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(C) SUMMARY. Clinics and hospitals in Salah ad Din are at
risk of failing due to a breakdown in the government medical
supply system. Some hospitals have begun sending patients to
private clinics or pharmacies to purchase medicines that
should be available through government channels at no charge.

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DE RUEHGB #0241/01 0301508
ZNY CCCCC ZZH
P 301508Z JAN 10
FM AMEMBASSY BAGHDAD
TO RUEHC/SECSTATE WASHDC PRIORITY 6368
INFO RUCNRAQ/IRAQ COLLECTIVE PRIORITY
Content
C O N F I D E N T I A L BAGHDAD 000241

SIPDIS

DEPARTMENT FOR NEA/I

E.O. 12958: DECL: 01/29/2020
TAGS: PREL, PGOV, AMED, TBIO, IZ
SUBJECT: PRT SALAH AD DIN: MEDICAL SUPPLY BREAKDOWN
JEOPARDIZES HOSPITALS AND CLINICS

REF: A. 09 BAGHDAD 2530
B. 09 BAGHDAD 2847
C. 09 BAGHDAD 3181
D. BAGHDAD 3387

Classified By: David C. Stewart, PRT Team Leader, for reasons: 1.4 (b)
and (d)

1. (U) This is a Salah Ad Din Provincial Reconstruction Team
(PRT) message.

2. (C) SUMMARY. Clinics and hospitals in Salah ad Din are at
risk of failing due to a breakdown in the government medical
supply system. Some hospitals have begun sending patients to
private clinics or pharmacies to purchase medicines that
should be available through government channels at no charge.
The provincial medical warehouse stands half empty, though
shelves should be full. Truck drivers, who have not been
paid in months, have stopped deliveries, and large quantities
of medical supplies are disappearing into the black market.
PRT Staff started to notice the deteriorating situation
following the removal of the previous provincial Director
General (DG) of Health in June 2009. Political jostling in
the run-up to parliamentary elections in Salah ad Din (SaD)
has complicated prospects for a solution to these problems.
END SUMMARY.

GOVERNMENT SYSTEM FAILS TO DELIVER
----------------------------------

3. (C) Kamadia, the company that runs the Ministry of Health
(MoH) medical supply system, is faltering in its obligation
to deliver medicine to Salah ad Din. Antibiotics, in
particular have not been stocked at Kamadia's provincial
warehouse since November. Officials with whom we spoke at
the Tikrit Teaching Hospital (TTH) recently reported the
hospital lacked IV fluid and other supplies; some area
hospital and clinic professionals are increasingly telling
patients the medications they require are unavailable,
forcing patients to purchase these items from private sources
instead of obtaining them at no cost from the hospitals.
Kamadia's Baghdad warehouse reported it had additional
supplies to send to Salah ad Din, but truck drivers are not
picking up the shipments for lack of payment. Though there
are MoH funds allocated through the provincial DG of Health
to pay the drivers, the DG's office has not procured the
necessary funding for almost two months.

4. (C) In discussions with the PRT, numerous physicians and
medical staff from hospitals and clinics throughout the
Tikrit area have alleged that supplies are diverted into the
black market. A recent visit to Kamadia's Tikrit warehouse
by PRT staff found a large volume of medical supplies sitting
on pallets outside, open to the elements. Warehouse staff
confided to us that supplies are usually left outside,
presumably to be taken away for illegal sale to private
pharmacies. Some of these pharmacies reportedly also operate
illegally. The warehouse itself is not held accountable
because any supplies left outside are never inventoried. A
CERP project supported by a previous BCT funded shelving
materials to provide better storage and organization for the
warehouse, but much of that shelving unfortunately sits
outside, rusting after four months. Prior to the removal of
the previous provincial Director General (DG) of Health in
June 2009, the PRT did not witness this degree of
mishandling. Up until that point, medical supplies were
always locked indoors.

HEALTH AND PROVINCIAL POLITICS
------------------------------

5. (C) The former DG of Health, Dr. Hassan, was forced out by
the Provincial Council (PC) following revelations that the DG
had mishandled funds for a hospital cleaning contract. The
current interim DG, Dr. Qutaybah Ibrahim al-Jabouri, is a
Qcurrent interim DG, Dr. Qutaybah Ibrahim al-Jabouri, is a
candidate in the upcoming elections and a relative of the
Provincial Council Chairman (PCC), Ahmed Abdullah Abid
Khalaf, better known as Abu Mazin. The MoH and PC continue
to negotiate the naming of a new DG, but the MoH has rejected
several candidates put forward by the PC. Part of this
problem relates to the ongoing dispute between the former
Provincial Governor (PGov), Mutashar Hussein Ilaiwee and Abu
Mazin but Baghdad politics is also playing a role (Reftels
A-D). When the PC nominates someone, the IIP comes back
against the name, insisting that candidates be from the IIP.
The PCC would like to nominate the next DG from Tuz, but the
IIP refuses to consider non-IIP names.

6. (C) While hospitals and clinics face serious shortages of
medical supplies, many of their staff are hesitant to

complain. There have been instances in which some hospitals
have shuffled their staff to move key professionals to other
responsibilities in favor of those who are unlikely to raise
concerns about the drastic decline in medical care out of
concern for the political ramifications. For those who do
complain, there are consequences. TTH's chief surgeon was
demoted December 31, two days after he voiced alarm over the
state of medical care in the province during a meeting with
U.S. Forces.

7. (C) Comment: As the health situation in SaD continues to
deteriorate, the Provincial Government appears to either
stand by and do nothing, or have its hands tied by provincial
and national politics. In the meantime, the population
suffers. End Comment.
HILL