IRAQ: Looking After Pockets, Not Patients

Dahr Jamail

by Ahmed Ali and Dahr Jamail
December 15th, 2008 | Inter Press Service

BAQUBA — A nurse at Baquba General Hospital asked Ahmed Ali, who co-authored this report, for a bribe to look after his sick baby. It was hardly an exceptional demand. Patients around Iraq have begun commonly to speak of the need to bribe medical staff to get some form of care.

“Nurses in Iraqi hospitals are no angels of mercy,” Falah Najim, who was a patient at the main hospital in Baquba told IPS. “They look after their pockets, not the patient.”

The practice of bribing medical staff has been around since at least the 1990s, during the difficult days of the sanctions imposed on Iraq after the first Gulf War. After the U.S. invasion of 2003, this seems to have become worse, like so much else in Iraq.

“The profession of medicine has changed from a profession of mercy to just money making,” Abdullah Najeeb, a trader in Baquba city, about 40km north-east of Baghdad, told IPS.

Staff shortage has clearly made the problem worse. More than half of about 36,000 medical workers who were in the country at the time the U.S. invasion, including doctors, nurses and other staff, have fled the country. “It is very hard to see a doctor in a hospital or in a clinic,” hospital employee Sabay Ismail told IPS.

Stories of suffering in hospitals have become commonplace.

“I spent a night in the public hospital without air-conditioning,” the mother of a baby, who did not wish to give her name, told IPS. “My baby kept sweating all night in the heat. The resident doctor came to see the child only once. I took my baby away; we did not complete the treatment. Then I could not find good medical treatment even in the private hospitals. The baby died because of their negligence.”

“There are two public hospitals in Baquba; one for children and the other is general,” an official in the Diyala directorate-general of health told IPS, requesting anonymity. In both, he said, “we continue to suffer from a shortage of doctors.”

“Twenty pregnant women might have only one doctor to help them deliver the child within a space of one or two hours,” the husband of a pregnant woman due to deliver told IPS. “Hundreds of people who go to hospital may find an employee or nurse, but no doctor.”

The few doctors who remain are mostly resident doctors or young graduates. Most specialists and senior doctors have long since fled.

The ones who remain make do with ill-equipped hospitals. “The government specifies big funds and projects for renovation and equipment for the hospitals,” an official in the provincial health office told IPS. “But deals are made between the contractors and the politicians.”

Former deputy minister for health Dr Amer Al-Khuzaie had told IPS in 2005 that his ministry was allocated a billion dollars of the 18.6 billion dollars set aside by the U.S. government for rebuilding Iraq.

But the Ministry of Health does not have control over the funds, Al-Khuzaie said. Instead USAID, the U.S. government body responsible for allocating reconstruction funds, handed out contracts to foreign corporations. The corporations spent the funds as they saw fit.

Now, the problem is more of corruption. In late 2007, the Ministry of Health was taken over by Shia politicians aligned with cleric Mutada Al-Sadr. There is almost nothing of the budget to show in Iraq’s hospitals. “They only paint the walls,” says Baquba resident Bahira Aboud.

Private hospitals have their own handicaps. “Two months ago my six-year-old daughter went for tonsils surgery,” said resident Abul-Amir Mahood. “After they gave her anaesthetic, the electricity shut down. They had no generator. I waited for my daughter to regain consciousness, then just took her back home.”

The health ministry has reported a recent outbreak of cholera. This has scared residents in Baquba because the local hospitals are not equipped to deal with it.

In Baquba, as in many other cities, most of the established clinics are closed. Some doctors see patients in their houses, that have been turned into impromptu, ill-equipped, clinics.

A large number of such ‘clinics’ have come up, where doctors charge patients ten to 20 dollars for a consultation. Where the average monthly salary — for those lucky enough to have a job — is around 180 dollars, this is a heavy fee.

And not for the best treatment. “There are doctors who see more than 100 patients a day,” said resident Fatima Edan. “Their diagnosis is badly affected by the speed with which they go through patients. The quicker the better, they are greedy for more money.”

(*Ahmed, our correspondent in Iraq’s Diyala province, works in close collaboration with Dahr Jamail, our U.S.-based specialist writer on Iraq who has reported extensively from Iraq and the Middle East).