Monday, October 29, 2012

Two New Studies Point To Worsening Health Situation In Iraq’s Fallujah

The September 2012 issue of the journal Health had two articles about the medical situation in Iraq’s Fallujah in Anbar province. One was about infant mortality rates, “Perinatal and neonatal mortality in Fallujah General Hospital, Fallujah City, Anbar Province, west of Iraq,” and the other was on cancer, “Incidence of cancer in Fallujah above 10 years age with over view of common cancers in 2011.” The two papers both found a worsening health situation in the city. A likely culprit could be the U.S. invasion and the intense fighting that took place in Fallujah. However, the reports were very circumspect to point blame in that direction. “Incidence of cancer” for instance, believed that the increased cases found in the study could be because of better diagnosis, reporting, and changes in population, although the military operations could be a cause as well. Likewise, “Perinatal and neonatal mortality in Fallujah General Hospital” thought the decade long sanctions deprived Iraq of the necessary medical equipment and money to maintain the country’s health system. Whatever the speculation may be, both pieces found more cancer and infant mortality rates in Fallujah since 2003, which is troubling enough trends even if the root reason for them remains unclear.
“Incidence of cancer in Fallujah above 10 years age with over view of common cancers in 2011” found higher rates of the disease in the city than in the rest of Iraq, and neighboring countries. The study looked at all cases of cancer from January 1 to December 31, 2011 in Fallujah and three of its sub-districts, excluding leukemia. This was the first look at the disease in the city since the 2003 invasion. It got its data from the Fallujah General Hospital, Al-Janabi Hospital, Amyrea Hospital, private health centers in downtown Fallujah and three sub-districts, a histopathology lab, private clinics, and the oncology center in Ramadi. Of the approximate 600,000 people in those four areas, the report found cancer in 27.2% of them. That broke down to an incident rate of 96 per 100,000 overall, with 92.6 for men and 99.4 for women. Fallujah city center had the largest amount of cases at 128 per 100,000, with the western district of Saqlawiya second at 82. The lowest rate was found in the eastern district of Karmah at 50 per 100,000. The two most common forms of the disease reported were breast and lung cancer. The overall rate of 96 per 100,000 was three times higher than that reported for the city in 2002, which was 34.5 per 100,000. It was also higher than the rate for all of Iraq at that time, 63 per 100,000. The same was true when comparing Fallujah to some other countries in the region. In Qatar for instance, the cancer rate was 63.1 per 100,000, 67.2 in Jordan, and 71.7 in Saudi Arabia. Only Iran, at 98 per 100,000 for females, and 103 for males was worse. The study speculated on many possible reasons for why such a high cancer rate was found in the city. The first was the two Battles of Fallujah, which took place in 2004. The authors thought that might be why there were much higher rates in the central area of the city, then in its sub-districts. At the same time, there were many other possibilities. Those included better diagnosis, improved reporting, and changes in the population. With the paper only focusing upon the cases of cancer reported, no direct correlation could be made with any of those causes.

Cancer Rates In Fallujah And 3 Sub-Districts 2011
Central Fallujah 128 per 100,000
Saqlawiya 82 per 100,000
Amyrea 66 per 100,000
Karmah 50 per 100,000
Overall 96 per 100,000

Cancer Rates In Fallujah vs Selected Middle Eastern Countries
Fallujah 96 per 100,000
Iran 100.5 per 100,000
Saudi Arabia 71.7 per 100,000
Jordan 67.2 per 100,000
Qatar 63.1 per 100,000

“Perinatal and neonatal mortality in Fallujah General Hospital, Fallujah City, Anbar Province, west of Iraq” wanted to determine the state of Fallujah’s health services after the U.S. occupation by looking at infant mortality rates. It looked at data collected at the Fallujah General Hospital’s intensive care unit from January 1 to December 31, 2010. The study included 290 neonatal deaths and 64 stillbirths. Those established a perinatal mortality rate of 50.3 per 1,000 live births, and a neonatal mortality rate of 41.5 per 1,000 live births. The latter was lower than the rate reported by the hospital from 2007-2009, which was 57.3, but higher than the national rate in 2009 of 23 per 1,000 live births. Fallujah’s neonatal mortality rate was also considerably higher than several neighboring countries including Qatar, 4 per 1,000, the United Arab Emirates, 5 per 1,000, Kuwait and Bahrain, 6 per 1,000, Oman, 7 per 1,000, Lebanon, 8 per 1,000, Libya, 9 per 1,000, Tunisia and Saudi Arabia, 12 per 1,000, Jordan and Egypt, 13 per 1,000, Iran, 19 per 1,000, Morocco, 23 per 1,000, Yemen, 32 per 1,000, and Djibouti, 35 per 1,000. Only Sudan at 41 per 1,000 was close. What troubled the authors was that Fallujah General Hospital is one of the best in Anbar, and is known for its equipment and staff. Despite that, it still had a very poor record of taking care of pregnant mothers. In Europe and America, infant mortality rates have gone down, because of better technology and treatments. The paper believed that the international sanctions imposed on Iraq in 1990 for its invasion of Kuwait, and the eight-year occupation by the United States caused a decline in the country’s health services. Those two events deprived the country of the advances that occurred in Europe and America, and can now be seen in many nations in the region. What the authors advocated for was more spending on Iraq’s health care services, so that it could make up for what it lost over the last twenty years.

Neonatal Mortality Rate Fallujah vs Selected Regional Countries
Fallujah 41.5 per 1,000 live births
Sudan 41 per 1,000 live births
Djibouti 35 per 1,000 live births
Yemen 32 per 1,000 live births
Morocco 23 per 1,000 live births
Iran 19 per 1,000 live births
Egypt 13 per 1,000 live births
Jordan 13 per 1,000 live births
Saudi Arabia 12 per 1,000 live births
Tunisia 12 per 1,000 live births
Libya 9 per 1,000 live births
Lebanon 8 per 1,000 live births
Oman 7 per 1,000 live births
Bahrain 6 per 1,000 live births
Kuwait 6 per 1,000 live births
UAE 5 per 1,000 live births
Qatar 4 per 1,000 live births

These two papers were important to add scientific data to Fallujah’s health situation. The city has been the focus of many news reports for its poor state of affairs, but they were mostly based upon anecdotal stories. These studies add specific data to that more general picture. They found large numbers of cancer cases and infant mortalities, which were above many other countries in the Middle East and North Africa. Those were disturbing figures. The causes were pure speculation, because there was no attempt to make a direct correlation between any included in the papers. Many articles have pointed the finger at the two Battles of Fallujah in 2004. Those could very well be the reasons why health has deteriorated in the city, but there are other possibilities as well. The cancer report for instance, pointed to a decline in spending for health services that occurred in the last twenty years, while the mortality rate paper also pointed to better reporting and diagnosis. Further studies will have to be made before a clearer picture emerges of what has led Fallujah to have such poor health conditions.


Abdul Ghani, Samira T., Sirhan, Yaseen Taha, Lawas, Abdul Sattar Kadhem, “Perinatal and neonatal mortality in Fallujah General Hospital, Fallujah City, Anbar Province, west of Iraq,” Health, September 2012

Al-Faluji, Abdul Wahab A.R., Ali, Salih Hussein, Al-Esawi, Arkan A. Jasem, “Incidence of cancer in Fallujah above 10 years age with over view of common cancers in 2011,” Health, September 2012


Anonymous said...
This comment has been removed by a blog administrator.
Joel Wing said...

Sorry, anonymous. I accidentally deleted your comment by hitting the wrong button! I agree however that there are probably other environmental factors that could contribute to the poor health in Fallujah.