The Foreign Service Journal, December 2004

gathered on Feb. 14, 2004 — less than a year after U.S. troops landed in Iraq — for the first international med- ical conference in Iraq since Saddam Hussein became president in 1979. Iraqi doctors came from as far north as Kurdistan and as far south as Basra for the opportu- nity to update their knowledge, exchange ideas and chart their future at the Iraqi Medical Specialty Forum. The forum was designed as an academic medical conference to help Iraqi physicians improve their health-care system to provide the best care for the peo- ple of their country. It was also intended to encourage Iraqi physicians to revitalize independent, nongovern- mental medical specialty societies in their country and establish an overarching organization to represent their interests as a group. The interaction would help Iraqi doctors establish connections with their specialty coun- terparts in the West and jump-start a return of Iraq to the modern medical age. The story of this unique initiative — its background, execution and follow-up — is a timely addition to the annals of medical diplomacy, and a reminder that med- icine transcends national boundaries and is a valuable bridge to peace. Despite the ongoing violence and dev- astation, the medical profession is reaching out to col- leagues in Iraq. A Once-Modern Healthcare System In the 1970s, Iraq’s health-care system was consid- ered the finest in the Middle East, with large hospitals and the latest equipment. The country’s oil reserves were used for large projects that advanced the country, including sophisticated water treatment facilities and an extensive school and university system, as well as a strong military. But under Saddam Hussein’s rule, from 1979 to 2003, neglect, mismanagement and corruption set in. If the Iran-Iraq War of 1980-1988 drained the country, the Persian Gulf War of 1991 and subsequent U.N.-imposed trade sanctions left the Iraqi economy and infrastructure in shambles. The U.N.’s “oil-for- food” program provided some aid for the Iraqi popula- tion, but deterioration of the health-care system and water supplies greatly threatened the health and well- being of the Iraqi people. In 1999 the International Committee of the Red Cross issued this bleak report: “Standards of care in hospitals and health centers have reached appalling lev- els, despite the doctors’ dedication and high qualifica- tions. Iraq’s 130 hospitals, many of them built by for- eign companies from the 1960s to the 1980s, have not received the necessary repairs or maintenance since the Gulf War, but above all since the imposition of sanc- tions. The buildings are in an advanced state of disre- pair (cracked and leaking roofing, broken windows and doors, bulging floors), as are the hospital sewage works, the electricity and ventilation systems [and] the eleva- tors. Expensive imported equipment, or even more basic items, are no longer being replaced.” The U.N. sanctions banned all trade with Iraq after its 1990 invasion of Kuwait. Further, the U.N. Security Council resolution did not grant an exemption for trans- mission of medical and scientific literature, effectively cutting Iraqi physicians off from the international med- ical community and creating an intellectual embargo. The U.S. enforced the embargo through licensing requirements for goods sent to Iraq, visa restrictions, postal regulations and a ban on travel by Americans to Iraq. The regime’s own prohibitions on satellite and Internet communication, and travel restrictions imposed on Iraqi physicians who wanted to attend con- ferences outside of the country, compounded the prob- lem. Those who spoke out against the regime were jailed, or worse. The future was grim, and many highly qualified Iraqis left their country or tried to do so. When coalition forces reached Baghdad in April 2003, military medical officers and humanitarian orga- nizations began to assess the civilian population’s health-care needs, the state of facilities and the medical community. It was difficult, however, to identify the leaders among the physicians they met. While Iraq’s medical education system, conducted in English and modeled after the six-year British curriculum, trains physicians in a range of specialties similar to the West, independent medical organizations did not function as the voice of the profession or specialty. “Under Saddam Hussein, you had to be a member of the Ba’thist party to be elected, and when medical soci- ety elections were held you were told whom to elect,” F O C U S D E C E M B E R 2 0 0 4 / F O R E I G N S E R V I C E J O U R N A L 31 Lousanne Lofgren, a certified association executive, is a free-lance consultant with more than 20 years of experience working with medical societies. Previously she was assistant executive director for health policy, practice and informatics for the American Society of Plastic Surgeons.