VZCZCXYZ0003
PP RUEHWEB

DE RUEHUNV #0145/01 0961537
ZNR UUUUU ZZH
P 061537Z APR 09
FM USMISSION UNVIE VIENNA
TO RUEHC/SECSTATE WASHDC PRIORITY 9249
RHMCSUU/DEPT OF ENERGY WASHINGTON DC PRIORITY
RUEAUSA/DEPT OF HHS WASHDC PRIORITY
INFO RUEHII/VIENNA IAEA POSTS COLLECTIVE
RUEHGB/AMEMBASSY BAGHDAD 0096
RUEHGV/USMISSION GENEVA 0871

UNCLAS UNVIE VIENNA 000145 
 
SIPDIS 
 
STATE FOR IO/T, ISN/MNSA, ISN/RA 
 
E.O. 12958: N/A 
TAGS: EAID PREL IAEA TRGY TBIO AORC IZ
SUBJECT: IAEA/PACT: IRAQ BEGINS CONSULTATIONS ON NATIONAL CANCER 
THERAPY PROGRAM 
 
REF: A) 08 UNVIE 541; B) 08 UNVIE 556 
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Summary 
------- 
 
¶1. (U) In spring 2008, Mission provided, through the Embassy 
Baghdad 
Health Attache's office, an IAEA Program of Action for Cancer 
Therapy (PACT) "imPACT" questionnaire, which the Iraqi Ministry of 
Health and the Ministry of Science and Technology completed in 
August 2008.  PACT subsequently produced an analysis of nuclear 
applications for cancer therapy, based on the GOI's responses. 
During the 2008 IAEA General Conference, Msnoffs participated in a 
meeting with the Iraqi Delegation and PACT to clarify short, 
medium, 
and long-term needs and assistance PACT might provide in Iraq. 
Mission conveyed general U.S. support for PACT, but made no 
commitments related to this project, though Iraqi interlocutors 
pressed for such assistance.  Instead, the next step discussed was 
the GOI's need to delineate a concrete timeline, strategy, and cost 
estimate for donors to consider.  PACT offered assistance in 
formulating a project package for donors.  After months of inaction, 
Iraq recently sent two experts from the Ministry of Health to Vienna 
for March 30-April 4 consultations with PACT. The Iraqi experts hope 
to create a short, medium, and long term plan to take back to 
Baghdad for approval and eventual roll-out to potential donors. 
 
¶2. (U) Action Request:  Mission requests preliminary guidance on how 
to 
respond to Iraqi/PACT expectations that the U.S. will help fund this 
project 
either monetarily or through in-kind contributions.  More detailed 
guidance will be needed once the GOI completes its plan.  We would 
also 
welcome thoughts from colleagues at Embassy Baghdad regarding where 
these ideas might fit into USAID Iraq's strategic planning or any 
other on-going USG efforts in cancer therapy.  From a Vienna 
perspective, a key benefit of this dialogue is the catalyst it 
provides for enhanced interaction between the IAEA Secretariat and 
IAEA board member Iraq.  End Summary and Action request. 
 
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Major Issues 
------------ 
 
¶3. (U) As described in ref A, PACT is the IAEA's highly regarded 
program to make nuclear medicine for cancer treatment available in 
developing countries.  The first stage in a PACT-Member State 
partnership is the completion of an imPACT questionnaire.  The 
questionnaire provides a baseline of the cancer therapy 
infrastructure in a country and the problems that remain to be 
addressed.  The Iraqi Ministry of Health and the Ministry of 
Technology and Science worked together on the questionnaire and 
submitted the responses below to PACT Director Massoud Samiei in 
August 2008.  Per ref B, the questionnaire revealed a number of 
problems associated with current Iraqi cancer therapy practices and 
capacity to treat patients. 
 
¶4.  (U)  PACT's initial analysis focused on assessing urgent actions 
that can be taken to improve the situation for cancer patients in 
Iraq in the short-term.  However, the security situation in Iraq and 
lack of funding are major obstacles.  Missonoff reconfirmed in early 
March 2009 that PACT's analysis, per ref B, still holds.  The major 
issues that need to be addressed are: 
 
- Iraq has only two cancer centers, with a third one in the north 
that Ministry of Health officials claim they cannot access due to 
political tension. The centers have three "functioning" teletherapy 
machines for a population of approximately 29 million. Because of 
the lack of treatment capacity, plans for additional radiotherapy 
centers should be a priority.  In order to do this, the national 
cancer control committee should conduct a feasibility study that 
provides a plan for expansion of centers based on patients' needs. 
 
- Because of antiquated equipment, patients often wait six to 12 
months for radiotherapy which means that only palliative treatment 
is given. Upgrading teletherapy equipment and training professionals 
to use the equipment properly is needed urgently.  According to 
PACT, this could be done in parallel to the feasibility study for 
the expansion of centers. 
 
- Three existing cobalt machines currently in use in Baghdad are 
also in need of refurbishment.  According to Iraqi and PACT 
information, the sources utilize aged cobalt-60 which leads to very 
long treatment times of low quality.  PACT advises that the machines 
be taken out of commission and the sources replaced.  This of course 
 
is predicated on the security situation allowing for transport of 
sources, material, and personnel.  The refurbishment should also 
include installation of a cancer treatment simulator, dosimetry 
equipment, QA/QC kits, and computerized treatment planning 
software. 
 
According to PACT, the Iraqis need to provide a list of prioritized 
plans for immediate short term action (such as replacing the 
radioactive sources, initiating a national cancer control plan, 
upgrading cancer registries, regulating supply cancer medicine, 
etc), and a list for longer-term actions in order to attract donors 
and keep their own inter-agency focused on the issue. 
 
--------------------- 
MARCH 2009 PACT-IRAQI 
CONSULTATIONS 
--------------------- 
 
¶5.  (U)  The Iraqi Ministry of Health, after six months of not 
moving on this issue, caused in part by difficulties in obtaining 
visas, has sent two clinical oncologists to Vienna for consultations 
with PACT on how to assemble a short/medium/long-term cancer therapy 
program.  Consultations began on March 30 with IAEA health experts 
and will continue throughout the week with relevant IAEA offices. 
Dr. Mahdi Al-Saraj from the Baghdad Medical Center stressed the need 
for new sources (cobalt 60) for the three existing machines and 
requested USG assistance in this regard. [NOTE: Mission will report 
on full request for removal septel. END NOTE] Al-Saraj also noted 
the lack of training and the need to institute short and long-term 
training for technicians and oncologists. Al-Saraj did not have a 
clear idea of next steps with respect to promotion of a national 
cancer therapy program to potential donors because the Ministry of 
Health has not been in close contact with the Ministry of Foreign 
Affairs on this issue.  Missionoff encouraged Iraqi interagency 
coordination and possible outreach by the Iraqi IAEA Governor on the 
margins of the June Board of Governors meeting to attract donor 
funding or services. 
 
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COMMENT 
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(U) Comment:  Mission recommends USG adopt a supportive posture 
toward IAEA/PACT cooperation with Iraqi authorities in charting and 
implementing a plan.  PACT involvement would ensure that GOI plans 
provide for due safety and security protections on radiological 
sources at cancer centers.  While the security situation will 
regulate the pace of implementation, the potential contribution 
this 
partnership could make to health and science in Iraq is consistent 
with broader U.S. assistance to Iraq reconstruction.  A forthcoming 
U.S. approach would also be helpful to our effort to work with Iraq 
as a member of the IAEA Board of Governors and would further our 
interest in constructive IAEA-GOI relations. 
 
SCHULTE