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Welcome to "Ask the White House" -- an online interactive forum where you can submit questions to Administration Officials and friends of the White House. Visit the "Ask the White House" archives to read other discussions with White House officials.

James Haveman
December 4, 2003

James Haveman
Hello from Baghdad. It has been a busy day at the Ministry of Health. Today we were working on some short and long term plans for the country of Iraq related to pediatric oncology. All 240 hospitals in the country are open and providing services as well as the 1200 primary health care centers. The public health system continues to work to prevent a major health care crisis. None has happened. The Minister of Health, Dr. Abbas, is very supportive opening the doors and windows of Iraq for people to see the strengths and challenges of its health care system. As the CPA Senior Advisor for Health, I have been in country since June 2003 and welcome this opportunity to share our observations and experiences with you.

Jason, from Boston, MA writes:
How has the health care system in Iraq improved from the health care system under Saddam Hussein? What specific achievements can you cite?

James Haveman
Under Saddam corruption was rampant in the Ministry of Health. Saddam in 2002 spent $16 million (US) on health care for 26 million people. That is a 90 percent reduction from what was spent 10 years ago. Physicians in 2002 were making $20 per month. Pharmacists $1 per month. People who wanted contracts for medicine and equipment had to pay anywhere from 10-25 percent corrupt surcharges that went to the former regime.

The system suffered from decades of neglect of maintenance. Today, all 240 Iraqi hospitals and 1200 primary health care clinics are operating offering basic health care services at better than pre-war capabilities. There are also 70 private hospitals operating in Iraq. The budget from July 1, 2003 to December 2003 is $210 million a significant increase. In 2004, health care budget will be almost $1 billion. In addition, the US supplemental provides an additional $793 million for hospitals rehab/reconstruction and purchasing of new equipment. This is in addition to what we will also receive from the Donor Conference in pledges.

The Ministry of Health building was completely looted after the war. It is now being remodeled and in full operation. Over 22,000 tons of pharmaceuticals has been delivered throughout Iraq and it is estimated that usage of health care has increased by 10-25 percent. The isolation of health professionals has stopped since the war and professionals are traveling to other countries. Other countries are also sending people into Iraq to assist in health care and teaching. Infant mortality has been some of the highest in the world at 108 of 1,000. Child mortality under 5 years of age was 131 of 1,000. The Minister of Health is committed to cutting this in half by the end of 2005.

ershad, from Dhaka, Bangladesh writes:
Wining the heart and mind of Iraqi people seemed to be a bit difficult at the present context of ongoing situation. Could it work if credible representatives from the countries, preferably from with which it(people)has long trusted relation be drawn into the country and mobilised motivating, convincing them on the good wills and desire of coalition forces.

James Haveman
There are more than 30 coalition partners currently helping rebuild Iraq. As part of the Health Senior Advisors team, we have representatives from Italy, Netherlands, United Kingdom, Canada, and the US. We welcome the assistance of our coalition partners.

Casey, from East Lansing, MI writes:
Mr. Haveman - first of all, thanks the great work you have done and for representing Michigan and the United States with such class and honor.

How close are the people of Iraq to having access to all areas of healthcare and what is the next step you need to take to achieve this goal?

Thanks so much.

James Haveman
I’m a Spartan fan from Michigan State University and GO GREEN!! The Ministry of Health has committed to have health care accessible, affordable and available to ALL Iraqi citizens – regardless of ethnicity, geographic origin, gender, and religious creed.

This is a significant change from the past where health care was used to punish people, increase death rates of children of ethnic groups and for other political gain of the former regime. We are excited with the Iraqis that these days are over.

95 percent of health care is paid for by the Iraqi federal government and many people who come for care such as children, pregnant mothers, people injured in the war, those who were tortured by the former regime and many other groups receive free care.

Adam, from Kingman, AZ writes:
How do you take religious and cultural differences into account when giving health education to the Iraqis? Given what my daughter learns in public school, I can't imagine you could have the same standards in a strictly religious country.

James Haveman
The Ministry of Health respects the unique religious and cultural beauty of this country. We are focusing our health promotion and education efforts with full consideration of all religious differences of the Iraqi people.

Basic health-related materials on nutrition, healthy living practices, avoidance of health risks and caring for yourself are universal issues and we are bringing them to the attention of the Iraqi people.

We are starting education and marketing campaigns in the local communities and schools. The public health education division of the Ministry of Health is staffed by Iraqis from many religious and ethnic backgrounds who are actively working on public health campaigns.

Health promotion materials are being re-written and updated to reflect different ethnic groups and religious backgrounds. For example, including photographs of women who chose to wear a chador, and those who don’t as well as printing materials in both Arabic and Kurdish.

We are targeting those in the local communities where preventive medicine is key to a healthy people.

James, from Camden, NJ writes:
How bad off was the public health system when you first went to Iraq?

James Haveman
The basic public health system in Iraq in better shape than one might have expected. Many were predicting massive health outbreaks this past spring and summer which did not happen.

This was due to the hard work of many health educators and health professionals and the Iraqi people listening to various health campaigns. For instance, immunization rates in Iraq in many areas is over 85 percent for infants and children. This is due to the fine work of UNICEF and the Ministry of Health.

Unfortunately, we found infant, child and maternal mortality rates at deplorable levels. As we refurbish our 1200 primary health centers and 240 hospitals, a major focus of the Ministry of Health is on women and child health to decrease these mortality rates.

Our public health team at the Ministry of Health is actively engaged in all public health areas from clinical and public health, laboratory reconstruction to the development of an improved nation-wide disease surveillance program.

Marek, from New Mexico writes:
The idea of a democracy in the Middle East is fascinating. And I understand the need to showcase the benefits of a democratic system -- it will make for an embracing of democracy.

Tell me, how does health care in Iraq (the current state) compare with other Middle Eastern countries? And is it the feeling that a much improved health care system is another important component of a democratic society?

Thanks for answering my questions.

James Haveman
I have had many occasions where staff from the Ministry of Health have asked me “what is freedom?” and “what does it mean to live in a free and open society?”.

These are fascinating and enjoyable discussion to have and Iraqis are embracing what freedom and free-speech and the entrepreneurial spirit can offer.

Per capita spending during the Saddam regime was about $.70. To compare, Jordan spends $134 per capita, Kuwait spends $630 per capita, Lebanon spends $499 per capita, Saudi Arabia spends $352 per capita and Syria spends $42.

In 2004, the per capita in Iraq will be about $55 for health expenditures which includes health care services, public health, pharmaceuticals, equipment and medical supplies.

Yes I believe that a accessible and effective health care system will parallel the economic reconstruction of Iraq. They go hand-in-hand.

Neha, from Dallas, TX writes:
My family immigrated from Kuwait when I was a girl. I have not been back for about 8 years. I was proud of our troops and our President when Mr. Hussein was taken from power. What changes are you seeing in Iraq?

James Haveman
I too am very proud of the leadership of President Bush and our troops in freeing Iraqis from oppression of Saddam Hussein. I think about this each day as I go to work at the Ministry of Health.

Many times each week, I pass the square where the statue of Saddam fell. There are many changes in Iraq today. You can travel throughout the country without hostile checkpoints from Saddam’s military.

Previously, people had no access to satellite TV and now millions are spouting up across the country. In the previous regime, you could not have a satellite. If you were caught with one, you were fined and put in jail for 6 months. Just think of what it is like to have the doors of the world opened via technology. The same thing is true for internet access. T

he access by families to education institutions, ministries and internet café are springing up everywhere. The markets are busy and well stocked with everything imaginable.

Over 100 newspapers have sprung up in Baghdad alone. In the previous regime there were only 2 newspapers – both owned by Saddam.

People today are speaking their minds in an open and free way and debating the issues for the future. These are just a few examples of some of the progress that is taking place.

Derek, from Pittsburgh writes:
Please continue to have Iraq-focused "Ask the White House" shows. Very informative. Thank you. Mr. Haveman, what has surprised you the most during your experience in Iraq?

James Haveman
What surprised me the most was the resolve and the capabilities of the Iraqi people. They have survived over 30 years of isolation, neglect and oppression by Saddam Hussein. The best description of what I have heard that it was like – is that a Pharmacist of the Ministry of Health told me yesterday that she felt “buried alive” during that time. She now describes her life as a new beginning and one of tremendous personal growth. Iraqis are smart, energetic people starving for today’s technologies and techniques to quickly come up to first rate standards in health care which this country deserves. Those who have been around Iraq for many years remember that in 1964, Baghdad was the center of health care for the Middle East. In fact, I have an Iraqi colleague in Baghdad who was doing kidney transplants in 1964. All that was stolen by Saddam Hussein and the first-world minds suffered over the past decades from a third world education. This is now changing.

Beth, from Philadelphia, PA writes:
What kind of managed care system will be implemented in Iraq? Will it be similar to HMOs here or will it be state run? Will Iraq's new managed health program reflect the Bush Administration's plans for revamping our healthcare system?

James Haveman
Managed care is a foreign concept in the Middle East. The people of Iraq will decide their health care system for the future. The system today – as in the countries in the Middle East – is more of a social medicine system available to all at no or low cost.

If people can afford to pay more, they go to private hospitals in their own country or go outside the country to other private hospitals. As the system matures, financing methods will be decided by the future government and their leaders.

Today in Iraq the Ministry of Health pays 95 percent of the health care costs. The remaining 5 percent is paid by Iraqi citizens who have the means to pay in the public hospitals.

For those needing prescription drugs, a flat fee of 250 Iraqi Dinar (equivalent to $.12 US) is charged. For those who cannot afford that cost, there is no charge.

Abner, from Toad Suck, AR writes:
As Health Director, do you just cover hospitals and medical care or a larger scope? What kinds of steps are you taking to prevent illnesses that are occuring from water supplies contaminated during wartime?

Have a good day

James Haveman
The Ministry of Health does cover hospital medical care throughout all of Iraq. In regards to preventing illness from water supply contamination, we are testing water and providing water purification materials.

We are also engaged in an active health promotion and health campaigns. The CPA is working hard for the Iraqi Ministries to improve potable water throughout Iraq.

Liz, from Portland, OR writes:
I've heard that womens' health in pre-war Iraq was all but ignored. How has this changed under the CPA? What steps are you taking to educate women about their own healthcare?

James Haveman
You live in beautiful city. Maternal child health was not “all but ignored”, but was a far cry from the standards you may expect in the UK or the US.

Infant and child mortality rates are exceedingly high and we are actively focusing on maternal-child health in our reconstruction plans, from the rebuilding and refurbishment of maternal-child hospitals to advancing treatment modalities for children with cancer, to building health education programs and promotional activities that address prenatal, nutrition and child development programs.

John, from Long Beach, CA writes:
I'm a doctor in California who specializes in radiology. Many of the techniques and procedures we use are made possible by extremely sophisticated equipment. What access do Iraqis have to these services?

Also, how can I as a citizen contribute to bettering the health care situation in Iraq?

James Haveman
Basic radiological services are available, but advanced equipment and digital radiology is a dream to the Iraqi people. CAT scans and MRIs are available sporadically throughout the country.

For instance in the Kurdish North, there is one MRI for 3 million people. When I arrived in Iraq in June, I found 55 brand new x-ray machines in a warehouse that had been there for several months and were purposefully withheld from the Iraqi people by the former regime.

What I have discovered over the past several months is that Saddam Hussein had no intention of improving the health care of the Iraqi people even though the Oil For Food program allowed a quality system.

This all was part of his deception of his own people to blame others for the Iraqi people’s plight and to make his case against sanctions.

The smoke and mirrors of this act was to divert the funds from health care to Saddam’s personal bank accounts, palaces, lavish life style, militarization and threats against others.

James Haveman
It was enjoyable to spend some time with each one of you to answer your questions. We all appreciate your interest in the beautiful country of Iraq as the Iraqis experience a country that is healthy and free! I hope to join you again sometime. Good day.

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