Public Health in Iraq

The United Nations High Commissioner for Refugees (UNHCR) reports that there are currently 31.7 million uprooted or stateless people worldwide. Refugees are defined by the U.S. Bureau of Population, Refugees, and Migration as: “any person who is outside any country of such person's nationality…and who is unable or unwilling to return to…that country because of persecution or a well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion.” Refugee status may be due to conflict situations, natural disasters, or other factors, but regardless of the cause, refugees and internally displaced persons face a number of health concerns.

In areas ravaged by war, poor quality food and water and nearly non-existent sewage treatment are major concerns. A 2007 World Health Organization (WHO) report indicated that nearly two million Iraqis are internally displaced persons and an additional two million have left the nation and are living as refugees in Syria and Jordan. Due to growing public health concerns in Iraq and the deterioration of the healthcare system, these numbers are expected to continue to increase. Seventy percent of Iraqis in-country do not have regular access to clean water, and 80 percent lack sewage facilities that do not contaminate sources of drinking water. As a result, in 2007 diarrhea and respiratory infections accounted for approximately two-thirds of the deaths of children age five and under.

The UNHCR reports that the majority of deaths of children under five living in refugee situations in developing countries are: malaria, malnutrition, measles, diarrhea, and respiratory tract infections. Priority is often given to controlling communicable diseases and epidemics, however public health surveillance is also important to ensure these potentially non-lethal conditions are controlled. Immunization, HIV/AIDS programs, reproductive health services, chronic disease management, mental health support are critical to ensuring that conflict-effected and refugee populations are able to survive.

Through online forums like those provided on iCons in Medicine, it may be possible to address and track public health concerns and outbreaks. By presenting these items to the group of volunteer medical experts participating in the iCons in Medicine program, perhaps we may begin to uncover ways of lessening the severity of these situations, or even halting them.

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United Nations High Commissioner for Refugees - The U.S. Bureau of Population, Refugees, and Migration - WHO Report on Public Health in Iraq

Using Telemedicine to Treat Chronic Disease

Chronic diseases pose a threat worldwide, particularly in the developing world. Heart disease, cancer, diabetes, and other chronic diseases account for over half of all deaths each year - double the number of deaths caused by infectious diseases, maternal and perinatal conditions, and nutritional deficiencies combined. Developing nations are facing an epidemic of non-communicable chronic diseases as risk factors such as obesity, lack of physical activity, and tobacco use continue to increase. Contrary to the popularly held belief that infectious diseases are the leading cause of death in the developing world, 80 percent of chronic disease deaths occur in low and middle income countries.

International attention and funding has primarily focused on communicable disease, and as a result the healthcare systems of developing nations are not well equipped to manage chronic conditions. For example, the World Health Organization spends only 50 cents per person on chronic disease (excluding mental health) per year, compared with $7.50 for the major infectious diseases. Regular doctor visits are necessary for proper treatment and management of chronic diseases, but most low- and middle-income countries have not developed the necessary infrastructure or network of specialty physicians to provide this type of care.

Telemedicine and teleconsultation programs offer a cost-effective solution to this problem. Through initiatives like iConsult, healthcare providers in remote or medically underserved areas can consult with specialty physicians over the Internet to gain access to their clinical expertise. By utilizing iConsult, an Endrocrinologist in New York City or Cardiologist in Portland would be able to offer assistance to a provider in a clinic in Chad, and ensure that a patient with diabetes or high blood pressure receives the highest quality of care.

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Reports indicate a nutritious diet, physical activity, avoiding alcohol and tobacco use, and regular medical exams help decrease the risk of developing a chronic disease.

CDC Report on Chronic Disease - WHO Report on Chronic Disease - Report from SciDev Net

See also:
Nugent, R. (2008). Chronic diseases: a growing problem in developing countries. DiabetesVoice, 53, 17-20.

WHO Report on TB and HIV

A recent report from the World Health Organization (WHO) indicates that though the total number of new cases of tuberculosis worldwide remained stable in 2007, the population becoming ill with TB has continued to decline slowly since 2004. However, the 2009 global TB control report also indicates that one of every four TB deaths is HIV-related – a figure that is twice what was previously recognized.

In 2007, there were an estimated 1.37 million new cases of TB among HIV-infected individuals and approximately 465,000 deaths. As quoted in the WHO report, Dr. Margaret Chan, Director-General of the WHO stated that "These findings point to an urgent need to find, prevent and treat tuberculosis in people living with HIV and to test for HIV in all patients with TB in order to provide prevention, treatment and care. Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases.”

Many areas have begun to see increases in HIV testing among people being treated for TB, especially in African nations. Where just 4 percent of TB patients were tested in 2004, 37 percent were tested in 2007 with several countries testing more than 75 percent of TB patients to determine their HIV status. This increase in testing has led to an increase in the number of people receiving appropriate treatment, though it is still only a small fraction of those who need care. Despite increases in testing, the co-infection of HIV and drug-resistant forms of TB presents one of the greatest treatment challenges. The WHO report indicates that in 2007 there were an estimated 500,000 people who presented with multidrug-resistant TB.

Due to the high cost needed to ensure that treatment can be delivered in the ninety-four countries in which 93 percent of the world’s cases of TB occur, additional funding will be needed by the Stop TB Partnership’s Global Plan to Stop TB. Though “remarkable progress against both TB and HIV [have been made] in the last few years…TB still kills more people with HIV than any other disease,” said Dr. Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

See the full 2009 WHO Global TB Report
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