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Iraq: A Health Care System Overwhelmed
September 30, 2006
Dr. Bassam is an Iraqi physician specializing in orthopedic surgery, who took part in the launch of this project. He now lives with his family in Baghdad, and is a member of the partner team working with MSF. He explains the current situation of the Iraqi health care system, and talks about his collaboration with MSF:
How would you describe the health care system in Iraq today?
The level of medicine has deteriorated considerably in Iraq. It had already dropped after the Gulf War, but it has really gotten worse in the past few years. Before the war, a lot of patients came to Iraq for surgery, from Syria, Jordan, and elsewhere. It wasn't expensive, and there were a lot of specialists. And medical care here had a good reputation. The situation deteriorated after the Gulf War, but got even worse after 2003. Now, security issues have top priority for the few existing financial resources, and medical needs are forced to take a back seat. This morning, dozens of people were killed in Fallujah. Yesterday it was Baghdad. And that's not counting the wounded, who add to the long list of emergency cases packing the hospitals. Every day brings a new batch of dead and wounded1. In this context, patients simply cannot receive proper treatment from an increasingly overwhelmed health care system. Some are forced to sell their car, or even their house, to get certain kinds of care in the few hospitals able to provide it.
Which areas of medicine are primarily affected by the situation?
Specialized procedures are very difficult to provide, particularly when they require sophisticated techniques. For example, when it comes to reconstructive surgery, congenital malformations, microsurgery, or neurosurgery, it's almost impossible right now to get operated on in Iraq. All the more so, since many doctors have gone farther north, or left the country, looking for someplace safer. As a result, there are fewer and fewer specialists, and—on top of everything—they are being particularly targeted. Many of them were kidnapped after the war began in 2003. They are caught between a rock and a hard place. Either they work for the Iraqi health care system, and earn a salary that makes them targets of abduction and ransom demands, or they get jobs with foreign nongovernmental organizations, and risk being perceived as working for the Americans.
How do you keep working, in this context?
The task is especially hard when, in addition to the shortage of doctors and specialists, you have overcrowded hospitals, little adequate equipment, corruption, and the constant insecurity and curfew requirements restricting our practice. This is why, in partnership with MSF, we are trying to seek out patients waiting for reconstructive surgery. We offer them the chance to come to Jordan for treatment; we take care of their medical paperwork, their administrative paperwork, and the logistics of their transfer to Amman. In addition, we are making contact with various Iraqi hospitals, which will allow MSF to supply them regularly, depending on their needs. Security constraints, however, prevent us from taking action and publicizing the project in the way we would like. Indeed, MSF is considered to be a foreign organization, which exposes its collaborators to the risk of abduction, or worse. So we have to keep a low profile, as much for our safety as for that of the patients. This is why a huge amount of discretion is a must, in order for a project like this to succeed. On the other hand, we have an excellent network of doctors in Iraq, whom we know, and with whom we are in contact. I graduated in the 1980s, and others even before that. So we have many relationships in the country. But despite our respective experience, we are running into many difficulties.
What are the difficulties facing patients trying to go to Jordan?
Before the war, it was very easy for people in northern Iraq to get to the south. For example, if someone living in Ninawa wanted to get to Baghdad, 400 miles away, it would take him four hours of traveling. Today, the trip takes two or three times longer. Given the numerous checkpoints, the risk of being targeted, and the bombings, people are afraid to come to Baghdad; they prefer to treat themselves, and stay home. The second important point has to do with getting passports. They are very hard to get right now. For example, one of my colleagues, under direct threat in Iraq, had to flee the country and now works for MSF in Jordan. But his wife waited more than a month to get a passport. The third point has to do with the nature of the project, which is focused on three narrow areas: maxillofacial, orthopedic, and plastic surgery. There are so many patients needing other types of surgery, which we cannot provide in Amman.