Qatar's healthcare crisis

DOHA // Feeling ill? You might not want to be in Qatar.

The country has about 1.4 hospital beds for every 1,000 people – the lowest total in the GCC, one-fifth as many as Turkmenistan and Slovakia and fewer than poor countries such as the Democratic Republic of Congo.

“It’s not a good situation,” said Moza al Malki, a writer and family therapist. “Sometimes people go to be hospitalised and they can’t find an open bed.”

Despite a spike in government spending and the hiring of thousands of health-care workers, Qatar’s few hospitals and clinics are under severe strain because of a tripling of the population in the past dozen years.

“This huge increase in the population has put a huge load on our public health facilities,” said Jamal Khanji, head of the government’s medical licensing department. “There is a definite need for expansion, and that expansion is happening.”

Qatar has four public and five private hospitals, but the lynchpin is Hamad Medical Centre. The country’s primary health facility, it receives more than 80 per cent of public health-care spending.

Since 1999, that spending has risen from QR850 million (Dh858m) to QR4.3 billion, and the number of both nurses and doctors has tripled. Yet no major new health facilities have opened since 2004, and relative to population, the numbers of doctors, dentists, nurses and pharmacists fell anywhere from 15 per cent to 40 per cent during the past five years.


On a recent afternoon in Hamad’s emergency room, dozens of workers sat waiting for medical attention. Several limped, two held their stomachs and one held a bandage to his bleeding face.

Hamad’s bed occupancy rate, in the low 70s a decade ago, has hovered around 90 per cent for two years. A March study from the University of Michigan Health System found that occupancy rates above 80 per cent increase the risk of in-patient death by nearly six per cent.

Qatar’s foetal death rate, at 4.8 per 1,000 births in 2005, is now near eight per thousand, its highest in a decade. This is similar to rates in the UAE and Saudi Arabia.

Many residents have turned to pricey private providers or travel outside Qatar for health care, abandoning essentially free services at government-run facilities. Zakia Ali Malallah, a Qatari poet and commentator, recently wrote a column in the local Arabic language daily Al Watan about her three-hour wait to see a doctor at Hamad, vowing to never return.

And when Ms al Malki’s son was seriously injured in a motorcycle accident, her family sent him to Germany for treatment despite the high costs. “Nobody trusts Hamad now,” she said. “Even if I had to sell my house I would’ve sent him.”

The government is spending billions to alter that mindset. Set to come online in the next few years are paediatric and orthopaedic hospitals, a cardiac surgery centre and, at a cost of US$3 billion (Dh11bn), the Sidra Medical Centre. Construction is to begin this year on three hospitals exclusively for male labourers.

Qatar’s 2.25 doctors per 1,000 people is higher than Germany (2) and the UK (1.8) and just below the United States (2.43), according to the Organisation for Economic Development’s annual health data report. Yet specialists are rare.

Qatar has one specialist in tropical medicine, for instance, despite the presence of hundreds of thousands of people who hail from and regularly return to the Philippines, India, Bangladesh and Sri Lanka.

The Supreme Council of Health recently gave all primary health centre employees a five-per-cent salary rise, in an effort to increase retention, and began a recruitment drive for doctors and other health staff from across Arab countries.

“If you look at the need for nurses in this country, I would like to tell you we are talking about thousands,” Mohammad Fathy Saoud, the president of Qatar Foundation, said at a recent event.

A new policy allows the wives and adult children of resident healthcare professionals (except physicians) to work as trainees until the fulfillment of the experience required for licensing.

Last month, the government created the Qatar Health Practitioners’ Council to monitor medical licensing. The new body appeared shortly after the licences of 32 general practitioners were revoked because they were found to be practising without medical doctorates. All were given three years to earn a post-graduate degree, failing which their clinics would be closed permanently.

Health-care staffers could also use certification training. As a western expatriate was being rushed to the hospital in an ambulance this week, an emergency medical technician tried to take his blood pressure but failed to use the electronic machine properly. The machine constricted the patient’s arm until his fingers turned blue.

“The nurses and some other staff, we have to admit it, are mostly unqualified,” said Ms al Malki. “They don’t know what to do.”

That may be starting to change. Last month, the University of Calgary-Qatar graduated the country’s first university-trained nurses, the result of a programme nurtured by Qatari First Lady Sheikha Mozah bint Nasser Al Missned.

“There is a huge move to improve health services here,” said Mr Khanji. “The leadership of this country wants Qatar to be a hub for medical services in the region and you cannot achieve that without competent staff, a high level of safety, and recognised accreditation systems.”


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originally appeared in the july 9 2010 The National (www.thenational.ae)

Left Out in the Cold

CHAR-E-QAMBAR, Afghanistan- When the fighting came to his village in south Helmand, Abdul Rahman gathered his wife and seven children and fled to this bulging refugee camp on the Western edge of Kabul. Five months later the steely-eyed 35-year-old is questioning his decision.

"We are only getting food if I can find work in the city, which does not happen very much," Rahman says through an interpreter, scanning the mud walls and torn plastic roofing of his home away from home. "My children go to sleep hungry. We have no money and nobody is helping us."

Rahman is not an exception at Char-e-Qambar, where as a result of bureaucratic balderdash, minimal health care and almost no foreign aid an estimated 5,000 Afghans are struggling to survive.

Not a refugee camp?

The United Nations High Commission for Refugees estimates there are about 250,000 internally displaced people in Afghanistan and 3.4 million Afghan refugees in Iraq and Afghanistan - the fallout of three decades of conflict. Those numbers are rising as the insurgency intensifies and insecurity spreads across Afghanistan and into Pakistan's tribal areas, from where 20,000 fled into Afghanistan in late September.

The village of Char-e-Qambar lies a dozen kilometers southwest of central Kabul. Here, on an open expanse of desert under looming mountains and a blazing sun, nearly 900 Afghan families have squeezed into a tight, ramshackle collection of tents, tarps and mud homes.

The first trickle appeared in mid-2006 but the majority arrived in early 2008, fleeing intense fighting between the Taliban and international forces in southern Afghanistan. More arrive every day, yet to UNHCR this is not a refugee camp.

"It's not officially a camp - it's a spontaneous settlement," says Nadir Farhad, spokesman for UNHCR in Afghanistan. "The decision to open a camp is totally the government of Afghanistan's. Then it can be backed by international organizations such as UNHCR and we would be responsible for the camp and be able to provide them with proper, monthly assistance."

An Afghan Ministry of Refugees spokesman says the government is conducting a survey to determine the status of camp residents - refugee, internally displaced, or other. But on several visits Devex failed to find a residents who had recently been visited by a government representative or filled out a questionnaire.

"To the best of my knowledge many are not really IDPs," Farhad says of the camp residents. "They are just squatters."

Either way, UNHCR's stance may be inaccurate.

"The government has the primary responsibility for the welfare of its people but UNHCR and other agencies have a mandate to respond to vulnerable individuals in situations of displacement," says Patrick Duplat, an advocate for the pressure group Refugees International, in an e-mail.

He added that the government does not need to make any official declarations for aid to move in - a view confirmed by a spokesperson for the International Committee of the Red Cross in Afghanistan, and other aid outfits. Duplat, who co-authored a recently released report on the refugee and IDP situation in Afghanistan, has not visited Char-e-Qambar but is aware that many residents do not receive adequate aid.

"If people are suffering," says Duplat, "it's because the response has been poor at all levels, but it is not due to a bureaucratic impediment."

Darkness falls

Makeshift, multi-colored tents press up close to hand-packed mud walls, leaving foot-wide passageways in some spots. The stench of sewage and rotting food lurks around every corner. Gaggles of wide-eyed children, some with distended bellies, prawl dusty alleyways in torn clothes, looking to relieve their hunger-borne boredom. Housewives with little to do - there is no food to cook, no house or clothes to clean - peer out from behind tent flaps, scanning for their children or good news.

In the afternoon, long-bearded men retreat from the desert sun. In dark, windowless tents they speak in low, solemn tones, the phrase "Insh'allah," or god willing, never far from their lips.

"My daughter has been sick for two or three weeks," Abdul Rahman says matter-of-factly, sitting next to his 10-year-old daughter, who lies prone, moaning and occasionally twisting her rail-thin body. "Sometimes she gets fever, sometimes she gets sick in all her body, sometimes she's bleeding from her nose and mouth."

Rahman has taken her to the camp's clinic, to no avail. Run by the Education Health Bureau of Afghanistan, a small local NGO funded by the Dutch government, the clinic operates out of a tent near the camp entrance three days a week, offering consultation and free medicine.

Pharmacist Asadrullah Siddiqui, 23, is overwhelmed with 60 or more patients per day. He has more than 100 medicines but is often unable to supply what residents need.

"The health is bad here because there's no clean water and no full meals," Siddiqui tells Devex. "It will most likely get worse during the winter."

Unable to find adequate care at the clinic Rahman went to a doctor in Kabul, who prescribed medicines costing 12,500 Afghanis, or $250. Rahman has no money, so he carries a prescription on a piece of paper everywhere he goes, hoping someone will help buy the medicine to cure his daughter.

Many camp residents are similarly desperate.

"The Americans, when the Taliban attacked our village, they just started attacking everyone," says Dadgul. The 25-year-old from Helmand, who like many Afghans goes by one name, barely escaped the fighting with his wife and three young children. "We haven't been given any food and I can't find work. This will be a long winter."

Sorgul Kasho, also from Helmand, has three children and is building a new mud room for his home, hoping it would keep his family warm during the winter.

"Sometimes we can find work and eat, sometimes we do not," the 36-year-old says. "Our children are crying for food, but we cannot feed them."

Dribs and drabs

Aid agencies and their backers have in recent months cut back their efforts because of targeted attacks and deteriorating security. Indeed, as Duplat points out in his report, refugees and the displaced have received less humanitarian aid as a result of increasing insecurity.

But Char-e-Qambar is on the edge of Kabul - headquarters for the international community and the safest place in Afghanistan.

"The ICRC concentrates its activities with regard to assisting displaced persons on the direct conflict zones," says Franz Rauchenstein, ICRC spokesman. "In Kabul and its surroundings other humanitarian actors, including the government, have access themselves."

Less than five miles from the camp, foreign workers sip frothy mocha chais and nosh on cheeseburgers at Chaila, a hip garden cafe in Karta Se. In the evenings, expat staffers and consultants kibbitz over cocktails with a foot in the pool at L'Atmosphere, a few clicks further east.

"I know they are living in a poor condition, it's very hard," says Farhad during an interview in his office at the sprawling, heavily secured headquarters of UNHCR Afghanistan. "Our preferred solution for the IDPs is to go back to their place of origin if security permits it. If the security doesn't permit it we do our utmost to provide assistance where they are."

Aid has trickled in since the spring. In July, UNHCR delivered "winterization assistance" - lanterns, blankets, small bags of coal and dozens of white plastic tarps, which can be seen underneath rags and cloth coverings on rooftops. The Afghan government delivered hundreds of 10kg bags of flour that same month.

"Still our tents are too old, we have no food, and the medical assistance is no good," says Noor Mohamed, a 26-year-old father of two from Uruzgan. "When they brought the bags of flour the police took more than half of them, to sell for profit. Please you must tell people to help us."

The Afghan Ministry says it handed out cash awards of US$100 to each family in May. Some camp residents say they received the hand-out, others complain that it was only given to the newer arrivals from the south. In August, soldiers from the Kabul headquarters of the International Security Assistance Force passed out Meals Ready-to-Eat, but only enough for a couple hundred families.

"The situation with the internally displaced in Afghanistan is of grave concern," says Duplat, from Refugees International. "The international community were not and are still not set up to respond to humanitarian crises. Rather, the emphasis is put on longer-term development and institution building, at the expense of humanitarian activities."

The lone aid group providing humanitarian assistance daily is a local outfit. Since spring, Kabul-based Aschiana has been running boys and girls schools in tents near the camp entrance. Six days a week Mohammed Wahid leads classes in Dari and Pashto before the children are fed a meal of bread and bean soup. At lunchtime, hungry families come to share their son or daughter's food, which often leads to fighting.

"Winter is near, and last year many children died due to cold weather," says Engineer Yousef, Aschiana's founding director. "If they don't receive any aid this year maybe children will die as well because the prices of food and heating have both gone up."

A bitter winter looms

In late August, an American air strike near Herat killed 90 civilians, including 60 children, according to the United Nations. This most bloody American attack added to 2008's record total of civilian deaths. The following week the British charity Oxfam warned that Afghanistan could be facing one of its harshest winters in 20 years, putting up to 9 million poor and displaced at serious risk. With drought, rising food prices and a renewed insurgency compounding the problem, the group urged the international community to act quickly to avoid a "humanitarian crisis."

Yet many aid agencies are short on staff and most have curbed operations in light of increasing insecurity across the country - particularly in the area immediately surrounding Kabul.

Duplat sees a broader, systemic problem. He acknowledges the insecurity, but says the U.N. Assistance Mission in Afghanistan's humanitarian branch "remains inadequately staffed." The result is poor coordination and few opportunities for advocates to raise humanitarian concerns. The Char-e-Qambar neglect may thus be of a piece with the international community's fitful progress in improving the lot of Afghans.

"Until there is a real humanitarian coordination both in Kabul and in the provinces," Duplat says, "delivery of emergency services - including responding to internal displacement - will remain inadequate."

-- posted to devex.com on October 13.