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Assessment of Current Health Threats and Capabilities (U)


Iraq:    Assessment of Current Health Threats and Capabilities (U)

       A.  Key Judgments

          Restoration of Iraq's public health services
and shortages of major medical materiel apparently are being
emphatically exploited by Saddam Hussein in an effort to keep
public opinion firmly against the U.S. and its Coalition allies
and to keep blame away from the Iraqi government [   (b)(1) sec 
1.3(a)(4)   ].  Both issues remain dominant international 

      Disease incidence above prewar levels is more attributable
to the regime's inequitable post-war restoration of public health
services rather than the effects of the war and [   (b)(1) sec 
1.3(a)(4)   ]. Current countrywide infectious disease
incidence in Iraq is higher than it was before the Gulf War, but
not at the catastrophic levels that some groups predicted.  The
Iraqi regime will continue to exploit this situation for its own
political purposes.

           Iraq's medical supply shortages are the result of the
central government's stockpiling and exploiting of domestic and
international relief medical resources.

            Compared with pre-war capabilities, hospital
services have been significantly reduced, with comprehensive
medical care available only to the political elite, the very
wealthy, and the military.

               Iraq may be storing nuclear, biological, and 
chemical    (NBC) materials in or around hospitals in an attempt 
to conceal [   (b)(1) sec 1.3(a)(4)   ]them from special observer 
teams [   (b)(1) sec 1.3(a)(4)   
   If true, the storage of these materials poses a serious health
   threat to hospitalized patients and medical staff.

         B.  Public Health
[   (b)(1) sec 1.3(a)(4)   ]                                      
                  restoration of water sewerage, and electricity 
services appears to be limited
   to select regions. while the water is dirty in appearance, 
   quality reportedly has improved in Baghdad. However, conditions
   have not improved correspondingly in Al Basrah or other Shiite-
   dominated southern cities and in northern Xurdish regions.
   Nationwide restoration of water potability has been slowed by 
   the destruction of Iraqi's chlorine production capability and 
   the financial cost of rebuilding damaged petrochemical plants 
and the interim requirement of importing chlorine products from
-  abroad. Water purification systems and portable generators
   provided through humanitarian assistance have served, at best, 
as stop-gap measures. Iraq's Ministry of Health (MON) continues to
   provide public health communiques instructing inhabitants to 
   boil water, fully cook food, and store food and water in clean

       The MON appears to be regaining administrative control of 
the nation's health care system, but restoration of nationwide 
public   health programs apparently is not being addressed. 
Resumption of pubIic health programs (such as disease 
surveillance, vector, control, and immunization programs; food and 
food handler
inspections; bacteriological testing of potable water sources;
and local level primary health services and education) is
completely dependent on the Iraqi government. Until these
programs are fully reinstated, most Iraqi citizens will remain
vulnerable to otherwise preventable diseases.

         Refugee medical care remains a specific concern of
international humanitarian agencies as an estimated 300,000 Iraqi
refugees remain in Iran and another 24,000 in[   (b)(1) sec 
1.3(a)(5)   ]  
A number of these refugees are attempting to return to northern 
Iraq before cold weather returns to the region. Current reports 
describe an influx of 10,000 refugees a week returning from Iran. 
However, destruction of villages and current violence in Kurdish 
areas may prevent a significant number from reaching their homes, 
leaving them without shelter and prone to cold and other 
exposure-related injuries and illnesses. Moreover, warehouses 
containing tents, clothing, and heating supplies provided[   
(b)(1) sec 1.3(a)(5)   ]                  for this contingency are 
located in the area of current fighting.  Workers at these 
warehouses have
reportedly fled, leaving those goods unprotected from looters on

both sides of the conflict. Additional humanitarian assistance
for the refugees is not likely to be forthcoming from the Iraqi
government, although the plight of the refugees continues to be
exploited by Baghdad.-

         C.  Infectious Disease Incidence

                            Current countrywide infectious disease
   incidence in Iraq is higher than it was before the Gulf War, 
   is not at the catastrophic levels that some groups predicted.
   Disease incidence above pre-war levels is more attributable to
   ttie regime's inequitable post-war restoration of public 
   services rather than the effects of the war and UN-imposed
   sanctions. Recent intelligence reports from reliable sources 
have indicated that life in Baghdad essentially has returned to
   normal, with no signs of poverty or food shortages. In 
   increased infant and child mortality rates, evidence of child
   malnourishment, and poor sanitary conditions continue to plague
   vulnerable groups outside of Baghdad, particularly in southern

       The current disease situation in Iraq is difficult to 
-  because the regime did not report adequate prewar disease
   surveillance data, and current disease reporting appears

   -politically biased. Because prewar disease surveillance data 
are not available for comparison, it is unclear what amount of

-  current disease incidence reported through the Iraqi government
   reflects normal incidence levels. Recent Iraqi reports linking
   increased disease morbidity and mortality (particularly 
   typhoid fever, hepatitis A, giardiasis, amoebic dysentery,
   bruceilosis, and echinococcosis) to vaccine and medicine
   shortages created by the international embargo are particularly
   misleading. These diseases are fundamentally prevented through
   basic sanitation and hygiene, not public vaccinations or 
   medicine. Therefore, much of the current reporting is regarded 
to be an attempt to gain international sympathy.

       In addition, morbidity and mortality forecasts publicly
   provided by international and private medical organizations
   frequently have been based on incomplete information. Baghdad 
has restricted the access of foreign observers, limiting the 
quantity and quality of collected data. Many of the early post-war 
 - estimates assumed that health and living conditions would not
   improve, which led to significant overestimates of projected
   morbidity and mortality rates. Because of the restoration of
   essential services and international relief efforts[   (b)(1) 
sec 1.3(a)(4)   ]

   recently reduced its estimates
   of Iraqi children at-risk from 170,000 children to between 

  50,000 and 80,000 children.

       Infectious disease incidence in areas where services are
   -restored is likely to stabilize in a range that is somewhat 
   pre-crisis levels, with discriminated groups (particularly 
   and Shiites) sustaining substantially higher disease incidence.
   With the advent of winter, acute respiratory infections,
   preventable childhood diseases (measles, diphtheria, and
   pertussis)1 and meningococcal meningitis are expected to 
  significantly in populations receiving inadequate public health
   services. The Iraqi regime will continue to exploit the 
   of discriminated groups for its own domestic and international
   political purposes.

[      (b)(1) sec 1.3(a)(4)    ]

[      (b)(1) sec 1.3(a)(4)    ]

       F. storage of NBC Materials in Hospitals

             Current reporting alleges that the Iraqi military is
storing nuclear, biological, and chemical (NBC) materials in or
around hospitals in an effort to conceal them [   (b)(1) sec 
1.3(a)(4)   ]

The health threat to patients and medical staff
is borne out by Iraq's historical lack of regard concerning safe
handling and storage of NBC material. Reports of accidental
chemical agent exposure among Iraqi military personnel date back
to the Iraq/Iran War. More recently,[   (b)(1) sec 1.3(a)(4)   ]
medical reports found at the Muthanna State Establishment (MSE;
33-49-56N O43-48-13E, also known as the Samarra Chemical Warfare
Research, Production, and Storage Facility) estimate an annual
chemical exposure accident rate at that facility approaching 30
percent. [   (b)(1) sec 1.3(a)(4)   ] a lack of appropriate

detection equipment at Iraqi chemical production facilities,
-indicating that Iraq would have a significantly limited
capability to detect a chemical contamination occurring during
the storage of chemical agents on or near hospital grounds.
Moreover, most civilian Iraqi physicians lack the capability to
diagnose signs and symptoms of chemical agent exposure.

                Suspect medical facilities believed to be housing
NBC material include the Saddam Hussein Medical City and the Al
Rashid Hospital, both located in Baghdad (33-21N O44-25E), the
   Saddam Hussein General Hospital in Kirkuk (35-28N O44-23E), the
   Mosul Hospital (36-21-28N O43-O7-OOE), and the Dagalah Hospital
   (36-O9N O44-23E)[   (b)(1) sec 1.3(a)(4)   ]
   chemical warfare agents stored in the King Hussein Medical 
 in Amman, Jordan (31-57N O3$-56E).

         G.  Summary

    [      (b)(1) sec 1.3(a)(4)    ]




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