COVID-19 in Kurdistan: Health system vulnerabilities in a fragile setting

 

As of May 01, 2020, The Kurdistan Regional Government (KRG) of Iraq has confirmed 381 COVID-19 cases and five deaths.

The low number in Kurdistan Region of Iraq (KRI) is not dissimilar to trends in The Middle East and North Africa (MENA). However, there are concerns that the numbers might be higher than official figures. Claims that the virus affects ‘infidels’ and culturally inappropriate burials practices introduced stigmas, is potentially preventing self-presenting and reporting of deaths.

If true, the low numbers represent a stroke because of limited capacities due to decades of conflict, corruption, privatisation, and mismanagement. The Ministry of Health receives less than 5% of KRI’s budget. There are only about 100 ICU beds and ventilators. Delays in salary payments have demoralised the workforce prompting boycott, protest and mass immigration among doctors. While the public sector is suffering, donors such as IFC of the World Bank are giving millions of dollars in loans to fund private hospitals. Given these circumstances, it was not strange for the Prime Minister of the KRG to cite ‘the limited abilities of the health system’ in his plea to the public to follow public health advice.

Few testing exposed the limited abilities (33955 as of April 25). Concerns were raised about politically motivated regional discrepancies in testing. To improve efficiencies, multiple samples were mixed in the same medium to then be tested as a single sample.Limited resilience led to the failure to continue providing essential services. Vaccinations programmes, child, and maternity care have been suspended. Patients with chronic health conditions were unable to access medicines.

Issues around quarantine highlighted the limited trust in the system. As of April 16, 7695 people were quarantined in five-star hotels for ‘VIPs’ and cheaper hostels for the rest . This encouraged many to smuggle themselves to avoid hostel’s poor conditions. Quarantine was also seen as a form of arrest reminiscent of political suppression.

The rapidly expanding private health market emerged as a beneficiary of the crisis. Allowed to continue working, private hospitals and pharmacies enjoyed higher demands due to the closure of public services. Some private services increased the fees they charge, prompting the MoH to take punitive action.

In these circumstances, WHO has helped to provide information, PPEs, test kits, and ambulances. Such assistance, however, was not immune from political interpretations. A Governor complained that his district did not receive WHO’s aid because of escalating political tensions, reminiscent of similar controversies at the global level.

The case of COVID-19 in KRI demonstrates the vulnerabilities of the fragile setting  To assist these settings, actors such as WHO need to think beyond the traditional logistical support and consider political and cultural factors.

About the author

Goran Abdulla Sabir Zangana is a physician and an Associate Research Fellow with the The Middle East Research Institute.

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