December 9, 2019

In a recent commentary, faculty from the UNC Gillings School of Global Public Health call for more urgency in the delivery of quality care to countries experiencing extreme adversity, documenting ongoing crises in Iraq and the devastating impact they have had on human health in the region.

Dr. Dilshad Jaff

Dr. Dilshad Jaff

Dilshad Jaff, MD, MPH, Gillings Humanitarian Fellow and an adjunct associate professor of maternal and child health, is lead author of the commentary “Responsive health services and quality care in settings of extreme adversity: the case of central and northern Iraq,” which was published online November 12 in Medicine, Conflicts and Survival.

Sheila Leatherman

Sheila Leatherman

Other Gillings School authors on the paper are Sheila Leatherman, MSW, professor of health policy and management, and John Tomaro, PhD, adjunct associate professor of health policy and management. They are part of a group of faculty leading the Quality in Extreme Adversity (QEA) project at the Gillings School.

Countries that face extreme adversity – such as humanitarian crises, refugees and displaced populations, and conflict and post-conflict zones – are at risk for unstable conditions that threaten public health with the breakdowns of infrastructure and medical systems. These settings can lead to poor health outcomes and health emergencies, disease outbreaks, natural disasters and other environmental emergencies.

In this paper, the authors document protracted, violent conflicts in Iraq, specifically in central and northern Iraq, and highlight the effects these conflicts have had on the public health system and the health status of the communities.

“There has been a lack of attention in global health to quality of care in settings of extreme adversity,” says Jaff. “Part of the QAE project at the Gillings School is to produce multiple articles that address gaps and develop definitions, frameworks and guidelines for global health leaders and agencies to utilize around the world in these challenging settings.”

Humanitarian crises in Iraq from 2003 to 2017, beginning with the United States invasion of the country in 2003 through 2014’s resurgence of ISIS, have resulted in extremely poor health conditions. Referring to recent data from the United Nations Children’s Fund and the World Bank, the authors report that life expectancy for men ages 20-29 has fallen, while the mortality of infants and young children continues to increase. Qualified health personnel such as midwives, physicians, dentists and pharmacists are in short supply, and many health care providers from the public sector have sought higher-paying jobs in the private sector.

The QEA framework on which this group has previously published includes interventions that are designed to increase access to medically necessary care, reduce avoidable morbidity and mortality and deliver patient-centered care. Creating and ensuring access to a basic infrastructure of health and safety services, building a better workforce and implementing quality control measures for services, improving front-line clinical care, and engaging and empowering patients, families and communities are all part of that framework.

“This case study demonstrates and documents how the minimum standard of quality of care is overlooked in humanitarian emergencies,” says Jaff. “Leaders should move quickly to define what is a basic level of responsive, quality care for these areas in order to protect the most vulnerable in some of the world’s most afflicted communities.”

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