system of sophisticated hospitals with advanced medical procedures, provided by specialist physicians. The UNICEF/WHO report noted that prior to 1990, 97 percent of the urban dwellers and 71 percent of the rural population had access to free primary health care; just 2 percent of hospital beds were privately managed. [2]
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