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By Goran Abdulla Zangana MBChB, MPH, PhD (Candidate):
Mecca
In an unprecedented decision, the Ministry of Health (MoH) of the Iraq Kurdistan Region (IKR) decided to ban travels by pilgrims to Mecca to undertake the Umrah as a precautionary measure to avoid an outbreak of the Middle East Respiratory Syndrome-Coronavirus (MERS-CoV)[i]. The MoH is also considering banning the Hajj trip for this season due to the same reason. This controversial decision by the MoH has been the topic of heated debate. This article examines both sides of the argument, for and against banning and restricting travel, and concludes that such a ban is unnecessary, illegal and politically charged and argues that the MoH should reverse the decision immediately.
Those who argue for a ban on travelling to Saudi Arabia are spearheaded by the Minister of Health, Mr. Rekawat Hama Rashid. His main argument is that the decision will help to avoid and prevent an outbreak in the IKR (Iraqi Kurdistan Region). He also suggests that MERS-CoV is a deadly virus that deserves such a ban and should not be taken lightly. Others hailed the decision citing the weak health system and the inability of health services to cope with such an outbreak should it happen. They cite the role that Hajj and Umrah play as a source of other outbreaks, such as cholera, which plagued Iraq and the region in the past.
On the other hand, those who oppose the decision argue that there no justifications for it and that it is illegal, unscientific and that it is made for political reasons rather than protecting the health and wellbeing of the residents of the IKR. I am part of this group and shall attempt to outline why the MoH should reverse this decision.
First, the IKR is part of a federal region. The IKR is granted powers pertaining to health, education and other social services by the 2005 Iraq constitution[ii]. However, matters related to international affairs and banning or restrictions on travel are not part of the authorities of the region and they are constitutionally part of the powers of the central Iraqi government. In fact, the Iraqi constitution of 2005 allows the central Iraqi government to interfere in health policy matters of the regions should there be a security justification for that (article 30 of the constitution).
Second, the decision by the MoH is, as far as we are aware, one of its kind in the world. All of the respected public health organizations and international bodies advised against bans and restrictions on international travels. The World Health Organization clearly states that in its periodic statements about MERS-CoV[iii]. The Centers for Disease Control and Prevention (CDC) issued banners advising people who travel to the Middle East to take precaution rather than advising them not to travel at all [iv]. In addition to being guided by standard public health and epidemiological guidelines, the International Health Regulations (IHR) provides the legal bases to such policies by those international organization and bodies that the MoH appears to either ignore or is not aware of[v].
Third, the decision appears to have more to do with the political context and the situation with the health system in the IKR rather than the eagerness of the decision makers in the MoH to protect the health of the residents of the region. About 260 days ago, parliamentary elections in the IKR were undertaken, but the political parties in the region failed so far to form a government. The current caretaker Minister of Health is eager to retain his office and he has made a series of highly visible decisions and moves to convince his party, the other political parties and the public in general that he deserve to continue in office for a four years term (he was appointed in 2012, following a reshuffle in the cabinet). In this regards, the Minister hope to achieve two goals; first, he want to appear as someone who takes the health of the residents of the region seriously and, second, he does not want to be embarrassed by yet another outbreak (similar to the cholera outbreak of 2012), especially in these politically charged times. However, the decision is backfiring and it resulted in protests, not only by the pilgrims themselves (who had paid huge sums of money to secure their trips), but also by the pilgrimage travel companies who are asking for compensation from the government in return for banning travel at such a short notice.
In sum, the MoH should reverse the decision to ban the travel by the pilgrims. This decision is unjustified from all legal, scientific and political aspects. Instead of restricting travel, the MoH should strengthen the public health system. It needs to screen the pilgrims for any underlying medical conditions and advise against travel by those who are at additional risk. It should cooperate with the Ministry of Religious Affairs and other stakeholders (including the travel companies) to offer health awareness campaigns and information prior to and during the Umrah and pilgrimage and after the return of the pilgrims. It has to introduce and strengthen the tools and technologies it needs to identify the MERS-CoV and train its health staff to test for it, manage it and prevent and control its spread. Travel bans could only worsen the situation rather than help it.
References:
[i] http://www.mohkrg.com/Default.aspx?page=article&id=858&l=3
[ii] http://www.iraqinationality.gov.iq/attach/iraqi_constitution.pdf
[iii] http://www.who.int/ith/updates/20130725/en/
[iv] http://wwwnc.cdc.gov/travel/page/infographic-mers-poster
[v] http://www.who.int/topics/international_health_regulations/en/
Dr. Goran Abdulla, a doctor from Kurdistan, is doing his PhD in International Public Health Policy at the University of Edinburgh’s School of Social and Political Science;goransbr@yahoo.com
