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Iraq: Health-Care System On Verge Of Collapse

Can Iraq's government provide basic health care? (epa) PRAGUE, October 27, 2006 (RFE/RL) -- The working conditions of Iraqi doctors have become increasingly difficult as they toil in a health-care system on the brink of collapse and attempt to treat Iraqis injured by the ongoing violence. At the same time, Iraqi doctors have found themselves being targeted by both insurgents and Iraqi security forces.

Before the U.S.-led invasion in 2003, Iraq's health-care system was already crippled by the eight-year war with Iran, the first Gulf War in 1991, and more than 12 years of UN sanctions from 1991-2003. The unrelenting violence since the invasion has now brought Iraq's health-care system to the brink of collapse. More troubling is the possibility that the system is in such dire condition that many of those who die from their injuries due to terrorist and sectarian violence could have been saved if Iraq's hospitals were functioning properly.

Health-Care System In Shambles

Iraqi hospitals lack basic medical supplies and many of the hospitals function without medicines, disinfectants, surgical instruments, clean bedding and anesthesia. As a result, Iraqis have had to rely on buying medical equipment such as oxygen supplies and medicines on the black market, where prices are often exorbitant.

Furthermore, emergency rooms in many Iraqi hospitals are unable to cope with the overwhelming demand due to the ongoing violence. Emergency rooms extend into overcrowded hallways with not much more than beds, oxygen bottles, and fluid-siphoning instruments. Radiology equipment and laboratory services are virtually nonexistent. These difficulties are further compounded by the lack of experienced medical personnel, who have either fled or been killed.

Dr. Bassim al-Sheibani, an Iraqi physician, wrote in the "British Medical Journal" on October 20 that many Iraqi doctors lacked the proper experience to deal with the influx of the wounded and many patients have died as a result of inexperienced staff.

"Emergency departments are staffed by doctors who do not have the proper experience or skills to manage emergency cases. Medical staff...admit that more than half of those killed could have been saved if trained and experienced staff were available," he said.

Reconstruction Setbacks

Efforts to rebuild Iraq's medical infrastructure have been placed on hold as more funds have been shifted to security. Meanwhile, Iraqi doctors and medical personnel have urged the international community to commit more resources to rebuilding the nation's shattered hospitals and clinics.

In the first 14 months after the 2003 invasion, the United Kingdom and the United States spent almost $20 billion on reconstruction in Iraq, with hundreds of millions aimed at rebuilding the network of 180 hospitals and clinics. However, billions have been lost through a combination of corruption, criminal activity, mismanagement, and incompetence, the "Belfast Telegraph" reported on October 20.

In fact, the situation has become so bleak that, according Amar al-Saffar, an official in charge of construction at the Iraqi Health Ministry, not a single hospital has been built since the Al-Khadimiyah Hospital opened in 1986 in Baghdad, London's "The Times" reported on October 21. Al-Saffar noted that the much touted $50 million project to build a pediatric hospital in Al-Basrah has remained unfinished because of financial mismanagement.

A senior Health Ministry official told "The Times," "It is the worst situation that the Ministry of Health has been in in its entire history."

Iraqi Doctors Targeted

Iraqi doctors face challenges beyond the lack of resources, as they have increasingly become targets of insurgents, militias, and the Iraqi police. The situation has become so dire that thousands of doctors have fled the country out of fear.

The nonprofit group Medact estimated in a report released in March that 120 doctors and 80 pharmacists have been killed and more than 18,000 physicians have fled Iraq since 2003. Doctors have also become frequent targets of kidnappings, because they are viewed as relatively prosperous and their families can afford to pay the ransom.

An Iraqi doctor, Peter Kandela, interviewed Iraqi medical personnel in Syria and Jordan who fled the violence, and discovered that doctors were actively sought after by insurgents and kidnappers.

"In the new Iraq, there is a price tag linked to your position and status. Those doctors who have stayed in the country know what they are worth in kidnapping terms, and ensure their relatives have easy access to the necessary funds to secure their speedy release if they are taken," "The Times" quoted him on October 20 as saying.

In addition, doctors have complained that Iraqi police have threatened and attacked medical personnel who have been less than attentive to the needs of the police. On September 28, doctors at the Al-Yarmuk Hospital in Baghdad went on strike after Iraqi police burst into the facility and forced doctors to treat a wounded colleague. The doctors demanded an apology from the Interior Ministry, which oversees the police, and called for a complete weapons ban in the hospital, the "San Francisco Chronicle" reported on September 30.

Future Repercussions

Health care is a basic and essential service and Iraq will continue to suffer needlessly if the system is not repaired. According to the Iraqi Health Ministry, 70 percent of deaths among children result from easily treatable conditions such as diarrhea and respiratory illness.

Furthermore, if basic services such as health care continue to be scarce, it may have serious repercussions for the Iraqi government. Prime Minister Nuri al-Maliki's government continues to suffer from the perception of being weak in the eyes of some Iraqis -- incapable of reining in the militias, stopping the insurgency, stemming corruption, and providing basic services. If Iraqis are not able to get the most rudimentary services, such as basic health care, this can only reinforce this perception.

There have been signs of improvement in U.S. efforts to shore up Iraq's health-care system. Based on a September report by the U.S. Agency for International Development (USAID)-funded Agriculture Reconstruction and Development Program for Iraq, out of the more than $4 billion spent on reconstruction and emergency relief programs from 2003-06, $138 million was allocated to improve the health-care system.

In addition, USAID has provided skills training to more than 3,200 primary-care physicians and established training centers in five governorates to support local health-care training. USAID has also partnered with the UN Children's Fund (UNICEF) and the World Health Organization to assist the Iraqi Health Ministry to improve access to health care for all Iraqis.

Iraq In Transition

Iraq In Transition

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