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Cancer in Iraq



You may be interested in the following.  

Chris Doyle

http://www.bmj.com/cgi/content/full/318/7177/203

BMJ 1999;318:203 ( 16 January )

Reviews

Personal views

Cancer services are suffering in Iraq 

The Iraqi health minister, Dr Omeed Mubarak, recently asked the
World Health Organisation to review the problem of cancer services in Iraq
and suggest how things
could be improved. 

It was immediately clear that there were staggering deficiencies in cancer
treatment facilities because
of the United Nations sanctions, which are intended to exclude food and
medicines. A cancer centre
without a single analgesic; a radiotherapy unit where each patient needs
one hour under the machine
because the radiation source is so old; and children dying of curable
cancers because drugs run out are
all accepted as normal. 


   We as doctors cannot stand idly by and watch this slow, silent tragedy
drag on


Iraq has a population of 20 million. The cancer registry is good in some
parts of the country and there
are an estimated 50 000 new patients a yeara relatively low but rising
incidence as found in many
Arab countries. Iraq is a wealthy, well educated country, but is now
completely reliant on the
administrators who enforce the politically inspired UN Security Council's
oil for food agreement. There
is plenty of oil, but Iraq can sell it only to buy food and medicines under
this humanitarian aid
programme. 

Somehow cancer care has become a Cinderella service. Requested radiotherapy
equipment,
chemotherapy drugs, and analgesics are consistently blocked by United
States and British advisers.
There seems to be a rather ludicrous notion that such agents could be
converted into chemical or other
weapons. Operating under the agreement is complex, slow, and frustrating.
Dr Isam Al-Rawi, recently
retired director of the Baghdad cancer centre, has endured eight years of
frustration and witnessed
much unnecessary human suffering. An internationally well respected
oncologist, and first chairman of
the Iraq Cancer Board, he has made the best of the deficiencies. 


   Stopping cancer treatment will not topple a dictatorship


Visiting the cancer centre in Iraq is a harrowing experience. The wards are
busy, the clinics
burgeoning, and the radiotherapy equipment primitive. There has been no
investment for a decade. The
medical staff are well trained and most of the consultants have spent a
year or more in Britain, France,
or the United States as part of their training. The younger physicians are
now unable to train abroad.
Clinical skills, the teaching, and enthusiasm are strong. Iraq follows the
British system of undergraduate
and postgraduate education. Now, because of hyperinflation, doctors earn
about 3 a month. 

The radiotherapy equipment is becoming unusable. Lack of replacement
isotopes for Baghdad's last
two functional cobalt machines means that treatment times can take up to 45
minutes for each patient.
One linear accelerator is working only intermittently. There are no
planning or simulator facilities
working. 

The department is open from 8 am until midnight each day to cope with the
workload. The availability
of chemotherapy is essentially a lottery. People with potentially curable
cancers can receive only the
drugs available at the time. Essential generic drugs such as cisplatinum,
tamoxifen, and
cyclophosphamide ran out during our visit. Symptom control is hopeless and
analgesics are just not
available. 

Patterns of cancer are changing. Iraq is one of the few countries where
stomach cancer is increasing,
probably due to reversion to poorer diets and the lack of good food storage
facilities. Breast cancer is
rising inexorably. A more sinister problem is the apparent threefold
increase in leukaemia in the
southern provincesthe sites of the major battlefields of the Gulf war. A
WHO investigation in
1995 suggested a possible link to products, now incorporated in the food
chain, which were derived
from depleted uranium used in piercing artillery shells. The trend has
continued and a major
epidemiological study is now proposed which will include a radiation survey. 

Whatever the political legitimacy of the embargo, the needless suffering of
those with cancer is an
unacceptable outcome. The WHO is making strong representations that drugs
on its essential list,
analgesics, and replacement radiotherapy equipment should be given
priority. We as doctors cannot
stand idly by and watch this slow, silent tragedy drag on. Stopping cancer
treatment will not topple a
dictatorship. It will serve only to consolidate a background of hatred in a
new generation who will never
forget the scars. 

Karol Sikora, chief.  

WHO Cancer Programme, and professor of international cancer medicine,
Imperial College School of Medicine,
London 



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