Research for stronger health systems during and after crisis

Health System Challenges in the face of the humanitarian crisis in Iraq

Posted on Monday, 04 Apr 2016

On October 24th, 2015 the Middle East Research Institute with funding from the Thematic Working Group on Fragile and Conflict-Affected States and collaboration from Health Policy Research Organisation-Kurdistan (HPRO) conducted a one-day meeting. The event explored the views of various stakeholders in Kurdistan region of Iraq on the challenges posed to the health system of the sudden increase of population it needs to serve.

In this blog, Goran Zangana outlines the background of the health system challenges in Kurdistan region, and the discussions at the meeting.

Iraq is experiencing one of the worst humanitarian crises in its history. Multiple political, economic and natural factors contributed to a humanitarian disaster unfolding in the country. The conflict with the so called Islamic State (ISIS) resulted in the death, injury and displacements of millions in the region. A financial crisis derived by low oil prices limited the ability of the government to respond effectively. These were combined with unusually hot summer temperatures and more recently flash flooding in many parts of the country.

Twenty two individuals participated in the event. Three were managers of local Non-governmental organisations (NGOs). Five participants were lectures at academic institutions. Three individuals represented international organisations. Eight persons were from governmental departments including the Ministry of Health and its related directorates and three were members of parliament. The participants were divided into two groups. A facilitator moderated the discussion in each group.

The findings of the meeting were categorised along the lines of WHO health systems building blocks framework. The challenges were then divided into high, moderate and low priority. This blog reports only on the high priority challenges.

The participants expressed anxiety over the limited resources available to continue providing health services in the challenging context of Iraq. Limited resources, reliance on only one source (oil) and the lack of pre-crisis planning in terms of dedicating funds were underlined by the participants. Many stakeholders expressed concerns about the increasing reliance on out-of-pocket sources of financing health services.

The attendees also reported long term and recently emerging issues related to the health workforce. For example, the participants voiced concerns over the ongoing mal-distribution of the human resources, lack of job descriptions, inadequate trainings and limited managerial skills. They also highlighted the lack of skills and training that are specific to the humanitarian and emergency situation in the country.

The stakeholders reflected on the limited interest and attention in part of policy-makers towards health management information system. They also expressed concerns over the limited capacity and willingness to collect, analyse and utilise data and knowledge related to the humanitarian crisis.

The group also highlighted what it called the lack of strategy and planning in part of the government in responding to the current crisis. Many participants reported the low priority attached to health by the government in its response to the unfolding humanitarian situation. Others expressed anxieties over the limited ownership of the response by the Ministry of Health and the government. Several others highlighted the lack of a patient-centred approach.

Many participants reported issues related to restricted access of vulnerable populations (mainly IDPs and refugees) to public and private services. Others underlined shortcomings in particular services such as maternity and child health, emergency services and communicable diseases as major threats. Participants expressed concerns about the overall bad quality of services. Others reported issues related to water and sanitation as considerable challenges.

Finally, the group also communicated worries about the inconsistent supply of medicines from the central Iraqi government to areas affected the most. Several participants conveyed anxiety over the lack of medicines, irrational use of medications and shortages in laboratory equipment and supplies.

 In the face of the challenges presented above, the group formulated a list of potential solutions for the government and related stakeholders to consider in their response to the humanitarian crisis.

To the best of our knowledge, the meeting is the first of its kind to address the challenges facing stakeholders in the provision of health services during the acute phases of the current crisis in Iraq. The meeting was able in bringing together a wide host of actors. The conduction of the meeting in the neutral environment of a research institution offered the opportunity for frank and comprehensive discussions. The adopted framework allowed the unpacking of the complex and usually hidden elements of the health system’s response to the crisis.

There were several limitations that became obvious during the meeting and upon reflection afterwards. First, the meeting did not include victims or members of affected communities. It was not possible to identify a representing organisation or body to voice the concerns and demands of affected communities. The participation of NGOs and civil society organisations, however, was thought as adequate in giving voice to affected communities. Second, there was an inadequate participation from international organisations, donors and other foreign agencies. Despite extending invitations to several such bodies, they either declined to participate or did not attend despite expressing interest in attending. Finally, several participants expressed concerns that such meetings can be of limited impact if their findings are not translated into concrete activities, plans or projects. The potential interest of the TWG or other relevant bodies in assisting with follow-up meetings or similar activities can mitigate some of those legitimate concerns. As a first step, the group was very interested in continuing its engagement with the TWG by, for example, becoming a member.