VZCZCXYZ0002
PP RUEHWEB

DE RUEHUNV #0191/01 1190641
ZNR UUUUU ZZH (CCY ADX05BE0DA MSI2878 611
P 290641Z APR 09
FM USMISSION UNVIE VIENNA
TO RUEHC/SECSTATE WASHDC PRIORITY 9359
RUEAUSA/DEPT OF HHS WASHDC PRIORITY
INFO RUEHII/VIENNA IAEA POSTS COLLECTIVE PRIORITY
RHMCSUU/DEPT OF ENERGY WASHINGTON DC PRIORITY
RUEANFA/NRC WASHDC PRIORITY
RUEHGB/AMEMBASSY BAGHDAD PRIORITY 0102
RUEKJCS/DIA WASHDC PRIORITY
RHMFIUU/HQ USCENTCOM MACDILL AFB FL PRIORITY

UNCLAS UNVIE VIENNA 000191 
 
C O R R E C T E D  C O P Y (ADDED ADDRESSEE) 
 
SIPDIS 
 
STATE FOR IO/T, ISN/MNSA, ISN/RA, ISN/CTR 
NA-243-GOOREVICH/OEHLBERT, BRUNNS; NA-241 O'CONNOR, SIEMON; 
NA21-CUMMINS, ILIOPULOS; NE- MCGINNIS, PEKO, CLAPPER 
NRC FOR OIP - DOANE, HENDERSON, SCHWARTZMAN 
BAGHDAD FOR RUTH HALL, MILA UYEHAVA, TIM FINGARSON AND USAID 
 
E.O. 12958: N/A 
TAGS: AORC ENRG ETTC KNNP MNUC PREL TRGY
SUBJECT: IRAQ SEEKS IAEA/PACT PARTNERSHIP TO LAUNCH NATIONAL CANCER 
THERAPY PROGRAM 
 
REF: A) 08 UNVIE 556, B) UNVIE 145 
 
-------------------------- 
SUMMARY AND ACTION REQUEST 
-------------------------- 
 
¶1.  In March 2009, after a five month lag, Iraq's Ministry of Health 
(MOH) resumed discussions with the IAEA Program of Action for Cancer 
Therapy (PACT) to create a short, medium, and long-term plan to 
implement a national cancer therapy program.  After consultation 
with multiple IAEA offices that would be involved in the project, 
PACT shared a roadmap with Msnoff in order to gain U.S. support for 
the removal of old cobalt-60 sources, procurement of new linear 
accelerators, and long-term financial support for the Iraq/PACT 
partnership.  The Iraqi MOH's next step is to gain interagency 
approval in Baghdad and per PACT's advice approach other potential 
donors (Japan, China, and Canada) to ensure that the total cost of 
USD 2.3 to USD 3.5 million for short-term goals is reached quickly. 
The implementation of medium and long-term elements will begin only 
if Iraq finds donors and submits appropriate TC project requests to 
the IAEA and Member States for consideration.  The IAEA has not yet 
committed any TC or reserve funds toward this project. 
 
¶2.  Mission requests guidance on USG views of the Iraq/PACT 
partnership, possible assistance on removal of cobalt-60 sources, 
possible training opportunities of Iraqi experts in the U.S., and 
USG funding support.  END SUMMARY AND ACTION REQUEST. 
 
------------------------ 
HOW THIS ALL GOT STARTED 
------------------------ 
 
¶3.  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 timeline, strategy, and cost estimate 
for donors to consider.  PACT offered assistance in formulating a 
project package for donors.  After months of inaction, caused at 
least in part by Austrian visa delays, Iraq recently sent two 
experts from the Ministry of Health to Vienna for March 30-April 4 
consultations with PACT (ref B). 
 
------------------------------ 
IRAQ-PACT CONSULTATION RESULTS 
------------------------------ 
 
¶4.  PACT arranged for a week of meetings with Nuclear Applications 
(Applied Radiation and Biology and Radiotherapy Section/Dosimetry 
and Medical Radiation Physic Section/Nuclear Medicine Section), TC, 
and program experts for Iraqi Ministry of Health representatives Dr. 
Ahmed Sabah Nooredin and Dr. Mahdi Abdullah Al Saraj from the main 
cancer hospital in Baghdad.  The Iraqi experts presented an account 
of their current oncology services across Iraq and then worked with 
IAEA counterparts on devising a plan for short/medium/long term 
priorities which are now divided into three phases (Phase I - 
immediate action in 2009/Phase II - action mid-2010-2011/Phase II - 
action beyond 2012.) Estimated resources and possible funding 
sources were also identified.  Based on the discussion, prior to 
departing, the Iraqi experts presented a draft project concept for 
the rehabilitation of the main cancer and nuclear medicine centers 
in Baghdad and Mosul and defined it as a Phase I need.  According to 
the experts they will ask the Ministry of Health and Ministry of 
Science and Technology to submit this project concept as a TC 
project request with the TC reserve Fund as the funding source. 
PACT Director Samiei, in a separate conversation with Msnoff, noted 
that the IAEA may designate USG 50,000 from the TC Reserve Fund for 
this project after approval. 
 
¶5.  The draft project concept will address the most urgent needs of 
the two cancer centers in Mosul and Baghdad. According to the draft 
outline the project requests: 
 
-- Six Cobalt-60 source replacements (2 for Mosul/4 for Baghdad), 
 
the decommissioning of old machines, and assistance procuring new 
machines; 
-- in the event that importation of Cobalt 60 replacement sources is 
not feasible, Iraq requests assistance in procuring two linear 
accelerators (compact 6MeV); 
-- intracavitary afterloading; 
-- assistance with improving radiopharmaceuticals for nuclear 
medical examinations; 
-- support for a comprehensive cancer control plan based on the PACT 
process; 
-- training courses: a) short-term program for three months for 
teams consisting of 4 radiation oncologists, 1 nuclear medicine 
physician, 4 radiotherapy technicians, 2 physicists, and 1 engineer; 
b) medium-term programs for 2 radiation oncologists, 2 radiotherapy 
technicians, 1 physicist, 1 engineer, and 1 nuclear medicine 
physician; c) long-term programs lasting 1-2 years for 3 radiation 
oncologists, 3 radiotherapy technicians, 2 physicists and 1 nuclear 
medicine physician. 
 
The IAEA's TC Division and Iraqi experts agreed that Phase II and 
Phase III needs, not defined as of April 2009, in radiotherapy and 
nuclear medicine, should be addressed through Iraqi submissions of 
regular TC project proposals in 2010 for approval by the TACC. Iraqi 
participation in existing regional TC projects will also address 
some needs. 
 
¶6.  Iraqi experts also briefed Nuclear Application's Medical Physics 
and Dosimetry expert Pernika on current equipment inventories at the 
four radiotherapy centers in Iraq.  The total inventory is: 
-- Baghdad - 4 Cobalt-60 units, 2 Primus linear accelerators, 1 CT 
simulator (Siemens), 1 TPS 
-- Mosul - 2 Cobalt 60 units, 1 Primus linear accelerator, 1 CT 
simulator, 1 TPS 
-- Arbil - 1 Primus linear accelerator, 1 CT simulator, 1 TPS 
-- Suleimania - 1 Elekta linear accelerator, other equipment 
unknown 
 
The centers and equipment are being staffed by a total of 80 experts 
with a variety of educational backgrounds (Master or Bachelors in 
Science and Medicine, etc.).  According to IAEA/NA and the Iraqi 
experts, the urgent need for Phase I and Phase II is the training of 
medical physicists.  Short-term training, from IAEA/NA's perspective 
should focus on dosimetry, treatment planning, quality assurance, 
and radiation protection.  For Phase II training needs, Iraq should 
consider sending two medical physicists on a 1-2 year clinical 
rotation in a major hospital in the region or elsewhere.  As a first 
step, IAEA/NA agreed to provide Iraqi counterparts with necessary 
material for teaching and training medical physicists especially in 
radiation oncology.  IAEA/NA will also provide further 
recommendation on clinical training opportunities. 
 
¶7.  A common thread throughout the consultations, according to PACT, 
was Iraq's need for funding.  According to the Iraqi experts, there 
are limited amounts of funding available from the Ministry of Health 
or the Ministry of Science.  PACT once again suggested that the 
Iraqis brief Member States and potential donors on their plans in an 
effort to solicit funds.  PACT will continue partner with Iraq and 
will try to mobilize funding from other international organizations 
or NGOs on behalf of Iraq. 
 
¶8.  PACT requested U.S. support, on behalf of the GoI, for the 
removal of the old Cobalt-60 sources, procurement of new linear 
accelerators should the U.S. or other donor be unwilling to supply 
new Cobalt-60 sources and machines, and long term financial support 
for the Iraq/PACT partnership in areas of USG interest such as 
training. (NOTE: While PACT has requested USG support, the 
partnership concept along with the three Phase approach has not yet 
been approved by the Ministry of Health or Ministry of Science. END 
NOTE) 
 
------- 
COMMENT 
------- 
 
¶9.  Mission believes the GoI and PACT are on the right track in 
forming a strategic partnership to create a comprehensive national 
cancer therapy program and mobilize necessary resources, not funded 
by TC monies, to ensure that all three phases of the initial concept 
come to fruition.  The USG continues to support PACT's work and 
given our strategic interests in Iraq and the region, support for 
this endeavor, either through training of Iraqi experts, removal of 
Cobalt-60 sources, or other forms of aid, would create good will and 
 
ensure that nuclear techniques are being used for peaceful purposes. 
 There are also benefits in Vienna given Iraq's presence on the IAEA 
board and the Iraqi governor's personal concern with nuclear 
medicine.  Mission suggests that before any USG funding or in-kind 
support is considered, a thorough review of the project (possibly 
via DVCs with Iraqi experts, the US Health Attach and USAID Bagdad, 
and IAEA officials) be conducted.  The USG may also want to consider 
working with the Minister of Health and Science specifically to set 
aside Iraqi national funds, on an annual basis, for specific needs 
in all three phases of the concept, thereby reducing the burden on 
potential donors. 
 
SCHULTE