Better Health For All

On Monday 23 April, the ‘Do No Harm’ amendment, tabled by Lord Warner to protect the public’s health as we leave the EU, reached Report stage of the EU (Withdrawal) Bill.

Responding on behalf of the Government, Lord Duncan of Springbank accepted that Ministers had “not thus far provided sufficient assurance…on the issue of public health”. At the despatch box, he presented fresh legal analysis of Clauses 4 and 6 in an effort to reassure Members that the Bill, as currently framed, already provides adequate legal safeguards to ensure that as we leave the EU there will be no erosion of our vital public health legislation, policy and practice.

In offering this new analysis, Lord Duncan acknowledged that Peers and the coalition of 54 medical Royal Colleges and health organisations supporting the amendment would need time to reflect on the detail, and so, in a rare Parliamentary move, agreed to revisit the issues at Third Reading. We welcome the Government’s reassurances and will now carefully scrutinise its legal advice. Should we feel that it does not offer sufficient certainty, we will encourage Ministers to table an amendment that will do, or, if necessary, will work with Peers to table a further amendment to the Bill.

Together, as a coalition, we’re changing the course of the debate and putting the public’s health at centre stage of the Brexit negotiations. We thank Lord Warner and the Labour and Liberal Democrat frontbench health spokespeople, Lord Hunt and Baroness Jolly, and Crossbench Peer Baroness Finlay, for tabling so important an amendment and working so tirelessly to make the case in Parliament. And, in turn, we thank our partner organisations and our members.

Former health minister and Crossbench Peer, Lord Warner said: “I welcome legal clarification that Government accepts EU protections of public health will be carried over after Brexit as part of retained EU law. We will return to the issue again at Third Reading to ensure these guarantees are adequate.”

Prof John Middleton, President, UK Faculty of Public Health, said: “I’m proud that the health and medical sector has made such a strong case for protecting the public’s health as we leave the EU, and am encouraged that the Government has recognised that the sector needs further reassurance.

While we take the time to understand whether these assurances do what we want them to, we look forward to continuing to work with the government towards our shared goal of safeguarding the public’s health as we leave the EU.”

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Fifteen years ago, in March 2003, the US invaded Iraq. The legality of this war continues to be debated and whether the world is a safer place as a result is also controversial. Meanwhile, the country continues to struggle with fighting terrorism, the economy is devastated and the lives of millions severely impacted.

Saif* was only 5 years old when the first American troops entered Baghdad on 9th April 2003. Whilst many children in the developed world would be learning to read and write, Saif was experiencing the “shock and awe” strikes by the coalition forces. Unable to attend school, with his family lived in a dark, cold and damp house. Growing sectarian violence in the power vacuum left behind following the deposition of the Ba’athist regime led Saif’s family to leave their home in Baghdad, living in a tent to avoid violence.

Saif is now 6 and used to death. His father was killed in a suicide bombing attack and he is forced to work in order to provide for his family. Saddam Hussein has been captured but this has no bearing on the trials Saif must endure. Clean water, electricity and food are a luxury. Saif sleeps in his tent not knowing if he may wake up the next morning.

A few years later and the new Iraqi government has reopened the schools near Saif’s new home. Scarred by bombing, riddled with bullet holes and lacking teachers and equipment, Saif attends school in the hope of educating himself to improve his life. Despite being a bright student, Saif is often seen distracted in class as he gazes at the walls remembering how a recent bombing left 155 dead. Saif has flashbacks of the bodies in the street, the blood smeared against the walls and the screaming that left his eardrums ringing.

In 2008, aged only 10, Saif fell ill with severe gastroenteritis and ended up in isolation in hospital for 2 weeks. He was diagnosed with cholera similar to 4696 other cases. The outbreak struck again in 2015 affecting over 2000 individuals. There are only 0.8 doctors per 1000 people in Iraq compared with 2.8 in the United Kingdom so the untrained nursing staff did their best to care for Saif.

After decades of conflict the region is littered with unexploded landmines and Explosive Remnants of War (ERW). Saif lost an arm fiddling with ERW, the only toy he could find in the neighbouring field, and had retrain himself in writing with his left hand. It is estimated ERW caused over 30 thousands casualties by end of 2015.

At the age of 16, ISIS took over large swathes of Iraq. A few of Saif’s friends, frustrated and disillusioned with their lives join their ranks. None are heard from again. Saif is working on a market stall and counts himself lucky to do so, with unemployment officially at 15%. All the money he earns is spent on caring for his now bed-bound mother and siblings. She coughs badly and lost weight, she was diagnosed with tuberculosis. There are an estimated 20,000 tuberculosis patients in Iraq with increasing levels of multi-drug resistant tuberculosis. Saif’s mother is one of the 4,000 Iraqi people that dies from this preventable disease this year.

In 2018, Saif is the oldest surviving member of his family, raising his two siblings. According to the WHO the probability of Saif dying between 15 and 60 years old is 224 per 1,000 population. If lucky Saif is expected to live up to 66 years.

The UN estimates that 4 million children in Iraq are in need of at least one form of humanitarian assistance in 2018. Despite this, the Iraqi government has deprioritised healthcare, slashing the healthcare budget by 25% in 2016. Iraq remains a public health disaster with clear scope for improvement should healthcare be prioritised. As per the Transparency Index, Iraq is consistently within the worst 10% of countries.

Saif is 20 years old now, with a traumatic history, interrupted education, mentally and physically damaged and the sole breadwinner in a young family. All he wants is a normal life, but has no job or marital prospects on the horizon. His only hope is that if he does have children, that they can live a full and healthy life like the one taken away from him.

* Saif is not a real person, but this is an example of what life has been like for many children growing up in Iraq in this period.

Written by Dr Bayad Nozad, FFPH co-chair of Global Violence Prevention SIG, and Dr Ahmed Razavi, Academic Clinical Fellow in Public Health

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