Iraq’s once envied health system, lost to war and corruption

BAGHDAD – Dr. Zinah Jawad leans over her patient and peers into his glazed eyes. It doesn't look good, she says, shaking her head.

The man had arrived at Baghdad Teaching Hospital’s emergency department a few hours earlier with a high fever and dizziness. Now he lies sweaty and shaking, soaking his dirty clothes.

This emergency room is cleaner than most here. In fact, it’s widely considered the best in Baghdad. But flies still buzz overhead and on busy days there aren’t enough beds or oxygen tanks to go around. Across the room a crude sign made with binder paper and tape marks the department’s two-bed cardiac unit, which lacks a reliable defibrillator.

Jawad, a second-year medical resident, turns to the sick man’s wife, who is perched anxiously on a ripped chair at his bedside. "We suspect meningitis," she says.

If Jawad is correct, her patient will probably be dead long before she confirms her diagnosis. Even slimmer are her chances of getting the right antibiotics to treat him.

Her hospital can’t perform the lab test she needs. Its stock of drugs and basic supplies is so undependable that doctors routinely dispatch patients' relatives to fetch medicines, IV fluids and syringes from private merchants or on the precarious black market.

Jawad can't explain the shortages. Her department is always careful in placing its order with the national health ministry, which supplies all of Iraq's public hospitals. But the medicines often don't show up.

"No one can tell us why," Jawad says. "It is as if they just disappear somewhere."

Stories like this one – of missing drugs, of desperately ill-equipped doctors and of patients left to suffer the consequences – are everywhere in Iraq's public healthcare system. Some hospitals are filthy and infested with bugs. Others are practically falling down. More and more, blame is being placed squarely with Iraq's U.S.-backed government, which by many accounts is overrun with corruption and incompetence.

There is no doubt that years of economic sanctions followed by years of war have taken a heavy toll on all public services here. But with violence down and some sense of normalcy returning, improvements in health care should be coming far faster than they are, according to doctors, patients, aid organizations and some public officials.

They fault widespread problems that reach all levels of Iraq's government, and the examples they cite are troubling: Health ministry workers routinely siphon drugs from hospital orders to make extra cash on the black market. Bribery is rampant. Millions of dollars meant for clinics and equipment have instead gone missing. Millions more have been wasted on government contracts to buy expired medicines.

The health ministry’s inspector general openly admits the problems. Even so, the culprits are rarely punished.

In Iraq, corruption and ineptitude are hardly limited to health care; they are endemic in most public institutions here. But when it comes to the sick the repercussions are especially devastating, and they bring into sharp focus the failures that are threatening the country's American-financed effort to rebuild itself as a democracy at peace with itself and its neighbors.

"It costs lives every day," said a fourth-year resident at Baghdad Teaching Hospital who asked not to be named for fear of retaliation by his superiors. "The security situation is better now. The government has money. So you tell me why I can't get basic medicines at the best ER in Baghdad."