Medical education and public health in Iraq are a complicated mix of resilience in the face of extraordinary adversity—generated by decades of intermittent conflicts—and the more ordinary need to address maternal health challenges linked to Iraq’s rapidly growing population.
Those were among the key impressions left by a panel of health professionals from Iraq who traveled to TropMed17 to discuss the issues encountered today in the country’s health care facilities, medical education institutions and public health programs. The talk was sponsored in part by the Washington, DC-based International Research and Exchange (IREX) program and is thought to be the first time Iraqi medical professionals have presented at TropMed on medical education and public health in their country.
The many conflicts experienced in Iraq loom large. They include the Iran-Iraq war in the 1980s, the war over the invasion of Kuwait in the 1990s—and subsequent crippling sanctions. Then there was the U.S. invasion in 2003 that was followed by an Al Qaeda insurgency and, most recently, the chaos wrought by ISIS.
“The wars have had many side effects and one is the destruction of health infrastructure in our country,” said Mohammed A. Alqortasi of the Al Kindy College of Medicine at the University of Baghdad. “Iraq’s (health system) in the 1980s was equal to a developed country. But the destruction affected that status.”
For example, he said there are now 3.5 million “displaced persons” in Iraq and that has led to a re-emergence of threats like cholera and outbreaks of diarrheal disease. Also, he said the country has lost many health professionals. It’s now down to about 10 physicians per 100,000, compared to wealthy countries like the U.S. where there that number is about 230.
But Alqortasi sees positive signs of progress. He said there are efforts underway to improve accreditation of medical schools and encourage more Iraqi health experts to conduct research and publish in medical journals.
His colleague, Ekhlas K. Hameed, also from Al Kindy, praised her country for setting high standards for incoming medical students and covering all of the costs for their training. The six-year education program is conducted “completely in English,” she said, in order to ensure students are able to communicate with their peers “all over the world.”
Taghreed Alhaidari, who works in Obstetrics and Gynecology at Al Kindy, said looking to the future, Iraq’s rapidly growing population, a cultural preference for large families, and a demographic trend in which one quarter of Iraqis are women of child-bearing age are increasing demand for maternal health services.
She said maternal mortality fell from around 200 per 100,000 births in the mid-1990s to as low as 32 just a few years ago. She said recently there has been an increase in maternal deaths to about 36 per 100,000, though Alhaidari said WHO believes that number is closer to 57. She said postpartum hemorrhage is the most frequent cause of maternal death.
Alhaidari said some of the increase in maternal mortality is undoubtedly due to the large number of people displaced by the military conflicts.
“Whenever you have a crisis, women and girls are more at risk,” she said.
Alhaidari said that the health system needs to adjust to the surging population by investing more in reproductive health and family planning and reshaping the curriculum in medical schools to focus more on disciplines like obstetrics.