NEWS AND VIEWS /NOTICIAS Y OPINIONES
Iraq Faces the COVID-19 with Limited Health Capabilities and Major Medical Challenges
Wedad H. Al-Dahhan1, Mohammed H. Al-Mashhadani2, Rasha Raheem 3, Emad Yousif4*
Available from: http://dx.doi.org/10.21931/RB/2020.05.03.19
Coronavirus disease 2019 (COVID-19) is an infectious disease affecting the respiratory system, which has had an unprecedented effect on healthcare systems globally with severe impact on specialist services. In December 2019, a novel coronavirus strain (CoV) was detected in Wuhan, China. By January 2020, It named as 2019 novel coronavirus (2019-nCoV) by the World Health Organization (WHO). On February 24, Iraq announced that an Iranian student has infected by coronavirus disease (COVID-19) in the south of Iraq in the holy Shiite city (Najaf). This was the first confirmed case in the whole of Iraq. The patient entered the country before the Iraqi government decided to restrict the entry of Iranian citizens on border crossings or airports. This article sheds light on the following concepts: The unqualified health system in Iraq to face the pandemic disease like COVID-19; the religious rituals in Iraq which contributed to the events of large gatherings to visit the holy shrines which increase the virus spread. Finally, discuss the social customs and traditions where the spread of the Coronavirus in Iraq has modified Iraqi customs and traditions that show personal affection through physical touch.
Keywords: Iraq, COVID-19, pandemic, social factors, disease spread
Coronavirus disease 2019 (COVID-19), or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an infectious disease affecting the respiratory system. It had an unprecedented effect on healthcare systems globally, with a severe impact on specialist services 1. In December 2019, a novel coronavirus was detected in Wuhan, a city of 11 million people in Hubei Province, China 2. A new coronavirus strain (CoV) was isolated; in January 2020, the World Health Organization (WHO) referred to it as 2019-nCoV 3. This virus was renamed later as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and the disease it causes was named Coronavirus Disease 2019 (COVID-19) 4. On March 25 2020, more than eighteen thousand patients have died because of the virus, and 413 467 were confirmed cases in at least 180 countries around the world 5.
On Monday, February 24, Iraqi authorities announced that an Iranian citizen, who entered Iraq before the Iraqi government decided to restrict the entry of Iranian citizens, has infected by coronavirus disease (COVID-19). The infected patient has come to Iraq as a student to study religious subjects on the holy Shiite city south of Iraq (Najaf) about 160 km from Baghdad, the capital of Iraq. This was the first confirmed case by the medical laboratory test. On February 20, the Iraqi government postponed the granting visas and the flight by Iraqi Airways for Iranian citizens after the news that several Iranians have been infected with COVID-19 6. At the beginning of March 2020, as a precaution, the local authority in Karbala prevented the outsiders from entering the governorate, which limited millions of visitors to the province on the religious occasion. During that time, the COVID-19 positive cases started to increase based on an international statistic published on July 10. Moreover, there are now more than 12.0 million confirmed cases in 188 countries. More than 560,000 people have lost their lives, as shown in Figure 1 7.
Figure 1: The virus is spreading rapidly in many countries, and the death toll is still climbing 7.
This article sheds light on the following concepts: The unqualified health system in Iraq to face the pandemic disease like COVID-19; the religious rituals in Iraq which contributed to the events of large gatherings to visit the holy shrines which increase the virus spread. Finally, discuss the social customs and traditions where the spread of the Coronavirus in Iraq has modified Iraqi customs and traditions that show personal affection through physical touch. Importantly, the economic factor plus the factors mentioned above have an essential role in the disease spreading in Iraq.
Overview of the health situation in Iraq
The Iraq Total Population 39,340,000 in 2018 8 spread across 18 governorates, including three governorates in a semi-autonomous region of Kurdistan. The estimated population living in rural settings is 30.1% (2017), with 40.5% of the total population under the age of 15 (2017), with an annual population growth rate of 2.4% (2017) and a life expectancy at birth of 70.3 years (2017) 9.
The Iraqi healthcare system considers one of the best across the Middle East; hence it has affected by wars and economic troubles since the 1980s. The most significant blows to the system came during the civil conflicts across the country after 2003. Furthermore, more decline, as a result of the Islamic State (ISIS) in 2014 and the war after that 10.
A report by the World Bank Group in February 2017 entitled 'Iraq – Systematic Country Diagnostic' stated the following: 'Iraq's health care capacity has been severely undermined by the effects of various wars, international sanctions, sectarian violence, political instability, and fiscal pressures 11.
It was evident since the last two decades that Iraq is facing enormous healthcare challenges, no other country in the Middle East having worse healthcare than that. Although other countries have made health gains, Iraq deteriorated from high levels to one of the worst in the region 12.
Confirmed COVID-19 cases and the health situation in Iraq during the Corona pandemic
On February 24, 2020, was confirmed the first case of Coronavirus in Al-Najaf governorate south of Baghdad, as mentioned before. On February 28 2020, the government went through quarantine across the country as this is the most robust approach to prevent the disease outbreak and protect the vulnerable people 13. Iraqi people could face many challenges regarding this pandemic, lake of sufficient, and qualified infrastructure to control the outbreak of the disease. The hospitals do not have enough beds; moreover, these beds are not be disturbed equally around the country, according to the population 14. Figure 2 shows the confirmed cases of COVID-19 in Iraq between June 27 till July 11. The figure shows that there were 75,194 confirmed cases in Iraq, including 3,055 deaths as of July 11, 2020. It has demonstrated that the curve has exponential growth, which is an indication of the massive increase of COVID-19 cases in Iraq, especially after the government has reduced restrictions about the quarantine on April 26 15.
Figure 2: The confirmed cases of COVID-19 in Iraq between June 27 till July 11.
Religious visits pose a severe challenge to the spread of the Coronavirus
On March 17, Iraqi authorities decided to lock down all the country for week-long to stop the spread of the Coronavirus; most of the Iraqi people were adhering to that restriction.
However, the religious visits are an essential and crucial part of the religious beliefs of a large number of the Iraqi people who have been keen to perform these religious rituals for centuries, especially those visits where millions of visitors gather in one place. Some Iraqi pilgrims have traveled for tens of kilometers by foot, from Karbala to Baghdad, to visit the shrine of Imam Musa Kazim. Many pilgrims thought that infected patients would get well when they visit the shrine and advised people from China, Italy, and Iran to seek remedy here 16.
The Grand Religious Authority supports the efforts of the Ministry of Health to address the Corona pandemic
Religious Authority directed the necessity of the obligation of following the directions of the experts to control the spread of the dangerous pandemic, and that includes prohibiting holding gatherings and attending them for any reason 17. Sayyid Sistani's ( A respected Shea Emam) supports the ministry of health efforts. His support can be summarized by The responsibility of treating, caring for, and helping the ill is Wajib Kifa'ie (collective obligation on those members of the community who are capable of contributing) upon those who are qualified to do so, including medical doctors, nursing staff and others. However, it is the responsibility of the authorities concerned to provide them, all that they need to defend themselves from the risks of constricting the illness, and there is no excuse for the failure or delay in doing so. The work that is being done by these individuals, despite all the challenges they face, is priceless. Their effort is close in importance as fighting side by side in the trenches with the heroes defending the homeland and its people 18.
Another case highlights the religious authority role during the pandemic; In a brief answer to questions about fasting the holy month of Ramadan with the spread of the Coronavirus (COVID-19) pandemic from religious authorities, it is obligatory to fast during the holy month of Ramadan. However, this obligation is lifted if a person has an authentic excuse, such as being not well, and one with chronic diseases. Otherwise, they need to do so, and it is not permitted for them to breakfasting 19.
We should not forget to mention the detailed instructions that had been issued. The instructions are stating how the Coronavirus infected dead should be buried in a manner that guarantees the implementation of health precautions and the implementation of burial provisions under Islamic law 20.
Coronavirus changes Iraq's traditions of physical touch
The spread of the Coronavirus in Iraq has modified Iraqi customs and traditions that show personal affection through physical touch. The banning of social gatherings of Iraqis in celebration of joyful events or even for condolences is one of the Coronavirus changes. Many Iraqis are now practicing social distancing even with their dearest ones, fearing transmission of the Coronavirus. The regular Greeting ways disappeared, Men no longer kiss each other's cheeks, and women no longer hug each other, essentially ending timeless traditions, even if only temporarily.
Iraqi authorities enforced strict measures on March 13 because of the growing number of coronavirus cases. They also banned religious gatherings and visits, funeral services, and wedding parties. However, some Iraqis are not sticking to these measures. In Iraqi culture, especially in the central and southern provinces, the families of a deceased person would set up tents to receive people paying their condolences. Arab coffee and two meals are usually served during these funeral celebrations. Dozens of those attending the funeral procession would drink from the same cup without washing it. Nevertheless, the tribes, who enjoy vast social influence, banned this tradition. Disposable plastic cups were used, and some tribes even refrained from serving coffee.
The burial of the dead is an essential ritual in Iraq. Several Iraqi proverbs stress the sanctity of burying the dead. Iraqis often repeat an Arab proverb is affirming that no deceased person should be left unburied. However, the spread of the Coronavirus seems to be putting an end to this well-entrenched ritual.
The Health Ministry of Iraq had to intervene to allow the families of the deceased to find places and ways to bury their dead.
While the pandemic has modified many Iraqi traditions and rituals, everyone still appears ready to resume these traditions once the Coronavirus is defeated immediately. On April 13, Iraq registered 76 deaths and 1,352 confirmed cases of COVID-19 21,22.
All the factors together, is it working?
In Iraq, the religious authority, and the traditions and the tribe role control the Iraqi society more than the government power. The article spotlight the role of every factor during the pandemic. However, the number of new cases and death are increasing until the day of writing this article. The Economic factor and the poverty high rate are playing an important role that can overcome all the authorities in Iraqi society23. Moreover, the World Development Indicators database also highlights the high poverty rates during the years before the Coronavirus pandemic 24.
On top of that, if we know the role of the stability of families, income was also a significant factor in people's experienced anxiety during the COVID-19 crisis, which could be explained by increased psychological and economic pressure 25. Adding all the factors together would explain the need of the unemployed people to support himself and his family with day by day life need. A free wok or street vendors, which in most of the time, they will not fallow the social distance direction and other direction to avoid COVID-19 disease.
Corona pandemic (COVID-19) hit Iraq as it affected most of the world, but to varying degrees. This epidemic, which was unable to tackle the most significant global health systems and the world's economies collapsed. The countries' capabilities varied in how to deal with it since the specialists did not have complete information about this virus, which take a long time to determine the means to treat it. It was limited to laying down plans to neutralize its spread. Iraq, with its modest health capabilities, has drawn up plans to confront this epidemic. Iraq is still facing significant challenges due to the weak health culture in some segments of society, in addition to adhering to social customs and traditions that encourage gathering and visiting people, plus the adhering to religious rituals by visiting holy shrines by millions of visitors. The role of religious authorities in urging citizens to adhere to the state's instructions regarding this matter has emerged here.
Conflicts of Interest:
The authors declare no conflict of interest.
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Received: 13 July 2020
Accepted: 5 Ago 2020
Wedad H. Al-Dahhan1, Mohammed H. Al-Mashhadani2, Rasha Raheem 3, Emad Yousif4*
1Department of Chemistry, College of Science, Al-Nahrain University, Baghdad, Iraq https://orcid.org/0000-0002-2019-5533
2Department of Chemistry, College of Science, Al-Nahrain University, Baghdad, Iraq
3Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, United States of America https://orcid.org/0000-0003-2816-7550
4Department of Chemistry, College of Science, Al-Nahrain University, Baghdad, Iraq https://orcid.org/0000-0003-1458-4724
Corresponding Author. E-mail: firstname.lastname@example.org