ERBIL, Kurdistan Region - Climate change has become a public health crisis in Iraq, with extreme heat, water scarcity, drought and dust storms increasing pressure on both the population and the country’s health system, the World Health Organization (WHO) representative in Iraq told Rudaw.
“For Iraq, climate change has become a public health crisis, not merely an environmental one,” Jamela Alraiby, WHO representative in Iraq, said in a written response to questions from Rudaw's Malik Mohammed on Saturday, warning that extreme heat, water scarcity, drought, desertification and dust storms are interacting with existing health vulnerabilities.
According to Alraiby, extreme heat "increases the risk of heat exhaustion and heat stroke" and can worsen cardiovascular, renal and respiratory diseases, while dust storms and poor air quality can aggravate respiratory and cardiovascular conditions.
The UN health agency’s recent heat-health risk assessment identified Dhi Qar, Maysan, Basra, al-Qadisiyyah, Wasit and Muthanna among Iraq’s "highest-risk provinces." High risk levels were also recorded in Nineveh and Salahaddin.
Alraiby also said that water scarcity is another growing health concern.
"While the proportion of the population using safely managed drinking water services increased from approximately 50 percent in 2000 to around 60 percent in 2024, water scarcity, drought, rising temperatures, population growth, and aging infrastructure continue to exert severe strain"
The representative said the organization is working with Iraq’s federal and Kurdistan Region health authorities, as well as environmental ministries and other partners, to strengthen health systems against climate-related risks.
"Our work focuses on strengthening multisectoral governance and coordination, generating evidence, building the capacity of health workers, enhancing water, sanitation, and hygiene systems and health facility climate resilience, and engaging communities and youth," she said.
The WHO also highlighted Iraq's progress in disease surveillance and early-warning systems since the COVID-19 pandemic, while stressing that preparedness must remain a permanent part of the country’s health system.
“One of the most critical lessons is that preparedness must be a permanent, institutionalized component of the health system before a crisis strikes, rather than an ad-hoc mechanism set up after an emergency begins,” the WHO representative said.
The WHO also described non-communicable diseases as “one of the most pressing public health challenges in Iraq,” accounting for approximately 56 percent of all deaths.
Alraiby also said that around 30 percent of adults have hypertension, 14 percent have diabetes and more than 30 percent are obese.
The agency also raised concerns about health risks among adolescents. Its latest Global School-based Student Health Survey found that 18 percent of 13–17-year-olds consume tobacco, 32.5 percent are overweight, 12.5 percent are obese and 88.4 percent do not meet recommended levels of daily physical activity.
“This demonstrates that investing in prevention and early detection must go hand-in-hand with developing curative and specialized services,” the WHO representative said.
She also said the organization is supporting Iraq in strengthening primary healthcare for the prevention, screening and early detection of diseases such as hypertension and diabetes, while also improving cancer prevention and referral pathways.
Mental health is another growing priority in the country, with Alraiby saying years of conflict, displacement and socioeconomic pressures have increased the need for accessible mental health and psychosocial support services across Iraq, including the Kurdistan Region.
“A central strategic direction is integrating mental health services into primary health care, enabling individuals to seek help early and close to their communities,” the representative said.
The following is the full transcript of the email interview with Jamela Alraiby:
Rudaw: How does the World Health Organization assess the growing impact of climate change in Iraq on public health, and what joint programs do you have with the Ministry of Health to confront diseases associated with drought and dust storms?
Jamela Alraiby: For Iraq, climate change has become a public health crisis, not merely an environmental one. Extreme heat, water scarcity, drought, desertification, and dust storms interact with existing health vulnerabilities, placing mounting pressure on the population and the health system alike.
The health impacts are multifaceted: extreme heat increases the risk of heat exhaustion and heat stroke, and can exacerbate cardiovascular, renal, and respiratory diseases. Water scarcity and deteriorating water quality raise the risk of waterborne diseases, including cholera and acute diarrheal diseases, while negatively impacting hygiene, food safety, and nutrition. Furthermore, dust storms and poor air quality are directly linked to the aggravation of respiratory and cardiovascular conditions.
This is where evidence generation becomes vital to guide health policies and investments. WHO has supported Iraq in conducting the National Health Vulnerability and Adaptation Assessment for Climate Change, which informed the development of the National Health Adaptation Plan (HNAP). We also recently conducted a heat-health risk assessment, which revealed that risks are not distributed equally across geographies. It identified Dhi Qar, Maysan, Basra, Al-Qadisiyyah, Wasit, and Muthanna among the highest-risk governorates, with high risk levels also observed in Nineveh and Salahaddin. This underscores the importance of tailoring interventions to the specific levels of exposure, vulnerability, and adaptive capacity in each governorate and region, including the Kurdistan Region.
Water is a critical piece of this equation. While the proportion of the population using safely managed drinking water services increased from approximately 50 percent in 2000 to around 60 percent in 2024, water scarcity, drought, rising temperatures, population growth, and aging infrastructure continue to exert severe strain. Therefore, water security is fundamentally health security.
WHO is actively working with the Federal Ministry of Health, the Ministry of Health in the Kurdistan Region, the Ministries of Environment, national authorities, and partners across Iraq. Our work focuses on strengthening multisectoral governance and coordination, generating evidence, building the capacity of health workers, enhancing Water, Sanitation, and Hygiene (WASH) systems and health facility climate resilience, and engaging communities and youth.
The immediate priority is to bolster early warning systems and anticipatory action by linking health, climate, and environmental data, enabling Iraq to foresee and prepare for risks before they escalate. Our ultimate goal is to transition from merely responding to health impacts after they occur to anticipating hazards, preparing for them, and mitigating their effects before they turn into full-blown health crises.
What progress has been made in cooperation between the WHO and the Iraqi government regarding health system reform and the implementation of the Health Insurance Law, and how are you supporting Iraq in achieving Universal Health Coverage for all citizens?
Universal Health Coverage (UHC) is one of the core pillars of our partnership with health authorities in Iraq. It means ensuring that all people have access to the quality health services they need, when and where they need them, without suffering financial hardship.
UHC is directly linked to the achievement of the Sustainable Development Goals (SDGs), particularly Target 3.8 under Goal 3 (Good Health and Well-Being). It also contributes to reducing poverty and inequality by protecting households from catastrophic health expenditures and guaranteeing universal access to essential health services, as well as safe, effective, quality, and affordable medicines and vaccines.
However, we view health insurance as part of a broader, comprehensive health system reform. UHC cannot be realized through a single financing mechanism alone; it requires robust Primary Health Care (PHC), service quality and patient safety, a qualified and equitably distributed health workforce, sustainable health financing, reliable access to essential medicines and health technologies, and resilient health information systems.
WHO supports the Federal Ministry of Health and health authorities in the Kurdistan Region—in line with national priorities and needs—in strengthening primary health care and developing context-appropriate models of care. This includes establishing clearer referral pathways and better continuity of care across primary, secondary, and tertiary levels. We also provide technical support in quality of care, patient safety, health workforce planning, health financing, pharmaceutical regulation, and the use of data for planning, resource allocation, and decision-making.
Generating evidence is central to this reform process. Decisions regarding services, financing, human resources, and resource distribution must be grounded in the population's actual needs and existing gaps in access and quality.
Equity is paramount in this journey. Success should not be measured solely by national averages, but by whether quality health services reach populations across all governorates and communities, including the Kurdistan Region, particularly those facing geographic, social, or economic barriers. WHO’s role is to support Iraq with international evidence, standards, and technical expertise to build a people-centered health system that achieves Universal Health Coverage in a sustainable manner.
Following the COVID-19 pandemic, how do you assess Iraq's current capacities in epidemiological surveillance and early warning for emerging epidemics, and are there risks of a resurgence of certain communicable diseases due to water scarcity?
Iraq has made significant strides in its surveillance, early detection, and emergency response capacities, drawing on the valuable lessons learned during the COVID-19 pandemic and previous public health emergencies. One of the most critical lessons is that preparedness must be a permanent, institutionalized component of the health system before a crisis strikes, rather than an ad-hoc mechanism set up after an emergency begins.
WHO works closely with health authorities at the federal level and in the Kurdistan Region to strengthen disease surveillance and early warning, laboratory diagnostics, rapid response mechanisms, emergency operations, infection prevention and control (IPC), hospital readiness, and mass casualty and mass gathering preparedness. We have also supported Iraq in enhancing its core capacities under the International Health Regulations (IHR 2005), including national assessments, preparedness planning, simulation exercises, and the development of standardized protocols and response mechanisms.
Digital transformation has become a vital driver of these capacities. The District Health Information System (DHIS2) now connects approximately 12,700 registered users, with 16 health programs and units integrated into the platform. Routine immunization reporting covers nearly 1,900 health facilities, event-based surveillance (EBS) has expanded to include more than 900 facilities, and over 3,000 Ministry of Health staff have been trained in using these digital systems.
Water scarcity, however, remains a substantial health risk factor. The diminished availability of safe water combined with rising temperatures can heighten the risk of cholera, diarrheal illnesses, and other waterborne diseases. Therefore, the next critical step is to strengthen the integration of epidemiological, climatic, environmental, and hydrological data to develop proactive early warning and anticipatory action systems across Iraq.
Our objective is to transition from simply detecting and responding to outbreaks toward building a comprehensive system capable of anticipating risks, detecting them early, assessing them rapidly, and mounting an effective response while maintaining the continuity of essential health services.
There is growing concern over rising rates of non-communicable diseases (NCDs) such as cancer and diabetes in Iraq. What is the WHO's strategy to support Iraq in establishing specialized centers and providing modern treatment protocols?
Non-communicable diseases (NCDs) have emerged as one of the most pressing public health challenges in Iraq, accounting for approximately 56 percent of all deaths. Cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases represent the leading causes of morbidity, disability, and premature mortality.
Available national data indicate that approximately 30 percent of adults suffer from hypertension, 14 percent have diabetes, and more than 30 percent are obese. This demonstrates that investing in prevention and early detection must go hand-in-hand with developing curative and specialized services.
Of particular concern is that risk factors are taking root at early ages. The latest Global School-based Student Health Survey (GSHS), conducted in collaboration with the Ministry of Health, revealed that approximately 18 percent of adolescents aged 13–17 consume tobacco, 32.5 percent are overweight, 12.5 percent are obese, and 88.4 percent do not meet the recommended levels of daily physical activity.
Accordingly, WHO supports health authorities across Iraq, including the Kurdistan Region, on two complementary tracks:
1. Within the health system: Strengthening the role of Primary Health Care (PHC) in prevention, screening, early detection, diagnosis, management, and long-term care for NCDs (including hypertension, diabetes, and cardiovascular diseases), alongside enhancing cancer prevention, early diagnosis, and referral pathways to specialized care.
2. Addressing risk factors through cross-sectoral policies and prevention: Tackling tobacco use, unhealthy diets, physical inactivity, and obesity requires interventions that extend beyond the health sector to involve education, municipalities, food systems, and relevant legislation, coupled with active family, community, and youth engagement.
WHO’s value also lies in supporting the generation of national evidence and translating it into actionable policies, strategies, clinical protocols, and interventions. The core message is clear: Iraq cannot tackle the burden of NCDs through clinical treatment alone; the greatest, most sustainable gains come from prevention and early detection, while ensuring equitable access to high-quality specialized treatment when needed.
Iraq continues to suffer from the repercussions of past wars and conflicts, which have left a profound mark on mental health. How is WHO working to integrate mental health services into primary care centers and train specialized personnel?
Mental health and substance use disorders have become growing public health priorities in Iraq. Years of conflict, displacement, and socioeconomic stressors have intensified the need for accessible mental health and psychosocial support (MHPSS) services across the country, including the Kurdistan Region.
WHO is collaborating with health authorities to build an evidence-based, integrated response embedded within the national health system. A central strategic direction is integrating mental health services into primary health care, enabling individuals to seek help early and close to their communities, rather than relying exclusively on specialized psychiatric institutions.
We are also supporting capacity building for healthcare providers in prevention, early identification, basic management, referral pathways, and rehabilitation. In the field of substance use, a major milestone was our technical support in developing and finalizing the Iraqi National Protocol for the Management of Substance Use Disorders. This provides a standardized, evidence-based national framework for treatment and rehabilitation services, complemented by community guidance, awareness materials, and training for healthcare professionals.
Key priorities moving forward include improving health data to better understand the scale and patterns of mental health needs, expanding both specialized and non-specialized workforces, elevating service quality, promoting early intervention (particularly among youth), and combating social stigma.
Our message is unequivocal: There is no health without mental health. The goal is a system where everyone can access dignified, high-quality, and evidence-based care—from prevention and early support to clinical treatment, rehabilitation, and long-term recovery.
Regarding pharmaceuticals and medical supplies, how does WHO contribute to strengthening quality control over imported medicines and supporting Iraqi central laboratories in obtaining international accreditation?
Ensuring equitable access to safe, effective, quality-assured, and affordable medicines, vaccines, diagnostics, and health technologies is a fundamental cornerstone of a resilient health system and essential for achieving Universal Health Coverage across Iraq.
The primary mandate for pharmaceutical registration, inspection, and post-market surveillance of imported and locally circulated medical products rests entirely with the competent national authorities. WHO’s role is to strengthen the institutional and technical capacities of the national regulatory authority, aligning its operations with international standards and best practices.
This support includes conducting systematic assessments of national regulatory functions (using WHO Global Benchmarking Tools), identifying institutional gaps and priorities, and developing institutional development plans covering product registration, regulatory inspections, market surveillance, pharmacovigilance, and quality control laboratories.
Regarding central laboratories, WHO's support focuses on strengthening Quality Management Systems (QMS), upgrading technical capabilities, ensuring testing accuracy and reliability, and adhering to relevant international standards (such as ISO/IEC 17025 and WHO Good Practices for Pharmaceutical Quality Control Laboratories), thereby supporting the national roadmap toward international recognition and accreditation.
It is important to emphasize that accreditation is not an end in itself; the ultimate objective is for Iraq to possess a sustainable, robust national regulatory and laboratory system capable of safeguarding the quality, safety, and efficacy of medical products, rapidly detecting substandard and falsified (SF) medical products, and making evidence-based regulatory decisions.
Across all these domains, WHO follows a unified approach: we start with data and evidence to identify gaps and priorities, support the translation of evidence into national policies, strategies, and standards, and build the institutional and human capacities required for sustainable implementation.
WHO works in close partnership with federal health authorities, the authorities of the Kurdistan Region, and partners nationwide. Health challenges do not respect administrative boundaries; achieving "Health for All" requires that evidence, policies, capacities, and services reach every person without exception. Our success is not measured simply by the number of activities we conduct, but by the lasting resilience and self-reliance of the national institutions, systems, and human resources that remain on the ground to deliver results for the people of Iraq.
