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November 11th, 2006 - Decrepit Healthcare Adds to Toll in Iraq
A once enviable system lacks doctors, medicine and key equipment.
Despite U.S. funding, no cure seems imminent.
By Louise Roug
Los Angeles Times
November 11, 2006
Baghdad - Thousands of Iraqis are believed to have died from shortages of medicine, vital equipment and qualified doctors, despite an infusion of nearly half a billion dollars from U.S. coffers into this country's healthcare system, Iraqi officials and American observers say.
Raging sectarian violence as well as theft, corruption and mismanagement have drained health resources and made deliveries of supplies difficult. Exacerbating the crisis, hundreds of doctors have been killed, and thousands have fled Iraq. The child mortality rate, a key indicator of a nation's health, has worsened since the U.S.-led invasion in 2003, according to Iraqi government figures.
In the most sinister reported development, provincial Sunni Muslim doctors charge that Shiite Muslims who control the Health Ministry deliberately withhold medicines and other vital supplies. Privately, some U.S. officials say that hard-line Shiites use the ministry for political and sectarian ends.
This fall, U.S. troops raided the ministry, arresting employees suspected of kidnapping and killing patients at the Medical City Hospital in Baghdad. Afterward, ministry officials severed ties with the Americans and refused to open an $800,000 clinic built by the U.S. Army Corps of Engineers in a deprived Sunni neighborhood in the capital.
The clinic has since been opened, but relations are still strained between U.S. military officials and the ministry, which is staffed by Shiites loyal to anti-American cleric Muqtada Sadr.
Across Iraq, a country whose healthcare was once the envy of the region, many hospitals have neither computers nor meaningful patient files. Functioning X-ray machines and MRI scanners are few and far between.
At one of the busiest hospitals in Baghdad, five people die on average every day because the staff does not have the equipment to treat heart attacks and other commonplace illnesses and injuries, said Husam Abud, a doctor at Yarmouk Hospital. That translates to more than 1,800 preventable deaths a year at that hospital alone.
"Frankly speaking, if we get cases of cancer, we can't treat them," he said. "They'll probably end their days here. We don't have the adequate medication or the adequate equipment, and specialized doctors are not available."
A pharmacist in the town of Taji, north of Baghdad, described a looming "humanitarian catastrophe" as medicine, blood bags, oxygen, anesthetics, vaccines and IV fluid run out. Taji has a hospital, but the surgical room contains little medicine and fewer instruments. In September, doctors there were forced to turn away a pregnant woman who was experiencing labor complications. She died on her way to another hospital.
Already overburdened by large numbers of civilian victims of the civil war, hospitals also are stretched by Iraqi military and police casualties. Because the security forces have no emergency facilities, soldiers take wounded comrades to hospitals for care, often forcing doctors at gunpoint to treat them first, U.S. military officials say.
Healthcare in Iraq once was first rate. Medicine and hospital care were free, doctors well-educated and respected. But neglect by former President Saddam Hussein and years of United Nations sanctions laid waste to the system.
Since 2003, U.S. agencies have spent at least $493 million of Iraqi reconstruction funds on healthcare, but no new hospitals and only a few clinics have been built. With reconstruction funds running out, officials can point to few success stories beyond a child vaccination campaign. Hospitals looted in the first days after the invasion remain decrepit, without vital equipment and supplies. The hospital rehabilitation program has been plagued by cost overruns and complaints of shoddy but expensive work.
A flagship $50-million children's hospital in the southern city of Basra, a pet project of First Lady Laura Bush, has run far behind schedule and over budget. If it is ever finished, the hospital probably will end up costing at least $40 million more than planned, not including medical equipment, according to a congressional report by the special inspector general for Iraq reconstruction.
The largest U.S.-funded construction program in the healthcare sector has fallen far short. A project to build 150 primary healthcare centers in Iraq was initially scaled back to 142 because of cost overruns. But only six clinics are open to the public, five of them in Shiite neighborhoods of Baghdad, according to information provided by the U.S. Agency for International Development.
In Sunni-dominated Al Anbar province, the poorest, most dangerous part of the country, it has become increasingly difficult to get medical care. Several clinics have shut down in Ramadi, Hit, Haditha and Fallouja as doctors have fled and supplies have dwindled, local officials say.
The nation's health has deteriorated to a level not seen since the 1950s, said Joseph Chamie, former director of the U.N. Population Division and an Iraq specialist. "They were at the forefront," he said, referring to healthcare just before the 1991 Persian Gulf War. "Now they're looking more and more like a country in sub-Saharan Africa."
At the outset of the 2003 war, the U.S. administration pledged to cut the child mortality rate in half by 2005. But instead it has worsened, from 125 deaths per 1,000 births in 2002 to 130 per 1,000 this year, according to Health Ministry figures. By comparison, the child mortality rate in the United States was 8 per 1,000 births in 2005.
Meanwhile, the Health Ministry's budget has grown substantially - $1.1 billion this year, compared with $22 million in 2002. More than 55% of its funds are spent on medication and medical supplies, and 33% on salaries. The rest is spent on upkeep and auxiliary work, according to ministry figures.
But much of the medicine and medical supplies never benefit the most needy patients. There is no reliable system for government agencies to track deliveries of medicine and equipment. Large quantities cannot be accounted for, according to a Western official who declined to be identified.
"The system still hemorrhages a massive amount of the goods for health at a time when the people can least afford to be without medicines," Richard Garfield, a Columbia University healthcare expert, told a Senate committee hearing in July. "The value of medicines lost this way far outweighs the amount lost to corruption, either before or after the invasion."
In Hussein's hometown, Tikrit, 57 truckloads of medicine have disappeared within the last two weeks, according to Army Sgt. 1st Class Jeff Newkirk, a civil affairs officer who operates in the area. Health workers have run out of such everyday items as painkillers, plastic gloves, test tubes and blood bags, said Jasim Mukhlis, a 28-year-old Turkmen who works in the outpatient pharmacy.
The once well-funded hospital in the city now needs repairs to its roof and water pipes. The only available MRI scanner has been broken for eight months, but the Health Ministry has refused to send engineers, local officials say. As a result, patients sometimes have to travel about 200 miles to the northern city of Mosul for scans, say doctors, who perform only the most urgent operations in the hospital.
Three newly built clinics remain unopened, lacking doctors and supplies. Omar Hadithi, a local doctor, said Shiite officials take care of Shiite regions. "The officials in the ministry think that our province received special treatment during Saddam's reign, so they are treating it with less care," he said.
Doctors and officials in Baqubah also charge that the Shiite-run ministry discriminates against them. "We have no medications or blood serum supplies," said Tariq Hiali, a Baqubah health official. "The Ministry of Health is not providing us with medications and medical equipment; they consider [us to be] terrorists."
Qasim Yahya, a Health Ministry spokesman, denied that the ministry discriminates against Sunnis. Supplies are available to all, but must be picked up in Baghdad, he said, adding that the ministry is not responsible for delivery.
Sending Shiite ministry workers to Sunni-dominated areas might indeed be a dicey proposition.
And Sunni health workers say it is too dangerous for them to travel to the capital, especially to the ministry. Health Minister Ali Shammari is a member of Sadr's political movement, and the militiamen nominally loyal to the radical Shiite cleric, the Al Mahdi army, control the Health Ministry complex and the surrounding area.
Ali Mahdawi, a Sunni health official from Baqubah, disappeared inside the ministry complex four months ago as he was on his way to a meeting with the health minister. Mahdawi and his guards have not been heard from since, according to his colleagues and American officials.
"The ambulances we send to Baghdad are being intercepted by the Mahdi army," said Jamal Qadoori, an employee at Baqubah's blood bank. The Shiite militiamen then sell the stolen supplies on the black market, getting as much as $100 for blood bags, he said.
But both Shiite and Sunni health workers are targeted. At least 455 doctors, medical staffers and hospital guards, on both sides of the sectarian divide, have been killed since 2003, according to Health Ministry figures. In the same period, about 7,000 doctors left the country, according to the Doctors Assn. of Iraq.
In a few provinces, healthcare has not deteriorated since the U.S.-led invasion. The quiet, semiautonomous Kurdish region in the north has benefited from the influx of Arab doctors fleeing the violence in the capital. And in the south, Japanese forces have built or rehabilitated three hospitals and 32 health clinics in the peaceful Shiite-dominated Muthanna province. As a result, child mortality rates have improved there, according to provincial health director Falah Hassan.
But in most of the country, the situation has grown worse. Like violence, theft and corruption have become endemic. People caring for sick or injured family members say health workers are on the take and refuse to treat patients unless they're paid extra.
"They will not take care of the patient unless you pay them money all the time," said Akram Hussein, whose 75-year-old grandmother was taken to the Chawader Hospital in Baghdad's sprawling Shiite neighborhood of Sadr City recently. "We paid money to the cleaners and the nurses."
When his grandmother was in need of an important injection, the doctor also demanded extra: 5,000 dinars, or about $4. Hussein's family didn't complain to the manager, he said, "fearing they might leave her completely." After 10 days, she died. "God decides people's ages," Hussein said. "But I think that the lack of care in this hospital caused the death of my grandmother."
Times staff writers Saif Rasheed and Shamil Aziz in Baghdad and special correspondents in Baqubah, Tikrit, Fallouja and Taji contributed to this report.
Copyright 2006 Los Angeles Times