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Iraq Report: October 27, 2006

October 27, 2006, Volume 9, Number 38

HEALTH-CARE SYSTEM ON VERGE OF COLLAPSE. 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. (By Sumedha Senanayake. Originally published on October 27.)

MECCA CHARTER UNLIKELY TO STEM SECTARIAN VIOLENCE. Last week, approximately 50 Iraqi religious leaders signed a text in the holy city of Mecca, Saudi Arabia, in the hope that it would lead to the end the sectarian bloodshed that has been raging in Iraq for eight months. However, many questions persist as to whether this document can seriously affects the security situation in Iraq.

The 10-point Mecca Charter issued on October 20 was drafted by four clerics under the auspices of the 57-member Organization of the Islamic Conference (OIC). It draws on Koranic verses and sayings by the Prophet Muhammad.

The document calls for an end to sectarian violence and attacks on places of worship. It calls for safeguarding the unity and territorial integrity of Iraq; releasing all innocent detainees; and allowing displaced persons to return to their homes. In addition, it urges Iraqis to "work together to end foreign occupation and rebuild the country's economic, political, and military capabilities."

Iraqi Religious Leaders Hail Signing

Religious leaders overwhelmingly praised the charter, saying that it was positive step for Iraq and represented a powerful message that the Shi'ite and Sunni religious communities supported Iraqi unity and rejected sectarian violence.

Salah Salim Abd al-Razzaq, a Shi'ite participant, said the document was significant because it was signed by both Shi'ite and Sunni religious authorities.

"The Mecca document will yield positive results and will have a great impact on the course of events in the Iraqi street now that it has been signed by Sunni and Shi'ite scholars and now that it has gained the blessing of Shi'ite religious authorities," the Saudi-based newspaper "Ukaz" quoted him on October 21 as saying.

Abd al-Salim al-Qubaysi, a Sunni cleric and a member of the Muslim Scholars Association, stressed that the charter succeeded in fulfilling its objectives and now needed to be implemented.

"The Mecca document included significant points that tackled practical issues such as condemning killings based on sectarian identity, considering it an act of fragmentation," al-Qubaysi said during an October 21 interview with Al-Jazeera satellite television.

Meanwhile, Al-Iraqiyah television reported on October 22 that several Iraqi cities witnessed large demonstrations in support of the Mecca Charter and Iraqi national unity -- an indication the Iraqi public has hopes the charter will end the bloody cycle of sectarian attacks.

Notable Absences

While many Iraqi religious leaders expressed optimism, the absence of Grand Ayatollah Ali al-Sistani and radical Shi'ite cleric Muqtada al-Sadr, or representatives from their respective movements, from the conference was a significant development. Although both men issued statements in support of the conference and the charter, their decision not to attend or to send representatives speaks volumes.

Al-Sistani called on all sides to accept the charter, but his absence may have weakened its potential impact among his followers, who may question its legitimacy. Al-Sistani is the most revered Shi'ite cleric in Iraq and if he had sent a representative to sign the charter on his behalf, it would have most certainly given it greater weight and legitimacy not only among his followers, but throughout Iraq's religious establishment.

Al-Sadr's decision to stay away from the Mecca conference places him further at odds with Prime Minister Nuri al-Maliki's government, which has been trying to reign in militias, particularly, al-Sadr's Imam Al-Mahdi Army. That militia has been widely blamed for much of the sectarian violence.

Furthermore, al-Sadr's absence sends a conflicting message as to whether he actually wants to halt the sectarian strife. Earlier he urged his followers to stop carrying out sectarian attacks and vowed to go after his militiamen who have been accused of being involved in death squads. His absence from the conference, like al-Sistani's, weakens the Mecca Charter.

Will It Make A Difference?

The gathering of Shi'ite and Sunni religious leaders and the signing of the charter sends a powerful message that Iraqi religious leaders are serious about preserving the nation's unity and halting sectarian violence. For a nation that has had difficulty in agreeing on just about everything since the overthrow of the Hussein regime, the unanimous acceptance of the charter undoubtedly represents hope for Iraqis.

Furthermore, the optimism generated by the signing of the Mecca Charter has created momentum for the OIC to organize a follow-up meeting. A high-level OIC source indicated the organization plans to hold a reconciliation conference of Iraqi political leaders in Mecca during the upcoming hajj season at the end of the year, the Jeddah-based "Arab News" reported on October 23.

However, Iraqis have heard these statements before only to be disillusioned by them. During the reconciliation conference held in Cairo under the auspices of the Arab League in 2005, delegates rejected divisions along ethnic and religious lines and stressed Iraq's unity. However, three months later Iraq was plunged into its current state of sectarian violence after the bombing of the Al-Askari (Golden) Mosque in Samarra.

Several Iraqi politicians have expressed doubts that the Mecca Charter can have any effect on the security situation in the country. Iyad Jamal al-Din, a lawmaker and a member of the Iraqi List, told Baghdad Satellite Television on October 21 that "those who murder, blow up, and deem spilling of Iraqi blood permissible do not believe in religion nor do they follow a religious scholar and will therefore continue on their path."

Similarly, there have been reports that some militia members have left to form freelance death squads that have been linked to sectarian violence, indicating that religious authorities have little influence over them. The U.S. military said there is evidence that rogue fighters from al-Sadr's Al-Mahdi Army were involved in some of these attacks, demonstrating that al-Sadr may be losing control of some of his militiamen.

Although the Mecca Charter declares a strong commitment to ending sectarian violence and maintaining Iraqi unity, there is no indication of how this agenda would be implemented on the ground. The sectarian violence has engulfed the nation since February and Prime Minister al-Maliki's government has so far been unable to stop it. It seems unlikely that this charter -- built on lofty proclamations, but without any concrete mechanisms to implement them -- will put an end to the bloodshed. (By Sumedha Senanayake. Originally published on October 25.)