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Re: [casi] Justifying Mass Murder

I would like to make some comment about the effect of hospitals on health,
which may put the health issue into context, particularly as it relates to
sanctions and hospitals in Iraq.
In one course in health economics which I studied a few years ago, the effect
of hospitals on health was considered.  I can't remember the exact figures,
but if all hospitals throughout the world were closed down, the effect on
overall life expectancy really would be minimal, in terms of months at most,
it may have even been days or weeks, I remember feeling totally shocked when
I first saw the figures.   That doesn't mean that certain people get their
life expectancy dramatically improved by a particular operation - for
example, appendicectomy, heart surgery, but taken as a whole population it
makes little difference.
What improves life expectancy is education, particularly of women (this has
the biggest effect of all in improving child survival, the more years
education the mother has OF ANY SORT, the longer her children are likely to
survive), good food, good hygiene, waste and sewage disposal, controlling
environment (eg., temperature control, keeping out water and damp,
controlling insects and other vectors of disease).  The effect of good GP
style treatment or good pharmacy advice would also be a factor in improving
quality and quantity of life, far more than hospital care. Even immunisation
programmes in poor countries have been shown to have nil effect on the number
of children who survive to the age of 5, because if you are very poor, if you
don't die from measles you will die from diarrhoea.  Its a simple as that.
So whilst we need to consider sanctions in some respect in terms of hospital
care available, pre-the Gulf War and after, it makes very little difference
to life expectancy of ordinary people. It seems to me that the major effects
of the war and sanctions which adversely affect life expectancy in Iraq are:
(1) Reproductive health, including fitness of mothers, child spacing
practices, hygiene, breastfeeding, attendent at birth who has at least basic
knowledge, all adversely affected in some way by sanctions.  For example, if
mothers can't work or if some of their children die, they are more likely to
have more children who are then more at risk. Also repeated pregnancy puts
them and their unborn child at risk. Another example, if there is a lack of
training and health text books then some women may have a less safe birth
(2) Water issues, and the hygiene issues which arise.
(3) Poverty in general, including the cost of food and availability of food.
(4) Contamination causing illness, including cancers and birth deformities.
(5) Restrictions on education.
(6) Risk due to dangerous machinery which cannot be repaired effectively,
including cars.
(7) Psychological factors, including the will and motivation to live.  By
this I don't mean suicide risk, but a person with a lot to lose will fight
harder when it comes to facing illness and will not succumb so easily.
(These risks are not in order of importance)
I hope this reduces the emphasis on the debate relating to the types of
hospitals and care available for ordinary people in Iraq, as it really is
only of very minor importance.  Unfortunately, hospitals provide status for
health workers and are visible symbols of health care, and in all societies,
developed and developing, they are over-emphasised because of the collusion
of medical staff and patients and misunderstanding of what health is - it is
not merely the treatment of disease.

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