Global Policy Forum

By Aamer Madhani

For most of his life, Dr. Ayad Abdul Kadhem kept a laser-like focus on his goal of becoming a doctor. He finished at the top of his class in primary and secondary schools, and proved to be among the most studious of his peers at the University of Baghdad's medical school. But these days, Kadhem, now a second-year resident at Sadr City Hospital, is looking for a way out of his profession. Recently, he and five of his colleagues applied for jobs at the Iraqna mobile phone company to answer a customer help line--unskilled work he is more than willing to take so he can quit a job he has come to loathe.

"Almost anything is better than being a doctor in Iraq now," said Kadhem, 26, who didn't get the call center job. "The situation is so difficult in the medical field that many of us would quit if we could." Before the war, even most critics of a U.S.-led invasion agreed that if dictator Saddam Hussein were toppled, Iraq's long-struggling health-care system would improve. But 2 1/2 years after the invasion, health care in Iraq is foundering.

Hospitals regularly run out of the most basic medicines, and the facilities are in horrid shape. Iraqi lawmakers and doctors report that scores of specialists and experienced physicians are leaving the country because they fear they are targets of violence or because they are fed up with the substandard working conditions.

"What we have done in our focus on improving the security situation is failed to address the terrible health crisis of Iraq," said Abbas al-Bayati, a member of the National Assembly. "We are not adequately compensating and training our doctors, and as a result we are facing the possibility of losing some of our best and most important citizens."

Doctors say the work has become gut-wrenching. With ill-equipped emergency rooms, they are unable to handle the complex injuries from the violence of Iraq's streets. The Ministry of Health has an annual budget of $1 billion--about $37 per Iraqi citizen.

Violence from streets

Worse, doctors say the dangers of the streets are seeping into Iraqi hospitals. Over sodas with a couple of fellow doctors and a reporter, Kadhem recalled a recent incident when he was sure he would die while working the emergency room's night shift.

About 20 armed and angry men from a family in the Sadr City slums brought in a gravely wounded woman. Kadhem said the woman, the family's matriarch, was accidentally shot when she tried to break up a fight between two of her sons. The woman had lost a great deal of blood and her chance of survival was slim, Kadhem said. Doctors explained the woman's dire situation to her family, and the men responded with a threat. "They said, `Keep her alive or we'll kill the entire staff,'" Kadhem recalled.

Soon after the threat, the woman died, but the doctors pretended she was still alive. They carted her off to an operating room to bide some time and called the Iraqi police. When police arrived, the woman's family figured out she was dead and started shooting randomly in the hospital corridors, Kadhem said. Police and the woman's family exchanged gunfire as the hospital staff raced for cover. The men eventually surrendered to police. None of the hospital staff was injured, but the doctors had to treat one of the relatives who just minutes earlier was shooting at them.

Dr. Usama Abbas, 30, a physician at Nour Hospital in Baghdad, spoke of a man who demanded Abbas sign a death certificate for his brother. The man, Abbas explained, was certain a leg in the hospital's morgue belonged to his brother, believed killed in a suicide car bombing. When Abbas told the man he could not issue the certificate without first conducting DNA tests to prove to whom the limb belonged, the man berated him in colorful Arabic. "These are the types of stories that just about every doctor in Iraq could tell you," Abbas said.

Abbas was so frustrated with the situation that in May he and a few other doctors organized a demonstration in front of the Ministry of Health. The residents demanded an increase in their salaries, which average $130 a month. They also called on the government to devote more resources to providing security at the hospitals and training doctors on the latest advancements in medicine.

Threat of a strike

Weeks after the demonstrations, Dr. Abdul Mutalib Ali, the health minister, called some of the protesting doctors to his office to let them air their grievances. Abbas said the doctors told the health minister they were considering calling on their colleagues across the nation to go on a strike, handling only emergency cases.

Ali told the doctors that the government did not have the money to increase doctors' salaries or training, Abbas said. The doctors went away unsatisfied but have not followed through on their strike threat. "With the security situation as the main focus of the government, there is little value for what we do," Abbas said. "We are probably the most educated in all of the country, but we are treated like insects."

Dr. Salwan Akran, 32, an orthopedic specialist at Al-Kindi Hospital in Baghdad, said poor conditions and shoddy management of hospitals are probably the most frustrating aspects of practicing medicine in Iraq. At Al-Kindi Hospital--one of Baghdad's busiest medical centers--loose wires protrude from walls, grime cakes the floors and flies buzz over patients. There is a shortage of simple surgical tools, Akran said, and his hospital is often short of basic anesthetics and painkillers.

"I am not saying that Al-Kindi is worse than any other hospital in Iraq. These are the same problems I hear from my medical colleagues from all over," said Akran, who is considering leaving Iraq to practice in Oman. "It is a difficult situation in which to work, and it is also a difficult situation to be a patient. This is not the place I would want to be treated."

As part of U.S.-led reconstruction efforts, more than $240 million has been allocated to construct and equip 142 primary health clinics throughout the country and rehabilitate 21 hospitals. The first primary health clinic funded with American money is set to open this month, and dozens more are expected to be opened late this year. The U.S. government has purchased millions of dollars in equipment such as incubators and beds for the Health Ministry to give to hospitals at their discretion. But distributing the equipment and setting up clinics have been frustratingly slow, according to a U.S. adviser on health-care matters in Baghdad.

Delivery, construction slowed

The security situation has slowed deliveries and construction, and Iraq's Health Ministry often moves at a snail's pace to pick up equipment, the adviser said. The official, who asked not to be identified because she was not authorized to speak to a reporter, said an American-run warehouse in the village of Abu Ghraib, west of Baghdad, is packed with equipment awaiting pickup by the Health Ministry.

Ali said his ministry has been slow to accept the equipment because it lacks storage space and many of the hospitals that are supposed to get the equipment are under repair. "What can I do? Should I throw it out in the street and let it be stolen?" he said.

Despite the problems, Ali and U.S. officials say they are optimistic that the health-care system will improve soon. But for Kadhem, one of the Sadr City doctors, hope for his profession ran out long ago. His younger brother recently scored high enough on his entrance exams to be accepted into medical college. Kadhem steered him away. "I told him: Become a pharmacist or dentist or anything but a doctor," Kadhem said. "I didn't want his intelligence to be a curse."