Living conditions in Iraq must improve if investment in health system is to yield results

Despite enormous investment in Iraq's health system in the 10 years since the US-led invasion, the health condition of Iraqis has deteriorated and will fail to improve unless more is done to improve living conditions. A review published today in the Journal of the Royal Society of Medicine concludes that continual investment in health services is crucial to elevate the health status of the Iraqi population, but that progress will be limited without improvements in housing, water and sanitation, electricity, transport, agriculture, education and employment.

The study was carried out by public health doctors from Imperial College London and Wayne State University, Detroit, who carried out several field visits to Iraq between 2011 and 2013. Professor Salman Rawaf, Imperial College London, who led the review, said: "There have been many attempts to come up with solutions that can help channel the resources needed to make Iraq's health system more effective. But our review showed that strategists and planners have a blind spot when it comes to the work that needs to be done to improve all aspects of living which play a vital role in positively affecting the health status of the people."

The authors found that housing conditions in Iraq are in a dire state for the majority of the population, with half a million people living in squatter settlements. While the government is building 25,000 housing units a year, the current need is for three million. The infrastructure for water and sanitation is too old and is a source of illness for many people, even in oil-rich Basra where the water supply is not suitable for human consumption. The national electricity supply is limited to 40%, forcing the public to purchase electricity privately or rely on noisy domestic power generators that increase CO2 emissions and noise pollution. Roads are in poor condition and road traffic injuries unacceptably high. The threat of roadside bombs and terrorist attacks in markets, cafés and places of worship is constant. Indeed terrorist attacks have intensified in 2014, prior to the 30 April general election, the third since the invasion of Iraq in 2003.

The authors also found that the Iraqi agricultural sector is not sufficient to cover the domestic market's need of essential food items and suffers desperately from lack of infrastructure and modern technology. The World Food Programme estimates that 22% of children under five years are stunted due to chronic malnutrition, despite the majority of Iraqi families receiving a monthly food supplement from the government. Literacy is relatively lower in Iraq than other countries in the region and the educational system, despite investment by the government, continues to be hindered by institutional corruption. Unemployment rates are unacceptably high.

Professor Rawaf said: "Living in Iraq today is not easy; nonetheless it is not all doom and gloom. The monumental investment to improve the health system, via national and international efforts, is very promising but needs significant and equal contribution in other aspects of life affecting health and quality of life."

He added: "Iraq's abundant natural and human resource base can be a valuable source for the revival of its economy and coherent social structure. Iraq's contribution to the regional development will be significant."