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Last Updated: Wednesday, 7 April, 2004, 18:16 GMT 19:16 UK
Iraq reconstruction: Health
Doctors work in an Iraqi hospital
Iraqi hospitals have faced shortages of basic supplies
Rebuilding Iraq's health system is proving a huge challenge after years of underinvestment compounded by damage during and after the US-led military campaign.

Looters and saboteurs destroyed crucial information systems during the war, doctors were plagued by post-war drug shortages and the country's entire stock of vaccines was lost as power cuts hit refrigeration units.

In addition, about 30 hospital buildings were damaged, according to a World Bank assessment.

A year on, the BBC has seen chronic problems in Baghdad's hospitals, with doctors lacking basic supplies such as oxygen and painkillers as they struggle to treat the city's sick and injured.

However, Dr David Nabarro, a senior manager working on the World Health Organisation's Iraq programme, says the overall picture is one of improvement:

"For the majority of Iraqis, health care is much more accessible at affordable rates than before the war."

An Iraqi doctor treats an injured boy
Some staff worked for weeks without pay
Although drug supply has improved, Dr Nabarro singled this out as an area where continued effort will be necessary.

"There will be shortages - it's inevitable when a health system is recovering from the state Iraq's was in last year," he said.

Medical staff who went without wages for weeks after the war have now been paid, he added.

But he predicted that some hospitals will see shortages of staff, particularly nurses, "for some time".

Ailing system

USAid says it has vaccinated three million children and bought 30 million doses of vaccine, although Unicef says poor security is limiting access to immunisation services in some areas.

Unicef says services at about 80% of Iraq's primary health centres have been restored or improved, including major reconstruction work at about 50 centres.

Before, a lot of these people couldn't get anything at all unless they paid through the nose
Dr David Nabarro, WHO
The country's health care system was one of the best in the Middle East before the first Gulf War, but suffered a massive decline in funding under Saddam Hussein and sanctions in the 1990s.

Health indicators plummeted to some of the lowest in the region, with the infant mortality rate triple that in neighbouring Jordan and Iran, and maternal mortality six times greater.

Reconstruction has meant trying to redesign the system while meeting urgent needs on the ground.

Equal access to care, particularly for vulnerable groups such as women and children, has been a priority.

"Before, a lot of these people couldn't get anything at all unless they paid through the nose," said Dr Nabarro.

A new strategic plan for the health sector has been published and in late March the Iraqi Ministry of Health became one of the first ministries to be handed over to Iraqi control.

Its new budget of $948m, up massively from $16m under Saddam Hussein in 2002, however, is still "not as high as it should eventually be," said Dr Nabarro.

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