Country profiles

Iraq

Overview

The surface area of Iraq, is about 435 000 km². The population of Iraq, at the end of 1997, was estimated at 22 million, 71% lived in urban areas. Baghdad, with an estimated population of 5.4 million in 1988, accounted for 30% of the population. The majority of Iraqis are Muslims (95%) with a small minority of Christians and others. The percentage populations below 15 years of age and above 65 years in 1993 were 42.6% and 3.3%, respectively. The total adult literacy rate and the female adult literacy rate in 1995 were estimated at 54% and 51%, respectively. By 1990, the coverage of civil registration and the compilation of vital statistics had reached more than 80%. The crude death rate and the crude birth rate in 1995 were estimated at 11 and 35 per 1000 population, respectively. In a child health survey conducted in Iraq in 1990, it was found that the infant mortality rate had dropped from 82 infant deaths per 1000 live births in 1982 to 25 per 1000 live births in 1990, but increased to 92 per 1000 live births in 1991 and 111.7 per 1000 live births in 1994. In 1994, the total life expectancy at birth was estimated to be 58 years for the total population. From the above survey, the maternal mortality rate was found to be 13 per 10 000 live births in 1994. Also, the under-5 mortality rate rose from 52 per 1000 live births in 1990 to 128 per 1000 live births in 1992, and the situation did not improve as a result of sanctions. In 1994, the under-5 mortality rate was estimated at 140 per 1000 live births.

The leading causes of mortality in 1990, in descending order, were the following: diseases of the circulatory system; symptoms, signs and ill-defined conditions; injury and poisoning; neoplasms and congenital anomalies. Iraq’s per capita gross national product in 1992 was US$ 3610.

In the constitution of Iraq, it is stated that health is the right of every citizen. Iraqi health policy is in line with the goal of health for all , with special emphasis on care of infants and mothers. Attention has also been given to equitable distribution of services and on community participation. Health policy focuses on reducing infant, child and maternal mortality through the following strategies: including maternal and child health services in all health centres; decreasing mortality from diarrhoeal disease through the use of oral rehydration therapy; decreasing infant mortality through ameliorating obstetric and postnatal services; decreasing child mortality due to respiratory diseases; increasing safe water and sanitation coverage; and increasing immunization coverage. The primary health care approach has been strengthened in the community and in the various professional cadres through primary health care councils.

The primary health care councils, which are made up of representatives from the health authorities and other government and nongovernmental organizations, with community support, supervise and monitor the activities of primary health care. A primary health care council also exists at the central level, headed by the Minister of Health and comprising senior officials from the Ministry of Health, other ministries, the Central Population Council, the General Federation of Iraqi Women, the Farmers’ Union and the Labour Union. The Ministry of Health per capita expenditure in 1989 was US$17 while the recurrent budget of the Ministry of Health constituted 5.9% of GNP.

Advances in provision of health care have been notable. Major hospital construction projects have given the country a first-class range of medical facilities, both in the larger towns and through a series of clinics in rural areas. In 1989, there were 135 general hospitals, 1055 health centres, 58 health centres with beds and 52 specialized hospitals. The overall rate of hospital beds per 10 000 population in 1998 was 114.5. Although the private sector contributes to health care delivery in Iraq, its contribution is limited. In 1989, only 749 beds out of 30 002 came under the private sector.

MENTAL HEALTH

Iraq has been in the forefront of mental health care from time immemorial in the Eastern Mediterranean Region. One of the earliest psychiatric centres was in Baghdad.

However, since 1990, mental health care has been badly affected because of war and embargo.

In every governorate (now six), there is a psychiatrist running outpatient and inpatient services (either in a psychiatric hospital or ward or within a medical ward).

Efforts are being made to revitalize the referral system in its well-defined formal shape, however, it is usual for the vast majority of people to attend the local primary health care centres and the physician sends the needy people to the hospital when required.

In addition to the psychiatric units in most general hospitals, the mental health component of the general medical services is being developed now, and general practitioners and medical assistants are receiving specialized mental health training courses.

Similar to other countries in the Region, mental health professionals are scarce, and approximately 50% of them are in the capital Baghdad.

Psychiatric hospitals and units in general hospitals form part of the specialized services that represent the third level of mental health care. There are 23 psychiatric facilities in the country, 16 in Baghdad. Six are university-based departments, but the Ministry of Health runs all facilities.

Al Rashid Mental Hospital, established in 1956 in Baghdad, is a long-stay institution with a forensic psychiatry unit. It has a bed strength of 1300, of which 300 are forensic psychiatry beds.

Ibn-e-Rushd Psychiatric Hospital is a short-stay hospital with 74 beds (established in 1968). It is located in Baghdad. . There is also an attached drug dependence centre with 15 beds, established in 1979.

The psychiatric units in general hospitals have bed strengths of 12-40 beds. These units are located at the Baghdad Teaching Hospital (30-40 beds), Al Yarmouk Teaching Hospital (12 beds), Saddam Medical College Teaching Hospital (20 beds), Mosul General Hospital (30 beds), Basra General Hospital (30 beds) and Al Najal General Hospital (30 beds).

Al Mukhtar Hospital, founded in 1989, is a private hospital with 20 beds.

There are 12 schools and institutes for the mentally retarded, under the supervision of the Ministry of Labour and Social Affairs.

There are outpatient psychiatric clinics in all the general hospitals and psychiatric hospitals.

There are some community care facilities like the homes for the elderly in Baghdad and Mosul and institutes for homeless children and orphans.

There are 160 consultant psychiatrists, 10 psychiatric social workers and 20-30 psychiatric nurses.

A postgraduate programme leading towards a full qualification in psychiatry (Iraqi Board in Psychiatry and Arabic Board in Psychiatry) is available with 10 positions per year at five centres. There used to be a two-year practical and supervised course in psychiatry for general practitioners, qualifying them as psychiatric practitioners without consultant status.

A new two-year MSc course in clinical psychology started in 1994. There are two courses of training for psychiatric social workers conducted annually.

As far as the teaching of paramedical personnel is concerned, graduates from the University Nursing College in Baghdad have good theoretical and practical training in psychiatry, but all other health workers (nurses from the nursing schools, medical assistants and auxiliaries) receive only theoretical training in psychiatry. A course in psychiatric nursing at the Al Rashid Mental Hospital has been abandoned .

All medical schools provide undergraduate teaching in mental health care during the two years of basic sciences. There are about 15 hours of lectures in psychology. During the three years of clinical teaching, there are about 30 hours of lectures in psychiatry. During the 5th and 6th year, some 60 hours of clinical training is given on the wards to groups of eight to ten medical students at a time. During the internship period (two years), rotation in psychiatry is obligatory for one month, while another three months in psychiatry are optional.

The national mental health programme was formulated in1989 and is based upon the following principles: mental health care and promotion are components of primary health care; mental health care and promotion should be delegated from the specialist to the general health worker, with the collaboration of other sectors and nongovernmental organizations; existing mental health care and promotion activities need stronger decentralization; and mental health care and promotion must be integrated with other health care and social services.

The overall objective of the national programme is integration of mental health care and promotion with general health care in order to improve the mental health of the whole population of Iraq. The more specific approaches towards this goal are: strengthening central coordination of mental health care and promotion at government level, bringing together the resources of various sectors of Iraqi society; decentralization of mental health care and its integration with general health care; renovation and reinforcement of the existing mental health services; facility of collection of reliable information on mental health problems and mental health care; and promotion of mental health research.

The Iraqi Committee for Mental Health Promotion is an advisory body to the Minister of Health. It consists of five consultant psychiatrists; one of them chairs the Committee.

There are various psychiatric medical committees. They usually consist of three senior psychiatrists, and deal with such matters as expert reports for the courts, insurance companies, universities, schools, the government and other offices. They are mainly seated in Baghdad. They comprise: the Permanent Neuropsychiatric Committee; the Psychiatric Appeals Committee; the Committee for Forensic Psychiatry; the Psychiatric Committee for Students; and the Psychiatric Committee for the Medical Professions.

The Iraqi Society of Psychiatrists is a nongovernmental association and is active in the field of mental health promotion. It issues a psychiatric journal, Al Razi, which cannot be published at present because of the embargo and shortage of resources). The Association holds no formal authority.

Most psychiatrists in Iraq have private clinics, through which supportive psychotherapy, medication and electroconvulsive therapy services are available.

Although the authorities and the community are worried about mental illness (alcohol and drug abuse and their consequences, epilepsy and mental retardation, mental ill health of the elderly, delinquency in children, the psychosocial consequences of years of war and international sanctions, and many other psychosocial problems such as divorce, suicide, migration, violence and accidents), there are no reliable data available regarding direct mental health prevention and promotion programmes in Iraq aimed at changing adverse public attitudes. Basic information on care delivered by the mental health services and the general health services is required in order to evaluate and restructure mental health care. Monitoring of the existing mental health services is not possible due to lack of operational data and other information. The country has to use, whether applicable or not, findings from abroad. The main reasons for this lack are a lack of a mental health information system and of tradition of mental health research. One of the duties of a national coordinating committee would be the introduction of a reliable monitoring system relevant to different levels of care.

Fragments of mental health legislation do exist in the civil and criminal codes of Iraq. These have been consolidated and expanded into a draft mental health act. This draft was reviewed and updated recently, and it is in the final stage of legislation.

A wide range of training programmes have been undertaken as part of the national mental health programme:

• training of teachers in ordinary schools to deal with children who suffer psychological trauma and behavioural problems

• training for teachers and social workers working in special schools and institutions for mentally handicapped children, hostels for the elderly, reform schools, and so on

• training courses in mental health for physicians working at primary health care level, two or three courses per year in Baghdad and in every governorate

• training in mental health for other colleges, institutes, and schools (nursing, education, literature, arts, medical technology, teaching)

• during 1996 and 1997, only 648 primary health care physicians, 462 nurses and 625 educational administrators and school teachers were trained in mental health (Involved in specialized mental health training courses)

• a new mental health manual for primary health care workers is under preparation.

The Ministry of Higher Education and Scientific Research has a research body for medical research. During the past few years, studies have been completed on prevalence of child psychiatric disorders; prevalence of psychiatric disorders in medical, surgical wards and outpatients; problems of drug and alcohol abuse; clinical and epidemiological aspects of mental disorders (through the Scientific Council of Psychiatry Iraqi Board and Arabic Board); and education of chronic psychiatric patients’ families.