The violence engulfing Iraq is creating more patients than the
country's strained health system can handle, and causing doctors
to flee in fear of their lives.
More than $500 million of U.S. reconstruction funds have been
spent on the health system, but shortages of medicine and equipped
facilities persist as the security situation worsens.
professionals have become easy targets for violence because of
their good salaries and public positions. More than 2,000 doctors
have been kidnapped or murdered since 2003 and 12,000 doctors
have fled the country, according to the Brookings Institute Iraq
"The Iraq health system is bleeding," said Salam Ismael,
a doctor with the humanitarian group Doctors for Iraq, from Baghdad.
"There were problems before, lack of medicine, lack of instruments.
But we have gone to another level. We don't even have the staff
to use supplies if we have them."
Almost all the senior physicians with the financial means have
left Iraq, according to Richard Garfield, a professor of international
nursing at Columbia University. Less experienced doctors and medical
students have been forced to fill in the gaps.
Garfield worked in Iraq with the World Health Organization, UNICEF
and Iraq's Ministry of Health after the 2003 war, and said "a
remarkable dearth of leadership" from the Ministry of Health
is one of the biggest problems facing the health system.
"They have become political power bases rather than technical
units. Most of the technically competent people got thrown out,"
The Ministry of Health has faced widespread accusations of Shiite
favoritism because the minister is loyal to the Shia cleric, Muqtada
al-Sadr. In two attacks targeting the ministry in November, Iraq's
deputy health minister Ammar al-Saffar was kidnapped, and a group
of gunmen tried to take over the ministry.
Iraq's health system was once one of the best in the Middle East,
but suffered from years of neglect and sanctions during Saddam Hussein's
rule. Destruction from the 2003 U.S. invasion and the continuing
violence has exacerbated the problem.
The country currently has 240 hospitals in operation, according
to the U.S. State Department, but many are dilapidated and Iraq's
newest hospitals were built 20 years ago.
The U.S. government allotted $819 million for work on the health
care sector, and has spent nearly $600 million. Most of the projects
ended in 2006, but some construction efforts are continuing.
There have been some success stories -- the U.S. Agency for International
Development supported a widespread immunization campaign for young
children and trained health care workers at community centers
throughout the country. However, many of the goals set for health
sector reconstruction have fallen short of expectations.
Planned construction of 142 primary medical care centers by the
U.S. Army Corps of Engineers was plagued by delays with only eight
completed as of December 2006.
Of the 20 hospitals that were originally supposed to be renovated
by the corps, 12 have been finished. The Basrah Children's Hospital,
the only hospital being built with U.S. funds, suffered from major
delays in planning and construction is about a third completed.
Even hospitals that are operating to capacity can't
keep up with the level of emergency care needed. Basic trauma
supplies like anesthesia and bandages are running out, and deliveries
of stocks from humanitarian groups can't keep up with the demand.
Shortages of medicines make treating some conditions impossible,
said one Iraqi doctor, now studying in the United States, who
asked not to be identified in order to protect family members
still living in Iraq.
He worked at the large Baghdad Teaching Hospital while getting
his medical degree and said the facility was in desperate need
of supplies, drugs and imaging equipment. There was only one MRI
machine in a compound of five hospitals.
"The people who are killed, tortured and burned they come
to you and you see it every day," the doctor said. "There
are people with chronic illnesses, children who need chemo, and
you can't do anything. You just have to tell the parents, 'Your
child is going to be dead in six months.'"
The security problems permeating Iraq are not stopping
at hospital doors. Reports of patients being dragged from hospitals
and killed have become increasingly common.
"It's a fact that the insecurity of the situation affects
civilians in their access to health care," said Dorothea
Krimitsas, Middle East spokesperson of the International Committee
of the Red Cross. "People are afraid to leave their houses
and go to hospitals. They have heard of people storming hospitals
and forcing doctors at gun point to treat their own injured."
Ismael of Doctors for Iraq said women who go into labor are refusing
to go to the hospitals because they fear being shot, kidnapped
or killed in the streets.
The insecurity has made it difficult for humanitarian groups
to help as well. In October 2003, the headquarters of the International
Committee for the Red Cross was hit by suicide bombers. The attack
caused some humanitarian groups, including Medecins Sans Frontieres,
to pull their workers out of the country.
In December 2006, two dozen workers from the Red Cresent, a humanitarian
organization that is part of the Red Cross movement, were kidnapped
The situation has limited the ability of humanitarian groups that
remain in Iraq to move throughout the country and provide aid.
Health impacts of war
While injuries from violence are occupying much of
the health system's resources and personnel, other diseases caused
by breakdown in the country's infrastructure are contributing
to high child and infant mortality rates.
According to UNICEF, between 2003 and 2005 the infant mortality
remained constant at about 102 deaths per 1,000 live births. Mortality
rates of children under age 5 also saw no change, with an average
of 125 deaths per 1,000 children.
Problems with clean water and malnutrition can cause major health
problems, especially for children. Diarrhea, respiratory problems
and lack of medical care are all causes for the high levels of
child and infant mortality, said Barry Levy, a professor of public
health at Tufts University, and an expert on war and public health.
Levy said the health problems Iraq is experiencing are part of
a long deterioration of the health system since 1991. With violence
continuing, health experts worry that conditions will get worse.
"The combination of an already fragile health infrastructure,
no maintenance, less and less personal, people not having access
[to health care] because of time or distance or sectarian violence
-- it's like a bad novel that just builds on each other,"
said Frederick Burkle, a senior fellow at the Harvard Humanitarian
Initiative and a former top USAID official who worked in Iraq
immediately following the 2003 invasion.
Burkle said one of the first things to break down in a health
system during times of war is the ability to track and collect
information about patients and conditions. The refugees and internally
displaced people in the country are some of the most vulnerable,
Burkle said, and it will be a challenge to keep track of what
health risks they face.
Any real assessment of the health system or progress on reconstruction
will be impossible, according to Levy, if peace is not restored
"In the midst of a war, it's hard to deliver even basic
medical care to people," he said.