Social determinants of health in countries in conflict - What is GIS ...

42 Social determinants of health in countries in conflict
among IDPs; and doctors have started seeing diseases that they have rarely seen before,
such as typhoid, hepatitis and measles.
Noncommunicable diseases include chronic illnesses, such as hypertension and
diabetes mellitus, which are increasing; patients suffer because of shortage of medication,
poor quality of medicines and poor case management (on problems of storing and
distributing insulin, see Mansour and Wanoose, 2007 [103]). An increase in leukaemia
was noted over the last year in Basra, the west of Iraq and in Baghdad.
Other health problems include drug abuse and mental illness. Drug abuse, especially
among young people, is evidenced by the increasing number of people being taken to
hospital as a result of an overdose. Mental illness, especially depression, is difficult to
deal with because of the stigma associated with it.
Since April 2003 doctors have reported seeing new kinds of injuries from the conflict,
including injuries from cluster bombs, and over the last year, an increase in multi-shell
injuries (including nails) mostly on the head and chest; patients with such injuries die
before reaching hospital because of severe bleeding and the lack of first aid at the scene
or in the ambulance. New weapons cause suffocation and first and second degree burns;
doctors in Ramadi reported two attacks with chlorine gas which killed victims and spread
irritating toxic gas in the surrounding area; most victims were children. Burns units do
not have the capacity to deal with these injuries.
Doctors who were interviewed were concerned about breaches of medical neutrality,
in contravention of the Geneva Convention, which they considered to be undermining
the whole health system. They referred to attacks on health units and arrests of health
workers. In addition, they noted that ethnic and political discrimination was rife with
most employees in a facility coming from the same ethnic background or sharing the
same political affiliation; doctors also alleged that the militias were infiltrating the
Ministry of Health and the hospitals.
The doctors interpreted the overall outcome of this situation as contributing to the
breakdown of trust and confidence between patients and health providers, for example,
people are afraid to go to a provider or facility associated with a different ethnic or
political background, and to the mass migration of health workers from Iraq; the Ministry
of Health estimates that one half of the country’s doctors have fled [37].
Doctors reported the development of coping strategies to respond to the health
crisis such as: doctors opening clinics in their homes rather than in commercial areas,
which they see as less secure; people visiting pharmacies or a local nurse rather than a
doctor; people returning to the use of natural remedies and herbs; and women returning
to dependence on midwives and on delivering at home.
SDH-chapters-countries in conflict-7 Oct.indd 42 08/10/2008 14:24:52