Marco Werman: In Iraq, healthcare issues are of a completely different magnitude. Violence has risen to its highest level since 2007. Bombings and bullets kill hundreds of Iraqis each month, but the country's health emergency goes even beyond that. Gil Burnham coauthored a study published earlier this month assessing how many people have died in Iraq over the last 12 years, in other words, before the US-lead invasion. Burnham is with the Center for Refugee and Disaster Response at Johns Hopkins School of Public Health. Gil, tell us what you found.
Gil Burnham: Well, what we found, of course, was that a number of people died from conflict-related activities, but what really struck us was the increasing number of deaths that were related to indirect causes. That means lack of access to services in some way. This was a pattern we picked up in 2006 to begin with, but we noticed it increased substantially as time went along.
Werman: Right, so you say lack of services, what are you talking about? [inaudible 01:01]
Burnham: Yes, well it means that hospitals may not function to their full facility. They may not have the medicines. They may not have the doctors, the nurses, the equipment may not be functioning, so it could be a variety of things. Or it could be that it's just unsafe to go there.
Werman: So have you been able to quantify how many people died from direct death and how many have died from indirect?
Burnham: Our overall estimate was about 451,000 of overall deaths, so we're estimating that probably around a third of those were excess deaths from indirect causes of conflict.
Werman: Are these problems continuing today?
Burnham: Yes, they are. Unfortunately, while many parts of Iraq have moved ahead, we've seen some progress in the health sector, but there's still many areas of difficulty there.
Werman: Iraqi Prime Minister Nouri al-Maliki is heading to Washington this week to meet with President Obama. They'll be talking on security mostly, but I'm wondering if you think public health, or how public health might actually figure into the agenda?
Burnham: Well, without security people are not going to have access to health services, but from the public health standpoint, the serious damages to the water and sewage systems that occurred during the war, and much of that has not been repaired. There's still extended periods of time when much of the country does not have electricity. That's a major issue. There have been continuing problems with poor nutrition among children in Iraq, although I think some of that is improving. Still, haveing the security of the food security as well as the personal security I think would go a long way also to improving the health status of people.
Werman: Did you go to Iraq yourself, Gil, to work on this research?
Burnham: Yes, I've been to Iraq probably six or seven times in various parts. Right now, we're working very much on research projects to reduce the deaths and illness in women and children, and that's a major US AID initiative at the moment.
Werman: What struck you about healthcare in Iraq when you were there? I mean just something, you know, that wouldn't occur to the average American?
Burnham: Well, what struck me was the high motivation of the people that I met. These were very dedicated nurses and doctors who've been through really terrible times, lost family members, had colleagues killed or kidnapped. Yet they've stuck through all of this. They have their frustrations as anybody would working in a system that's not fully functional, but the dedication to their patients and the dedication to the health of the country to me was a very striking message.
Werman: Gil Burnham of the Johns Hopkins Center for Global Health, thank you very much.
Burnham: Thank you.
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