Transcript of the press conference WHO Resumes Permanent International presence in Iraq
Announcer: Ladies and gentlemen, good morning, and welcome to the WHO conference call. Sir, please go ahead. Paul Garwood: It’s nice to speak to you all today. On the phone we have the WHO's country representative to Iraq, Dr. Naeema Al-Gasseer, as well as the Assistant Director General for the WHO's Health Action in Crises Cluster, Dr. Eric Laroche. Both people are here today to speak in relation to WHO's renewed permanent international presence in Iraq and how this can benefit the people of Iraq and how this can assist the Iraqi Government in its plans to reform its health system and provide vital health services to its people. On the phone, I would like to now hand over to Dr. Al-Gasseer to give a brief statement on what's taking place and Dr. Laroche is also available for questions. Naeema: Thank you, Paul. Hello to everybody. I would like to start out briefly explaining WHO's resumption of a permanently based international mission in Iraq for the first time since 2003, and just a bit of background and the reason for such a move and where WHO will have an added value to be in Iraq. Its not news to everybody that the international community is increasing its commitment to Iraq and the people of Iraq and to assist the Iraqi people within the country and the neighbouring countries. The recent International Compact and the commitment of the world stakeholders is the centrepiece of this effort. Within the United Nations there has been a Security Council Resolution demanding the UN to provide full support for Iraq. And WHO, which is part of the UN, is already there intensively and recently as part of the permanent presence as part of renewing the continued commitment to serve Iraq. WHO has been in Iraq since 1960 and since 2003 when we left, the national, very capable, competent national staff have been providing the full support directly to the local authorities and to the national Government with a very strong backup from the international team, whether WHO Iraq or region or headquarters. However, saying that, the difference now between permanent presence and what has happened now since 2003 until the announcement of the permanent presence, the international team in Jordan has help with an intensive mission inside Iraq with three main components of work. That is, the immediate address to the humanitarian urgency, while having also a focus for reconstruction and development, and focusing on the vulnerable, the women and the children plus, the difference in Iraq is not only the security but also the violence that the Iraqis are exposed to. As international team visiting over the past three or four years, we have been made akin to the control of public health care by the diseases such as Avian Flu and cholera.
Where are we today? Today, with the announcement of the permanent international presence we are going to increase more and more our footprint within Baghdad which is already now there, within Arbil where we have a very capable national team, with in Basrah Kirkuk, Hillah and very soon within Najaf and Karbala. Very soon we are also in (town). What are our priorities? It is to support the Iraqi Government, to address the needs of the health of the people. We have been present with them. We have very early on placed primary care synthesis at the essential, should be public health services be as the cornerstone of the delivery of services to the people and strengthening the health services accordingly. Where are we today? We are taking the fruits of the work that has been done for the last four years. Now, we and Iraqi Government, led by the Prime Minister, have committed to strengthening the health system through the primary health care approach, for ensuring the basic health services package. The other thing that has been very interesting to see, requesting direct support from WHO to provide assistance in reaching the international public health sector but also in passing the public health legislation and all. With our presence inside Iraq permanently we can deliver more of this not forgetting or losing sight that there are still security concerns and we have a challenge to continually come up with other approaches and creative approaches to be able to move inside Iraq. Paul Garwood: If anyone has any questions, please go on now. Announcer: We have a first question form Mr. William French, AFP. William French: Hello there. I see that you opened the government office back at Baghdad last month. I wonder if you can give us some details of what you've actually been doing since then and how you view the security situation within Baghdad itself, whether it is better or worse than you had expected. Naeema: Since then, with the continued presence we have focused on supporting the Government. I was invited to work at the roundtable by senior officials strengthening the health system. There has been a discussion around the refugees and internally displaced and how their immediate needs can be placed. I participated as a WHO representative on the policy conference which was held in Baghdad last week on refugee policy for the whole country. IDPs and vulnerable were there, so their presence was a direct involvement rather than a virtual involvement. Also, we were active partners on the first national conference on protection of physicians and bringing them back to the country, so we could see the fruit in coming out. The Prime Minister has taken the lead in this. The permanent presence has allowed much more to be closer to the decision-making, not only to the Government, but also to the parliamentarian and the civil societies in addressing the health system and ensuring the basic health services are delivered. However, also
raising concern for control of public health right and advocating for the women, children and vulnerables, whether they are displaced within Iraq and in the care of or if they are in the neighbouring countries. I think the security situation is very clear for everybody and what is going on. Speaking of my experience, I am one of the lead head of agencies that has been going to Iraq since 2004. Between 2004 and 2005, 2006 was the most difficult, and also the beginning of 2007 in terms of movement. I managed during this past month to visit a women's prison and see the difference. To visit hospitals, public health outside the green zone. I have seen a difference in the movement of the people if I take one hospital that I have visited in 2005, 2006 and 2008 I would say that there has been almost close to 90% if not 100% change in the cleanliness, rehabilitation in that hospital. I take it as an indicator that there are hopes, there are positive changes happening. However, the media is only focusing on the violence and negative security aspect. To that extent, it is not reflecting the success stories and achievement on the ground. Talking back to the security, daily we are hearing of bombs here and there, affecting the UN, and as WHO we are really assessing the situation closely. We try to deliver as much as possible, what we can, and are committed to deliver, given the context, and are aware that we are no able to give as much as we like, as much as really being able at the health facilities on a daily basis, for example. The past three months we have managed to visit several sites, and that itself in an achievement compared to 2006 and 2007. Paul Garwood: Dr. Laroche is able to speak on a range of activities with resource mobilization that are underway within Iraq to raise resources for the humanitarian needs health wise in the country. And to talk about the level of support that headquarters is providing to Iraq and the country office there. Announcer: The next question is from Mrs. Maria Cheng from AP. Maria Cheng: Hi. I wondered if you could be a bit more specific about the health priorities in Iraq, if it’s things like vaccination programmes for kids, or things like setting up disease surveillance systems. Could you identify what you think are the top one or two priorities that you will be focusing on and give some specifics in terms of what you will be doing, rather than simply supporting the government? I just wonder if we can get a better idea of what's actually being done. Naeema: For the past 5 years we have been intensively working on the immunization campaign for the Iraqi children, close to 5 million that we have covered for the polio prevention, also for the measles prevention. The immunization campaign is done with the support of the MoH. We are talking about more than 10,000 employees from neighbourhoods, districts, and into the centre. And in collaboration with our sister agencies UNICEF.
What are our priorities? To continue what I call the health gains and successes to assist the countries and the Government of Iraq in meeting the MDG. For example, definitely the immunization campaigns are going to continue, meanwhile we are working with the Iraqi Government in focusing the routine expanded program. Fortunately, and because of our committed presence, the Government has decided to introduce two new vaccines which will be vital to the children under 5 against hepatitis against rotavirus virus. So that’s an achievement that we are going to help in the coming years. If I take other gains. The past four years we have been working closely on malaria. We are seeing results today. There are no reported cases this year. Last year there were only 3 cases and our plan is to continue the strategy to eliminate malaria from Iraq and the plan is by 2010. There are many areas in the public health care. The concern that was raised last year if you recall, we had a cholera outbreak, now there has been a very robust surveillance system, not only for the human beings but also for the water quality control and we are looking at that very carefully because there is a fewer that this summer, if all the sectors are not going to work together that we are going to experience cholera and typhoid again. This is our immediate, urgent priority and our focus, again, are the internally displaced, the vulnerable because they are the ones at highest risk. Other plans that we have besides the robust surveillance system… we have just finished a course and there will be another one inside Iraq, we are continuing our support to the public health care. I think some of the achievements; Iraq has remained polio free over the past 8 years, even though we have had some polio in the neighbouring countries. For example, the Avian flu which is a concern of many countries in the region and the world. Iraq has a robust programme and strong surveillance in management of the disease. WHO has a close watch relationship with the neighbouring community. What are our plans now? As I said earlier, we are looking at a three-prong idea. We are looking at humanitarian and urgency, however not losing the sight of the recovery and policy development. We are now at the stage where Iraq is ready to come up with a five year plan and that’s where we are working with them. We are fortunate that we are working closely with our partners and the UN agencies. Now what we have is that action is going to be based on evidence and information. We have done the Iraq Family Health survey, we have done a noncommunicable health diseases and causing factors survey in 2006. Other agencies have done complementary surveys. All of this is used to influence the Iraqi Government in their future strategy. Why? Because we are also looking at very closely assisting the immediate service delivery. One thing that again because of our permanent presence, there is a push for the approval on the basic health services package. Our advocacy role has managed to push more funds from the Government of Iraq to health. The other thing that WHO has been continuously doing, but now will be more pushed for, is the whole pharmaceutical vaccine availability with other partners pushing the Government to do a review, which has been done, but now to take action and implement political promises. So these are the things, from advocacy to mobilize more resources to health to advocacy to sustaining the health developments already. I just only mention a few of them towards meeting the MDG and at the same time through providing full technical support on the packages of intervention. If I take, for example, cholera control, if it is intensified programme on the social awareness committee now . For example, we have managed now that families are getting their health messages through mobile phones and text messages and face-to-face health visits. So its actually going
back and forth from policy development support, what are the resources, but at the same time looking at day-to-day critical issues and our two main issues that we are looking at are public health factors, such as looking for outbreaks of cholera or typhoid but also lifesaving, that is how to handle the nature and the impact of the violence . The psychosocial mental health is a major area where we have been working. Very soon there will be the results of that survey which show the burden of the disease and the impact on the economy of the country because of the psychosocial mental health problems inside Iraq. These are just, in a nutshell, some of the things that we have been doing in Iraq. Taking from the assessment of the real situation, rather rapid assessment. For example, when IDPs meet, which can be a very rapid, immediate thing, to surveys that we have been put towards the government, so we can talk out of numbers and present an organized response. However, I have to say health needs much more investment. We have been working with the Government. Yes, there is money inside Iraq. Yes, the Iraq country is rich. However, one has to be careful, it’s the efficiency of using the money, the profits of handling, the legality, all these management component, to ensure that the vulnerable, the women, the children, the IDPs are actually receiving the care. In a nutshell, the immediate response to making sure that people are receiving the care and the immunization and health care, but also the immediate support to making sure that the system is working and is strengthened in primary health care. Maria Cheng: Did anyone come up with a figure that would be needed to address all these primary health needs? I'm guessing it would be pretty massive, but I'm just wondering if there is something that you are going to be going forward to donors with? Naeema: Well, the budget of the Government was requested for health was US$ 4 billion so it showed that the Ministry of Health did not get what it needed to get. As I said, the last three months, there has been a major shortage. There has been a lot of advocacy by direct people speaking to the Prime Minister saying that there needs to be more of an investment in health. So the current acting Prime Minister is also following this. This US$ 4 billion is just to bring the basic services. The hospitals need rehabilitation. Now the primary health centres, some have been rehabilitated, the United States already gave 80 of them to the Government. The Government has decided they need 10,000 PHC. Now this would take maybe 10 years to construct them. The advice that WHO is giving is that it is not only the construction and the recruitment, but also the cornerstone, the right technical competence of the personnel to run such a service and system. The system cannot focus only on materials. It should be assessed at all angles. The budget for the medicine, for example, has been very limited. It has been increased recently, compared to the needs of Iraq. Yes, the needs are very huge, as I said, however with all the advocacies, also working with the MoH, the parliamentarian, and WHO, we have had close contact the past year and a half or two and the past 6 months almost on a two week basis because as a representative, the announcement is new, but if you look at my presence inside Iraq, especially since January, I have been more inside Iraq than anywhere in the world and the real reason I have come out is to accompany the Iraqi officials to different meetings. So, the last six months, I see has gotten the fruit, plus
definitely the development partners for work. The donors push, the Compact, have all brought a definitely positive push to the agenda on health. To make it slowly on the top of the agenda of the Government, besides the issue of security. One message that we try to say as WHO is that if you don't invest in health, then your economy development reform will not happen. For example, if there is a public health outbreak such as cholera, you cannot attract investors. People are sick, they cannot run your industry and economy. These are some of the simple messages given, but we are also given them lessons learned, statistics, evidence based on the health impact and the recovery of any country. And this advocacy, mainly between the MoH, the parliamentary, and WHO, mainly in the last 9 months to a year, has really been working very well. The needs are very great. The health system will not revive not only because there is not enough PHC, hospitals, security is an issue but also because to have the right health personnel and a commitment of the health institutions to produce the categories of personnel. Dr. Eric Laroche: There are so many needs in Iraq. Everyone talks about Iraq, how do we help, and as a result is the CAP, the appeal process that was launched in Feb. this 2008 which was calling for US$ 35 million for health, out of which US$ 19 million was to be provided, which was asked by WHO, nothing has been so far financed. This is not acceptable. I don’t know why it is so under funded, and I think that we will find ways by which we will be able to redress this internally by our own mechanism, but it is quite surprising to see that there are so many needs. Iraqis are also going towards a kind of transition in terms of disease. When you look at the type of disease that we have to face, they are much more related to noncommunicable diseases. But when you see that almost half of all diseases are due to cardiovascular diseases, and you see the amount smoking, you can see that many of these diseases are probably related to stress, and the global stress in Iraq, and we need to highlight that. It is as important to fight against communicable diseases for kids as is to fight for all stress generated type of diseases among others. All the more reason to try to take it more serious, and to ask the donor community to be more responsive. You should look at the Iraqi outside of Iraq. In September 2007, there was a WHO and UN partners issued a health sector appeal of US$ 85 million to cover the needs of Iraqi in neighbouring countries, and WHO was asking for only US$ 18 million, and to date you have seen all of US$ 7.4 million come in. It is also the case in Afghanistan. Iraq and Afghanistan are very much in the news, but when you see the reality in terms of how much the donor community wants to help the people, I think their response is not always as vocal as the media's is. Announcer: We now have a question from Mrs. Stephanie Nebehay from Reuter's News Agency. Stephanie: I wonder whether Dr. Al-Gasseer can clarify what hospital she spoke about early on, which hospital she visited.
Naeema: The past month I visited Baghdad Teaching Hospital, which I have seen in 2005, 2006 and 2008. But I have also visited others. We are now monitoring closely three labs that we have supported, and we are very proud to say that the support is not only in building, but also in all aspects. For example, the Central Public Health Lab. If you know, in 2003, it was only 30% functioning. Now it is fully functioning. There are so many things that we are doing so that we can see if the quality is maintained. I have been impressed by the level of cleanliness. I have taken surprise visits. I could see the level, the number of patients, the women, children, the functioning of the specialized centre. I was also impressed by the personnel. Were the physicians young? Yes, all paramedics, nurses, they were young, but very professional, I would say compared to the previous years. Competent, confident, and the way I would describe it, their heads were high. Not like before, looking down and having difficulty looking at you. So I was impressed by this change. That they are there ready to serve and they are not just doing a job. Stephanie: Are you able to say how many people are part of this international presence now? Naeema: Today, WHO is the second agency, before us is UNHCR. They are the first agency that has announced presence inside Iraq, and WHO is second. I understand that very soon, other UN agencies will be joining. The numbers are not as much as we want because the demand is very great, however we will go back to the very critical question about security. Security remains as an issue and a concern, that’s why the numbers are back and forth. For WHO our numbers, the coming months will be two to three and we are looking to have at least 6 to 8 inside Iraq. This is international. We already have a large number of national all over Iraq.
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