Extended Interview: Dr. Khudair Abbas
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SUSAN DENTZER: Dr. Abbas, welcome. Let’s start by talking a bit about your background. You were born in Iraq. Tell me where you were born and what happened during the rest of your life?
DR. KHODEIR ABBAS: I was born in July in 1948 in Basra. I completed my full school education in Basra, as well. And then I went to the Medical College of Madras, six years of study. I was a graduate in 1972. I have some training in Iraq, the internship, the rural health, the military service, as well, the residency program, all in Basra.
I left the country in 1979, going to U.K. to complete my post-graduate study. I was qualified as a Fellow of the Royal College of Surgeons. … I’ve been working since I arrived in the U.K. in the National Health Service as a general surgeon. My service specialty is the breast oncologic surgery.
SUSAN DENTZER: Why did you stay in the U.K.?
DR. KHODEIR ABBAS: On arrival to U.K. and on very simple, just discussing some political matters, I’d been reported by the Baath Party machinery as anti-state and as for Khomeini then, because I was not in support for the Iran-Iraq war, that simple.
SUSAN DENTZER: So, politically, you were unable to return?
DR. KHODEIR ABBAS: That’s right and I stayed in the United Kingdom for 23 years; out and back in June, this year because I and many medical colleagues, we sat and we had the idea of putting a plan for an advance primary health center in Baghdad in Iraq to serve the poor people. And I spent a month, the whole month of June and thanks God we could succeed with that project, which is serving the people outside the heavy populated area in Baghdad.
SUSAN DENTZER: How is it that you came to be health minister?
DR. KHODEIR ABBAS: I had been chosen by the Governing Council as the interim health minister. There were a few candidates and I was chosen by them to run this ministry. That’s why I decided this is the time whereby I have to pay part of the debt which I owe to my country.
SUSAN DENTZER: Tell me what the state was of health care in 2002, the last full year of the Saddam Hussein regime.
DR. KHODEIR ABBAS: In order to know the state of the health system in 2002, we have to go back a little bit further in history. Our system is very much centralized and mismanaged, focusing on the secondary health level, like the hospitals. The primary health preventive medicine, although it exists, [was] of less importance [to] the previous regime.
Something added to that, the management of many of our health institutions, hospitals, clinics and so forth are run by the party machinery, who are the party members. That’s what added to the problem, because most of them are ignorant, who are not managers, really.
Our system deteriorated over the years by the lack of training for medical and nursing staff. Because only the elite and those affiliated to the regime, they could go abroad and for training. That’s why the majority, they’ve been deprived of this and they lag behind in history in regard to what the international community had, really.
The economic sanctions added some more dimension to this. But more than that was the politicization of the economic sanctions. Because Saddam’s decisiveness is to win the battle, the political battle against the allies, the United Nations Security Chamber, all the time that’s his aim. He politicized that in the sense that Iraq for the … oil for food and gained about $4.3 billion — half on medicines and half on medical equipment. Unfortunately, what Saddam used to do is to lock doors on warehouses designated to go for the people and then blame the United States and the allies for whatever mortality and fatality happens in the Iraqi nation … Even after the liberation back in April, some of those warehouses were locked, which were found full of medicines, as well as wheelchairs. At the time, our disabled, they were looking around for any wheelchair, and there were hundreds of wheelchairs locked in those warehouses.
The other dimension of the corruption of the regime and the family of the regime and the few elites. They have created certain companies for drug procurement neighboring Iraq. And they were running all these contracts with the surcharge at least 30 percent over the original price. We have discovered those and we have taken certain firm steps by stopping many contracts of such sort.
You can see what happened in April, the last leg of the evidence that the looted happened. The burning of many hospitals and health centers. And we are certain and confident that that was an orchestrated scenario because Saddam before a few weeks prior to the April conflict, he decided that he would leave Iraq available for whoever takes after him, through his party members the followers and the security and intelligence forces, the Fedayeen.
SUSAN DENTZER: The World Health Organization reported in 2001 that Iraq was spending about $190 per capita on health care.
DR. KHODEIR ABBAS: This is very surprising and very odd figure. It does not reflect itself in reality. I find it very astonishing from a well-respected U.N. organization to mention that. I will tell you one thing, in 1997 and his failure to give a decent budget for the health system, he decided to start what we call the self-finance [system], to be started in 1997 and being completed in 1999 to include all the hospitals and primary health centers.
In that system, the Iraqi citizen has to pay for his admission to the hospital for the medicines he buys, for the investigation, the path lab, the X-ray, he has to pay. And, more than that, for his hospital stay and worse, for the operations he needs. Some operations, for example, they may cost 400,000 Iraqi dinars, which for the low social class and for those who are unemployed, that’s impossible. That’s why the stories of Iraqi people, they die at home was not astonishing, really to hear about. Those figures, I think, really, it has to be affirmed reality, not on paper.
SUSAN DENTZER: The figures were manipulated by Iraqis reporting that to the WHO?
DR. KHODEIR ABBAS: We know that Saddam, over the years, he could get through to the biggest news media [and] to some organizations like the WHO, that’s why we were unhappy about the performance of the WHO over the years and we are demanding now, that a new course for the WHO has to be redrawn.
SUSAN DENTZER: How much was Saddam actually spending on health care on a per capita basis?
DR. KHODEIR ABBAS: I’ll give you a very striking, astonishing figure: The health budget for 2002 is $16 million dollars, your dollar, that it means per capita is less than $1.65 cents. Because, as I told you, the money he gets legally and illegally, he spend it on many other unnecessary needs. Like, he has more than 70 huge palaces all over Iraq. And the daily expenditure of those, every palace; they have to get prepared just in case he might visit that site on that day; every palace has to prepare for three meals, courses all the other supplements and so forth, while at the same time the Iraqi were dying of hunger and of disease.
And the other picture is building up huge mosques which the cost run into billions of your dollars, I don’t think God need to be praised in such [a] big mosque, while his slaves and creature are dying of hunger and, you know. So there’s this discrepancy of what Saddam would like to portray, himself and the reality of what the Iraqi are suffering.
SUSAN DENTZER: Where was the money that was being spent on the health care system going?
DR. KHODEIR ABBAS: He had targeted 4 percent of the Iraqi health institutions, those institutions only which carried his name. Like, for example, Saddam Center for Diabetes and Endocrinology or Saddam Center for Cardiology. Only the institutions carried his name, being taken care of. All the others being neglected.
SUSAN DENTZER: When you returned and helped to set up the primary health system, and then began to tour other health facilities in Iraq after the war, what did you see?
DR. KHODEIR ABBAS: The tragedy is on visiting our health system facilities, bring me to a very sad example. We have, at the East outskirts of Baghdad a very good hospital [that] used to be a military hospital, but very sophisticated and it used to serve the military, as well the civil servant. That was [in] rubble when I saw it. It’s all rubble, nothing even the hard and thick iron supports, they melted and they bend….
The Ministry of Health, itself, I mean it had been burned. And all what was happening was orchestrated from inside. It’s not coming from outside. As I told you, it’s been preplanned by Saddam’s gangs and security forces in the Fedayeen as a way of vengeance, really, of losing their grip on Iraq.
SUSAN DENTZER: What was the worst health abuse that you became aware of that occurred under Saddam?
DR. KHODEIR ABBAS: The first one, I have met hundreds now Iraqis from the South from Basra in Baghdad, almost now you can say around 250. Those Iraqi citizens, they lost their ears because they were cut off; they refused to serve in the army. The other portion, they talked, either joked about Saddam or made remarks about the party and they lost their tongues. And for other offenses, they been disfigured in their foreheads.
The extreme example, one of those became housebound. He couldn’t dare to face his family members; he couldn’t dare to face his neighbors; he couldn’t dare to walk in the street; all the time was crying, staying inside home; and holding the missing ear and just crying.
And when he saw me, he kept crying on and on and then he asked for a desperate and immediate help. That’s why, I have made contacts with our plastic surgeons inside, of course, and the ex-patriot in the United Kingdom and the United States, we are making files for all these patients and we are trying to go one-by-one examine, assess what reconstructive procedure they need. And I’m sure it will be in the near future we will start with these.
The other remarkable sad thing is when I went to visit [a] prison [in] the worst outskirts of Baghdad. This is very notorious prison. Hundreds of thousands of Iraqis, they went through that and they lost their lives by hanging or execution. I’ve been told by the director of the — the current director, he is a military surgeon. He told me how they used to hear the cries at night because those, the political prisoner they used to be brought at night and they start executing them and then burying them in mass graves.
And the saddest story, again, in that same prison, some of those victims, some, I’m not sure that is allegation which I will go in depth about it. Their eyes were [inaudible] in order that their cornea to be used as graft for some patients elsewhere.
SUSAN DENTZER: The mutilation of tongues foreheads, ears. Who performed those?
DR. KHODEIR ABBAS: Unfortunately, it’s known that some doctors who — it’s very, I feel very ashamed to call them doctors. Because what I know about doctors, they are given on their graduation the oath of Hippocrates that they will spare the lives, they will do their best to really improve the health and the figure of the human being, as this is their soul. And it seems some being done by other than medical people. So, what I say, I mean, we are going to go into depth in this problem.
Any Iraqi who committed crimes, any crime, really, the court has to look into it and then he has to be, you know, judged and sentenced according to the Iraqi laws…
SUSAN DENTZER: How has the health system been rebuilt in the months since the official end of the combat period?
DR. KHODEIR ABBAS: We began a crisis plan to rehabilitate our health system and that, including rapid assessment to all the facilities for our system, the hospitals, primary centers, the public central labs. That was done and then the refurbishment has started immediately that’s by the Ministry of Health, with the help of many international NGOs, as well the allies and, thankfully, the United States.
We have started that and we have assessed and, really divided those facilities which is beyond repair, we have not done anything for it because that it means it will need new reconstruction.
Those which will not survive for long, for example, not beyond six years or so, we have only done very critical repair in order just to get it functioning and then, possibly, in five six years, they will need to be rebuilt. And those which are still in tact by the need some care, that is the ones which we have given a lot of care and refurbishment to it.
So, according to this, you could say that not many facilities being repaired. We have done on the pharmaceutical side by supplying, until now, more than 20,000 of medicines. …With the help of the international NGOs, the UNICEF and the WHO, we have done extensive immunization schemes and until now, we have covered more than 70 percent of all Iraq. And we got weekly tracing of the escapees, two days out of a week, in that sense. And we had some shortages of the supplies recently … and we are working on that. But until now, we have done about two and a half in the last few months; two and a half million vaccination.
The nutritional schemes, we have already started; and the schools, the students, the school children examination, health examination, as well immunization out of school. And some education in that sense. SUSAN DENTZER: What are you now spending on health care in Iraq? Where is the money coming from? And what further assistance does Iraq need from the international community for health spending?
DR. KHODEIR ABBAS: You know, we received Iraq, nothing in the central bank, because Saddam took everything with him. And we had, from June, to the end of December a budget of $210 million. This we’ve been using it since that time and we are now to the end of December. For next year, we will have a budget of $1.8 billion, about $800 million is coming from the U.S. supplemental and the rest from the general budget.
That’s what we have and we got to plan for 2004 what to spend on.
SUSAN DENTZER: What do you need?
DR. KHODEIR ABBAS: We need is to continue with the process of rehabilitation of our system, as I said to you before. We have to continue the process of re-equipping our hospitals and path labs. We have to continue procuring the medicines needed. We got, of course, by the way, a new system, which we have for the first time in the history of Iraq, we got a new Iraqi national formulary. According to that, we have classified the drugs, essentially needed and the one used to be procured in the past, which is of no use, we are not going to procure anymore. So, our needs will be decided according to this formulary from now and on. SUSAN DENTZER: What is the state of health care now in Iraq in terms of what Iraqi citizens have to pay for health care?
DR. KHODEIR ABBAS: Under Saddam, the self-finance system [was] introduced, as I said before. What we have done last August, we have reduced the cost for the Iraqi citizen to 50 percent, but we still encounter some Iraqis they cannot afford even with reduced pay. So that’s why I have written to the honored Governing Council to abolish the system, at least for the immediate and the short-term until our high unemployment figures reduce and then the Iraqi citizens will be able to pay.
In our ministerial meetings and the government council we put a vision for the future that the private sector will be given a role in the new Iraq. That will be so, but in the health sector, I said, on the time being that will be a little bit postponed further, until our economy becomes healthier and our citizens will be more able to pay.
SUSAN DENTZER: So, eventually, you foresee a system where there’s a large public system, side-by-side with a private sector, as well?
DR. KHODEIR ABBAS: Quite right, because we feel that both sectors are needed. And some Iraqis, they might request the private sector to be there, and that’s why our number of private hospital has flourished in the last few years. Now, we’ve got about 70 private hospitals in Iraq.
So, we are going to provide both. Strength in the public sector, as well, give the chance for the private sector to function, as well.
SUSAN DENTZER: There were reports that the Health Ministry will be the first to be transferred entirely to Iraqi control, correct?
DR. KHODEIR ABBAS: That’s correct. It seems, I mean, according to the CPA [Coalition Provisional Authority] monitoring that the Health Ministry in Iraq has performed very well and we will be the first people to get full independence in our management of the health system in Iraq.
SUSAN DENTZER: Some have said that the level of professionalism of Iraqi doctors and others was essentially frozen around 1970. What do you intend to do in terms of reinvigorating the training and education of Iraqi physicians, nurses, and others going forward?
DR. KHODEIR ABBAS: We realize that from the first day. This is what we are lacking desperately. That’s why we have made contacts. We have started the problem. We have made contacts abroad in the U.K., the United States. And part of our new plan for 2004 is the health education schemes. We are going to provide about 15 medical colleges and seven hospitals affiliated to the medical colleges, with many journals, 100 journals and 100 CDs and videos and various educational programs.
And we have also asked for training grants abroad. And, as well, we are going to hold the first international conference in Iraq at mid-February in order to tell the international community that we are back and we are standing on our feet and all our professionals would like really intermix and to have their look in their professional fields with the international professional community in order to feel alive, really, improve their education and knowledge and to feel really to feel better.
SUSAN DENTZER: Will you be health minister, once the transfer of the ministry to Iraqi civilian control is completed?
DR. KHODEIR ABBAS: As I said before, in the new Iraq, there’ll be no president for life; no manager for life; and no professional for life, there will be a limit for everyone and including myself. My role is to function until January 2004 — but I’ll be very glad if the elected then, the General Assembly chose me to serve for a further period, I’ll be more than willing to do so. But even if I go, I’ll feel very relieved that, at least, I have started something and I have done something for my country. And I don’t regret it.
SUSAN DENTZER: Dr. Abbas, thank you very much.
DR. KHODEIR ABBAS: My pleasure. Thank you very much.