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Is it the guy who asks you after the meeting about how the antiwar movement needs to get "serious" and asks you lots of questions about terrorism and "fighting back"? Jennifer Van Bergen reports, first-hand. Part 2 of our series on what really happened on 9/11/2001: the physics of collapse, and how not to make a "pancake" by Manuel Garcia, PLUS Engineer Pierre Sprey on why "controlled demolition" theories are off target. What you just missed, but can still get, in our last newsletter: Paul Craig Roberts on the Collapse of America. CounterPunch Online is read by millions of viewers each month! But remember, we are funded solely by the subscribers to the print edition of CounterPunch. Please support this website by buying a subscription to our newsletter, which contains fresh material you won't find anywhere else, or by making a donation towards the cost of this online edition. Remember contributions are tax-deductible. Click here to make a donation. If you find our site useful please: Subscribe Now! |
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Today's Stories October 16, 2006 Gary Leupp October 14/15,
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Weekend
Edition Where Have All the Doctors Gone?The Collapse of Iraq's Health Care ServicesBy DAVID WILSON The Fourth Geneva Convention (1949) contains specific provisions pertaining to the delivery of healthcare services in occupied territories. Article 55 states: To the fullest extent of the means available to it, the Occupying Power has the duty of ensuring the food and medical supplies of the population; it should, in particular, bring in the necessary foodstuffs, medical stores and other articles if the resources of the occupied territories are inadequate. Article 56 states: To the fullest extent of the means available to it, the Occupying Power has the duty of ensuring and maintaining, with the cooperation of national and local authorities, the medical and hospital establishment and services, public health and hygiene in the occupied territory with particular reference to the adoption and application of the prophylactic and preventive measures necessary to combat the spread of contagious diseases and epidemics. Medical personnel of all categories shall be allowed to carry out their duties, () As occupying powers, the 'Coalition' forces in Iraq are in breach of Articles 55 and 56 of the Geneva Conventions. There has been an abject failure to carry out even minimal humanitarian duties. Indeed the healthcare system in Iraq has massively deteriorated since the start of the war. From a public health point of view, an end to occupation is vital for the life-chances and good health of the population of this country. Until this takes place Iraq will remain a place of 'social breakdown' (1), a country of the dead, the dying and the despairing. THE DEAD
A survey carried out by Iraqi physicians, overseen by epidemiologists at Johns Hopkins University's Bloomberg School of Public Health, supported by Massachusetts Institute of Technology's Center for International Studies (3), estimates that 655,000 more people have died in Iraq since coalition forces arrived in March 2003 than would have died if the invasion had not occurred. The surveyors found a steady increase in mortality since the invasion, with a steeper rise in the last year that appears to reflect a worsening of violence as reported by the U.S. military and the news media. In the year ending June 2006, the team calculated Iraq's mortality rate to be roughly four times what it was the year before the war. According to the study of the total 655,000 estimated "excess deaths," 601,000 resulted from violence and 54,000 from disease and other causes relating to the broken infrastructure of Iraqi society. Both this and an earlier study from the same team in 2004, are the only ones to estimate mortality in Iraq using scientific methods. The technique, called "cluster sampling," is used to estimate mortality in famines and after natural disasters. The methodology of the John Hopkins study is tried and tested. "It has been the basis for mortality estimates in war zones such as Darfur and the Congo, writes Lancet Editor, Richard Horton (4). "Interestingly, when we report figures from these countries politicians do not challenge them. They frown, nod their heads and agree that the situation is grave and intolerable. The international community must act, they say. When it comes to Iraq the story is different. Expect the current government to mobilise all its efforts to undermine the work done by this American and Iraqi team. Expect the government to criticise the Lancet for being too political. Expect the government to do all it can to dismiss this story and wash its hands of its responsibility to take these latest findings seriously." For the dead we can only mourn meanwhile for the living there are . THE BASIC NEEDS OF THE PEOPLE Law and order does not exist as the police themselves are involved in the killing. There are so many bodies that their disposal has become a problem of waste management. Most cities have to cope with fly-tipping of rubbish. Baghdad has to cope with the fly-tipping of corpses. (5) Vast sums of money were made
available to the US-led provisional authorities (CPA), headed
by Paul Bremer, to spend on rebuilding the country. By the time
Bremer left the post, $8.8bn of that money had disappeared. The
situation has not improved under the new 'independent' Iraqi
government The International Advisory and Monitoring Board (IAMB) was established to provide independent, international financial oversight of CPA spending. (This board included representatives from the United Nations, the World Bank, the IMF and the Arab Fund for Economic and Social Development.) The IAMB spent months trying to find auditors acceptable to the US. KPMG was finally appointed in April 2004. KPMG stated that they "encountered resistance from CPA staff regarding the submission of information required to complete our procedures." The auditors even had trouble getting passes to enter the Green Zone. Millions of dollars in cash
went missing from the Iraqi Central Bank. Between $11m and $26m
worth of Iraqi property sequestered by the CPA was unaccounted
for. The payroll was padded with hundreds of ghost employees.
Millions of dollars were paid to contractors for phantom work.
Some $3,379,505 was billed, for example, for "personnel
not in the field performing work" and "other improper
charges" on just one oil pipeline repair contract.
In October 2006, Jan Egeland, UN Under Secretary General gave the following information: 1,000 Iraqis are fleeing their homes every day, 365,000 people have been displaced in the last eight months, with 1.5 million displaced people throughout Iraq, revenge killings are 'totally out of control', 100 people are killed every day. "Many of those who were fleeing were highly educated people such as doctors some estimates are that universities and hospitals had a loss of up to 80% of their professional staff."(7) While Iraq's infrastructure lies in ruins, billions of dollars have flowed into the coffers of US companies such Haliburton, while billions more are simply unaccounted for. With such a cataclysmic breakdown of basic infrastructure the first question is ... WHERE ARE THE DOCTORS?
There are said to be one million Iraqis living in neighbouring countries as a result of war and occupation and a further 350 thousand outside the region. They include those rich enough to get out and many professionals fleeing threats to their lives and possible kidnapping. Of these many are medical personnel. The Iraqi Health Ministry estimates that, as of October 2005, 25% of Iraq's 18,000 physicians had left the country since the invasion in 2003. Earlier this year MEDACT reported that "doctors and other health workers were being attacked, shot at, threatened, kidnapped, and told to leave the country or die". (9) In March 2006, Dr Alaa Hussein, Manager of the Health Ministry Labour Development Department said that 400 medical specialists had left Iraq since 2004 and that 176 medical workers had been killed in the same period. Unofficial figures put these much higher and to them must be added the numbers of doctors kidnapped (said to be in excess of 250 since 2004). In some areas nurses have replaced doctors. This has had a devastating effect on the Iraqi health sector with understaffed hospitals and inexperienced medical staff undertaking procedures they are not qualified to perform. Amer Hassan Fayed, Asst Dean of Political Science at Baghdad University says, " we could end up with a society without knowledge. How can such a society make progress?" The Institute for War and Peace reporting say that in Baghdad those doctors still practicing have moved their clinics into residential areas or inside medical compounds for safety. They only open in the morning and leave in the early afternoon because of curfews and poor security. Most of Baghdad is now shut down by the evening. Throughout Iraq healthcare provision is in such a poor state even compared with the era of Saddam Hussein's rule, let alone international standards, that many families have been driven to learn basic medical care themselves. Dr Majeed al-Naomi, who runs a private clinic in the Iraqi capital, is quoted as saying: "Healthcare in Iraq since 2003 is worse than during the sanctions. At that time we had little equipment and medicine, but in the last three years we have lost almost all the specialists." (10). In UK 'controlled' Basra there are no reliable statistics on how many doctors, dentists, pharmacists and nurses have left the area, but unofficial data suggests that at least 200 health professionals have left since January 2006 alone. The emergency unit in Basra's Teaching Hospital was closed for five months after a number of doctors were killed by unidentified attackers while working there. Now many doctors and nurses refuse to go to work, fearing for their lives. "I have a family to look after," said one paediatrician from the Teaching Hospital, speaking anonymously. "Even though it's my responsibility to look after my patients, I can't risk turning my sons into orphans - their father, also a doctor, was killed while doing his duty at the hospital." The British armed forces, nominally overseeing the infrastructure of occupied southern Iraq, admit that they have no idea what the situation is in Basra's health clinics and hospitals and that they are in no position to undertake visits, medical or other deliveries. Hospitals, their staff and patients have also come under attack from Coalition forces. In the US attack on Fallujah in 2004 the General Hospital was not the place to be for better health and security. Its services and those of clinics throughout the city were obstructed by US Marines with US snipers targeting medical facilities and ambulances. Dr Ahmed told Dahr Jamail, "The Americans shot out the lights in the front of our hospital. They prevented doctors from reaching the emergency unit at the hospital, and we quickly began to run out of supplies and much needed medications."(11) Dr Rashid who worked in the Juamria Quarter of Fallujah told Dahr Jamail, that the major problem they faced was from US snipers. He told of an incident in which a sniper shot an ambulance driver in the leg. He survived, but a man who came to his rescue was shot and died on the operating table after Dr Rashid had tried to save his life. Other hospitals throughout Iraq have reported similar incidents. Doctors have also been targeted by death squads and US military at home and in the streets. In September 2005 in the al-Kudat district of Baghdad, a brain-surgeon, Basil Abbas Hassan was travelling to his hospital in the city centre. He drove out of a side street without noticing an American convoy approaching from behind. A US soldier shot him dead. Not many of his friends attended his funeral because so many had already fled from Iraq. (12). Do the overworked doctors and medical staff have adequate funding and supplies? DISAPPEARING MEDICAL FUNDS AND SUPPLIES
Iraq's hospitals were once the envy of the Middle East. Wealthy businessmen used to fly their relatives in for everything from heart transplants to plastic surgery, and Iraqi specialists travelled the world lecturing about their research. But medical care deteriorated under twelve years of UN sanction, and war and occupation since 2003 have resulted in a further collapse. In April 2003, the US awarded Abt Associates Inc, a Massachusetts-based consulting firm, a $43 million contract to improve the Iraqi Ministry of Health and distribute medical supplies throughout the country. At the same time according to a USAID audit, 'medical kits intended for 600 clinics contained damaged or useless equipment.' Deputy Minister of Health al-Saffar recently announced that of the 180 health clinics the US hoped to build by the end of December 2005, only four have been completed and none have opened. Power supply is a major problem for most Iraqi hospitals. Ahlan Bari, the nurses manager at Yarmouk Teaching Hospital in Baghdad told Dahr Jamail on 8 April 2004, "We had a power outage while someone was undergoing surgery in the operating room, and he died on the table because we had no power for our instruments." Many hospitals do not have fully functioning backup generators because they lack funds to have them repaired. In many cases, spare parts are unavailable. Al-Yarmouk, the largest emergency hospital in Baghdad, lacks medicines, disinfectants, surgical requirements, bed sheets, cleaning aids and personnel. (14) A medical aid worker in Basra informed MEDACT that most hospitals there have limited - and in some cases no - supplies of IV fluids, IV cannulae, antibiotics and oxygen. Chuwader General Hospital in Sadr City, one of two hospitals covering an area of nearly two million people, has a shortage of most supplies with the lack of potable water the major problem. Chief manager, Dr Qasim al-Nuwesri has said: "of course we have typhoid, cholera, kidney stones but we now even have the very rare Hepatitis Type-E and it has become common in our area". He added that they had not faced these problems before the invasion of 2003. (15). Dr Qasim al-Nuwesri also testified that his hospital was short of every medicine. "It is forbidden, but sometimes we have to reuse IV's, even the needles. We have no choice." In or out of hospital the most vulnerable victims are the youngest. THE CHILDREN Iraqi children, says UNICEF, are now dying faster under the Blair and Bush occupation than under Saddam Hussein. The children of Iraq are caught up in war for the third time in 20 years. According to UNICEF almost half of the population is under the age of 18. Even before the most recent conflict began, many children were highly vulnerable to disease and malnutrition. One in four children under five years of age is chronically malnourished. One in eight children die before their fifth birthday. (16) According to Hayder Hussainy, senior official at the Iraqi Ministry of Health, approximately 50% of Iraqi children suffer from some form of malnourishment and one child in ten is suffering from chronic disease or illness. A UN study in 2005 found that a third of children in southern and central Iraq are malnourished. According to a 2004 Health Ministry study, 'easily treatable conditions such as diarrhoea and respiratory illness account for 70% of deaths among children'. (17) "The only things they (Iraqi children) have on their minds are guns, bullets, death and a fear of the US occupation." (Maruan Abdullah, Spokesman for the Association of Psychologists of Iraq.(API) Acccording to API , 'children in Iraq are seriously suffering psychologically with all the insecurity, especially with the fear of kidnappings and explosions. The API surveyed over 1,000 children across Iraq and found that '92% of children examined were found to have learning impediments, largely attributable to the current climate of fear and insecurity.' Marie Fernandez, a spokeswoman for Vienna-based aid agency Saving Children from War, said that the agency - which has been working with local doctors - has noted a lack of essential supplies, especially intravenous infusions and blood bags. "There's a lack of everything. Children are dying because of bleeding because there are no blood bags available," said Fernandez. "Antibiotics, Pentostam [an antimony compound used in the treatment of parasite infection], special milk for dehydrated children, and almost all medical material for emergency conditions aren't available." (18) In Baghdad, Ministry of Health officials say they are struggling to acquire the required medicines, but noted that their efforts were largely impeded by security issues and official corruption. "Because of security problems, it's difficult to have a complete picture of the problem," said senior ministry official Ahmed Saled. At the Paediatric Teaching Hospital in the Iskan neighbourhood of Baghdad two or sometimes three children have been crammed into single beds. Sewage leaks onto the floors of the rooms where doctors perform surgery. And the lines to get prescriptions filled stretch outside the doors. Flies hover around beds that smell of wet bandages. And it is not uncommon for blood and other spillage to remain on the floors for hours because antiseptic cleaning supplies are not available.(19) In 'UK-controlled' Basra, "there are no official statistics about the number of children who have died since January," said Hassan Abdullah, a senior official in the Basra governorate. "But local health department employees and volunteers from some NGOs have collected information suggesting that in 2006 alone, about 90 children have died as a result of the lack of medicine." According to Abdullah, this is worse than the same period last year, when some 40 children died for similar reasons. According to doctors at Basra's Maternity and Child Hospital about 40 children per day had been admitted to the hospital since May 2006, due to high temperatures resulting from poor water quality. "Children between the ages of one and three years are the most affected by problems of dehydration and pneumonia, meningitis, malnutrition and typhoid," said Marie Fenandez. "And some cholera cases have also been reported." About 14 to 16 new cancer and leukaemia cases have also been reported among children each month. "It's painful to see so many children dying of cancer as a result of inadequate treatment," said Dr Ali Hashimy, an oncologist at the hospital. "If there was medicine, they would have been saved." Specialists also note a disturbing increase of cases of Kala Azar among children, especially at the height of summer and under deteriorating sanitation conditions in Basra. Kala Azar is a potentially fatal disease transmitted by the sandfly parasite that preys on internal organs. "There are about 40 to 50 cases of Kala Azar per month in Basra's Maternity and Child hospital," said Fernandez. "Kala Azar can be completely cured if treated by Pentostam, but it can be fatal without treatment." Pentostam has not been available in southern Iraq for several months--not even on the black market, where the drug had been available last year. But Pentosam would be unnecessary if it weren't for the garbage. It has recently been reported that in Basra children who play in piles of rotting garbage throughout the city are increasingly suffering from typhoid fever as well as fungal and bacterial skin diseases.(20) Up to 15 children per week come to the Children's Hospital of Basra with diseases related to their contact with accumulated garbage. Dr Hussein Ashayri, clinician at the Children's Hospital of Basra, reports, "ome children even eat food found in the garbage, and others usually do not wash their hands after playing with it" But the garbage may contain a weapon of mass destruction DEPLETED URANIUM
There are accounts that US forces have used illegal weapons in Iraq with eyewitness reports from towns such as Fallujah claiming many people were killed by napalm combined with white phosphorous. This combines to become a sticky gel that burns at 300-350°C (572-662°F), causing fourth degree burnings. The chemicals react with the water in human cells. Clothes stay intact, but the affected skin burns to the bone. Since these chemicals react with water, the effect worsens when you pour water on it. The only means to stop the burning is by smothering it with mud. Without 'independent' media reports from affected areas of Iraq it is difficult to find out the extent of such war crimes, but on one such crime the evidence is available and it is stark and shocking.(22) This is the use of depleted uranium weapons which have an immediate and long-term affect on public health. "DU will remain part of our arsenal for the foreseeable future because we have a duty to provide our troops with the best available equipment with which to protect themselves and succeed in conflict" Sec of State for Defence Geoff Hoon, March 2003 The BBC reported on 24 April 2003 that "The MoD could give no figure for the amount of DU used in Iraq: one unconfirmed estimate suggests the total could be about 1,500 tons, five times more than was used in the 1991 Gulf war. Two hundred tonnes of radioactive material were fired by invading US forces into buildings, homes, streets and gardens in Baghdad alone and it is believed much more has been used across the rest of the country. (23) Because of its hardness it is used as armour plating for tanks and 23 weapon systems are now suspected of using uranium warheads, including cruise missiles, bunker busting bombs, small smart bombs, and cluster bombs. Depleted uranium (DU) is the waste product from the process of enriching uranium ore for use in nuclear weapons and nuclear reactors. Like other heavy metals such as lead, it is chemically toxic but it is also an alpha particle emitter with a radioactive -half-life of 4.5 billion years. In the words of The US Army Environmental Policy Institute: "DU is a low-level radioactive waste, and, therefore must be disposed of in a licensed repository. DU is extremely dense, pyrophoric, cheap, available in huge quantities; and used in kinetic energy penetrators (rods of solid metal shot from guns). Kinetic energy penetrators do not explode but fragment and burn through armour due to the pyrophoric nature of uranium metal and the extreme flash temperatures generated on impact. When a DU shell hits a hard surface target, it burns at 10,000ºC. 30% of the shell fragments into shrapnel with the remaining 70% vaporising into three different and highly-toxic oxides, including uranium oxide. A target hit by a DU shell is left covered in black dust, whilst much of it remains suspended in the air and is subject to the whims of wind and weather. If this radioactive vapour is inhaled, it can mutate 35% of cells in surrounding tissue. The impact of one 120mm DU shell fired from an American Abrams tank creates between 900 and 3,400 grams (roughly 2 to 7 pounds) of uranium oxide dust. 52 to 83% of those respirable size particles are insoluble in lung fluids. Respirable size particles (less than 5 microns in diameter) are easily inhaled or ingested. Insoluble particles may remain in the lungs or other organs for years. The emission of predominantly Alpha as well as Beta and Gamma radiation from these particles and debris will persist for the life of the planet, not only in target areas but also wherever they are carried by winds. The particles can remain suspended in the earth's atmosphere for months and travel vast distances. Internalised DU may cause kidney damage, cancers of the lung and bone, non-malignant respiratory disease, skin disorders, neurocognitive disorders, chromosomal damage, and birth defects, immune deficiency syndromes, rare kidney and bowel diseases. Children are born with genetic defects, moderate to severe deformities, rare illnesses and develop cancers very young. "This (DU use as a 'weapon') has caused a health crisis that has affected almost a third of a million people (in Iraq)"(Dr Ahmad Hardan, scientific adviser to the World Health Organisation) He adds that women as young as 35 are developing breast cancer and sterility among men has increased tenfold. Dr Hardan has stated that one of the worst affected areas is in Basra and surrounding area and that if the experience of Basra is played out in the rest of the country, Iraq is looking at an increase of more than 300% in all types of cancer over the next decade. In Basra every form of cancer has jumped up at least 10% with the exception of bone tumours and skin cancer, which have only risen 2.6% and 9.3% respectively. Another tragic outcome is the delayed growth of children. Skeletal age comparisons between boys from southern Iraq and boys from Michigan show Iraqi males are 26 months behind in their development by the time they are 12-years-old and girls are almost half a year behind. "The effects of ionising radiation on growth and development are especially significant in the prenatal child", adds Dr Hardan. "Embryonic development is especially affected." Three years after the invasion of Iraq it is very hard to estimate the exact situation because all barriers have been placed in the way of those who want to find out. "I arranged for a delegation from Japan's Hiroshima hospital to come and share their expertise in the radiological related diseases we are likely to face over time," says Dr Hardan. "The delegation told me the Americans had objected and they had decided not to come. "Similarly, a world famous German cancer specialist agreed to come, only to be told later that he would not be given permission to enter Iraq."(24) Reporting from Iraq in October 2002, Felicity Arbuthnot, visited the Al Mansour Children's Hospital in Baghdad and spoke to doctors there who told her that slow-motion nuclear weapons had been used on Iraq during the first Gulf War. Cases of child cancers and leukaemias seemed to have a common denominator; they all came from heavily bombarded areas. Dr Ali, doctor in charge at the Al Mansour, estimated a fivefold rise in child cancers since the (first) Gulf War: 'though since we are not allowed the scientific facilities to implement a proper investigation and statistical survey, we have no proof.' He told Felicity that between 1978 and 1992 there were two hundred and seventy cancer and leukaemia cases recorded at the Al Mansour. Between November 1992 and 2002 the hospital had recorded 1,714 cases. The American and British occupation forces are responsible for:
These acts are breaches of
the Geneva Conventions and represent crimes against humanity
because these weapons are causing incalculable harm and suffering
to civilians in all contaminated areas. CONCLUSION Tony Blair resisted Clare Short's call (when Secretary of State for International Development) for the United Nations and the Red Crescent to take over civil and humanitarian aid in post-war Iraq. He had already surrendered this role to the Pentagon, the CPA and the Bechtel's and Halliburton's. With the disbandment of the Iraqi Baath administration in contravention of the 1907 Hague Convention, the situation was set up for chaos and corruption. The 'election' of the Jalal Talabani government allows the US and UK, now renamed the 'international' forces, to claim that they are no longer occupiers, but remain in Iraq as guests of an independent country and working under a UN mandate. They will claim that the Geneva Conventions, in so far as they apply to 'occupiers' therefore no longer apply to the actions or inactions of their military forces. This is as about as disingeneous as the logic applied to their arrival in Iraq under the hail of 'shock and awe'. The Geneva Conventions have been flouted and war crimes have been committed. That remains the case so long as the situation of effective and real occupation pertains. With the use of weaponry such as depleted uranium there is evidence of a massive, and in terms of public health, conscious crime against the people. In so far as weapons of mass destruction can be found in Iraq, here it is! It is time for the occupation to end and for those responsible for the invasion and all that has taken place in Iraq as a direct result of military action and civil negligence to be brought to account. The world must then turn its attention to putting right a terrible wrong. ".Iraq is an unequivocal humanitarian emergency. Civilians are being harmed by our presence in Iraq, not helped . We need a new set of principles to govern our diplomacy and military strategy--principles that are based on the idea of human security and not national security, health and wellbeing and not economic self-interest and territorial ambition." (Richard Horton, Editor of the Lancet, 12 October 2006) David Wilson prepared this report for the London-based Stop the War Coalition. He can be reached at: david@stopwar.org.uk
(1) USAID paper quoted in the Washington Post, 17/10/06 (2) House of Commons Liaison Committee, 04/07/06 (3) The Lancet, 12/10/06 (4) The Guardian, 11/10/06 (5) Peter Beaumont, The Guardian, 12/10/06 (6) Figures from the Iraq Health Ministry (7) Press Conference, 11/10/06 (8) Chief Surgeon, Al Sadoon Hospital, Baghdad, referring to the deteriorating health situation throughout Iraq as a result of the exodus of qualified health personnel (9) MEDACT, Iraq Health Update, 2006 (10) Daud Salman & Zaineb Naji: IWPR trainee journalistsin Baghdad (11) Interviewed on 10/05/04 by Dahr Jamail: Iraqi Hospitals Under Occupation, issued by the Brussells tribunal on Iraq, Istnabul 23-27 June 2005 (12) Patrick Cockburn: The Occupation, War and Resistance in Iraq (13) Iraqi physician and member of the humanitarian organisation, Doctors for Iraq (14) Gerry Hains, Feb 2006 and quoted in MEDACT, Iraq Health Update, Ibid (15) Dah Jamail, 14/06/04 (16) UNICEF. See www.unicef.org/emerg/iraq/index.html (17) MEDACT, Iraq Health Update, Ibid (18) www.health-now.org/site/article.php?articleId=647&menuId=14 (19) The Washington Post, March 2004 (20) UN Office for the Coordination of Humanitarian Affairs, 08/08/06 (21) Health Physicist assigned to US Army DU Assessment Team, 1991. US Army DU Project Director, 1994-1995. (22) The Case Against Depleted Uranium, Don Monkerud, Counterpunch, 15 October 2006 www.counterpunch.org/monkerud10142006.html (23) Al Jazeera, March 2003 (24) Al Jazeera, 30/10/03
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