Reestablishing leadership is the pressing medical need in Iraq

What we still do not know is what has been going on in the many homes in the Baghdad, a city with millions of people, when the primary health system along with the hospitals broke down. ... According to the Geneva Conventions, it is the occupying power that has the responsibility to see that needs of the civilians are met.
The following is an edited excerpt from Dr Rostrup's presentation to journalists on April 23 in Brussels, Belgium. We have an occupying power in Iraq and according to the Geneva Conventions it is the occupying power that has the responsibility to see that needs of the civilians are met and urgently so. As long as we have an occupying power it is up to the Occupying power to find a solution to the problem. Whether they do it themselves or they bring in other parties, it is up to them to decide. But I think it is telling that, after two weeks, and after being in ten cities, MSF has not found any reason to justify a major humanitarian medical programme in Iraq. I think it is pretty interesting and for me what we have been doing so far contrasts what has been portrayed, especially in Europe, about this huge humanitarian crisis or catastrophe in Iraq. This perception does not correspond with what we have been able to see ourselves and I think we also have to ask a question whether it is really justified to use the whole notion of a major humanitarian catastrophe from a medical perspective at this point in time. The people responsible today for Iraq have to address the current problems. The lack of leadership and administration has to be addressed very, very urgently. (These) issues mean that people are not getting adequate treatment. It should be easy to put in place a system very quickly that will take on the responsibility to get the Iraqi health care system working. It is more needed now than huge amounts of medical supplies. On April 9, due to insecurity - the Americans were entering Baghdad - the Al Kindi hospital closed down. There were 120 patients in the hospital. Some were referred to other hospitals but many patients were sent home for not any kind of follow-up medical treatment. At the same time we saw a partial collapse of the hospital system in Baghdad and we started to wonder what were the reasons for this. We said at the time, and it was stated by other organisations being present - although there were very few international organisations present - that it was the security problem. The looting started. Hospitals were not protected and many of them were looted. And (people) were afraid of being looted themselves and so staff from the hospitals stayed home to protect their homes. There was a lack of public transport, a lack of petrol, people could not move so even though some of the hospital structures were there. Even though they were not being looted, they were very short of staff. Some of the Iraqi doctors who stayed in the hospitals did very good work. Some of these Iraqi doctors were pretty heroic working for 24 hours for many days trying to treat their patients under very difficult circumstances. So I think we should also pay tribute to those doctors who stayed as many people left these facilities. (But) there was looting of the hospitals and a lack of medical supplies. We saw a staff shortage as a key problem at this stage ... in addition to electricity failure and a lack of generators in some hospitals, which made it pretty difficult to carry out appropriate medical work shortly after Baghdad came under the control of the Americans. However it was also interesting to see things moving to another phase. The problems in hospitals in Baghdad are no longer related to lack of transport, security or so on as much as disorganisation and a lack of administration. What we are seeing is a power vacuum in Iraq in general and very clearly in the hospitals. There is a lack of leadership, there are different groups that are trying to control the hospitals and I think we have to agree that hospitals may play a political role when it comes to the importance of service institutions and the control of hospitals may be looked at as a political issue. And it has been a bit frustrating to see that what has not been addressed that well is the problem of leadership in the hospitals. Many of the problems we see today in the hospitals are really due to this lack of leadership. That has to be addressed. Outside Baghdad and in the other cities some of the structures have been kept going, so they could work, more or less, in the same old fashion and you did not see the same crisis there. But In Baghdad still we have problems. There is no big hospital that is functional in Baghdad today, two weeks more or less after the Americans took control of the city. So that is a great concern. When I was in Baghdad there were a lot of patients who were discharged and we have been pretty worried about the condition of these people because they have been without medical attention. Many of them may need secondary surgery so we still want to ask the question of whether there will be a kind of second wave with a lot of patients needing surgery coming again to the hospitals. In addition to this, we also know there are many patients there with chronic diseases. Diabetes, epilepsy, cardio-vascular disease, kidney diseases that need regular follow up and also medication. Many of these patients have been without their regular medication and if you think of a diabetic who is insulin dependent, without insulin you will die of diabetes if you do not get care. So what we still do not know is what has been going on in the many homes in the Baghdad, a city with millions of people, when the primary health system along with the hospitals broke down. We are here in a very politicised crisis as well and the media attention has been tremendous in this crisis. Take a step back and look at what is really happening and what kind of crisis is this and what is an adequate way of dealing with this and also keep a perspective on other crises in the world today. On April 23, Dr Morten Rostrup, president of the MSF International Council, spoke to journalists about his experiecnes during the war in Iraq and the conditions and issues facing the country today. Dr Rostrup served as the medical coordinator for a six-person team based in Baghdad and was one of the team members providing assistance in the Al Kindi hospital in Baghdad. MSF suspended its assistance on April 2 when three members of their team were taken by Iraqi authorites until they werer released nine days later.