title: Understanding the impact of conflict on health services in Iraq: information from 401 Iraqi refugee doctors in Jordan.
abstract: OBJECTIVE
  This study aims to assess how conflict has affected the function of Iraqi health services and its doctors.
  
  
  METHODS
  Interviews were conducted in person or by mobile phone with 401 Iraqi doctors entering Jordan since 2003, using respondent-driven sampling methods.
  
  
  RESULTS
  Of the Iraqi doctors interviewed in 2008, 94% came from Baghdad, although 25% had moved within Iraq in the past year. They reported a steady year-by-year decline in Iraqi health services from 2003 through 2006, with perhaps some improvement in 2007. By 2006, 67% of doctors said essential drugs were present less than half of the time (95% confidence interval [CI] 54-81), and 69% (95% CI 56-84) said essential equipment was available or working half the time or less. By 2006, 95% said their facilities lacked skilled health workers, and 90% noted reduced quality of care. Violent death rates among doctors in Baghdad reached 47.6/1000/yr (95% CI 42.0-53.7) in 2006. In the same year, migration rates for Baghdad doctors moving elsewhere in Iraq were 143.8/1000/yr (95% CI 134.0-154.1), and departure from Iraq was 299.5/1000/yr (95% CI 285.3-314.3).
  
  
  CONCLUSIONS
  Deterioration of health services quality, staffing levels and violence against doctors continued from 2003 through 2006, although these may have improved slightly in 2007. In 2009 and 2010, reports suggest that assassinations of doctors and out-migration have continued. Few have returned.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. gburnham@jhsph.edu
authors.forename: Gilbert
authors.initials: G
authors.lastname: Burnham
authors.forename: Sana
authors.initials: S
authors.lastname: Malik
authors.forename: Ammar S Dhari
authors.initials: AS
authors.lastname: Al-Shibli
authors.forename: Ali Rasheed
authors.initials: AR
authors.lastname: Mahjoub
authors.forename: Alya'a Qays
authors.initials: AQ
authors.lastname: Baqer
authors.forename: Zainab Qays
authors.initials: ZQ
authors.lastname: Baqer
authors.forename: Faraj
authors.initials: F
authors.lastname: Al Qaraghuli
authors.forename: Shannon
authors.initials: S
authors.lastname: Doocy
mesh_terms: D000328:Adult; D000368:Aged; D003625:Data Collection; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D054542:Iraq War, 2003-2011; D007597:Jordan; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D012036:Refugees; D055815:Young Adult