A Baghdad ER

Aggression, corruption and courage -- a night in a hospital offers a glimpse at a city in tumult.


Jonathan Steele
July 30, 2004 6:22PM (UTC)

Unconscious, a woman lies in the emergency ward as doctors struggle to save her life after she was knocked down by a hit-and-run driver. Her teenage son and daughter, her husband, and four other male relatives crowd round the hospital trolley.

When a young house doctor writes out a chit for more plastic bottles of saline solution or more disposable needles, one of the family rushes off to the hospital pharmacy to get the supplies. More often, the huddle of jostling people is a nuisance and - with the danger of grief that can suddenly turn to rage - a threat.

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An evening in the Yarmuk hospital in western Baghdad is like a microcosm of Iraq's tense, no-holds-barred society; aggression, corruption, shortages and courageous efforts by a few people to improvise solutions.

It is also a window on the random violence which faces the capital's residents from bombs, street gangs and kidnappers.

In one bed lies a young man shot in the back in a quarrel between two families. Two police officers sit on another bed. One is bleeding from the mouth, the other has gashes on his forehead. They were attacked while arresting a street gang.

Three uniformed members of Iraq's National Guard run in with a captain bandaged above his left eye. Someone hit him on the head, apparently without provocation. The doctors redress the wound. "At least they're getting out now and doing something," says Dr Adham Sadoun Hamid, with no great sympathy for the guardsmen.

Doctors are still pumping mucus and blood out of the stomach of the woman who was run over. "It's an old problem," says Dr Aws Wael al-Shehabi, when asked why relatives have to fetch the basic supplies he needs. "The pharmacies have always wanted to keep control of drugs and other supplies. Probably they sell some of it out of the back door."

Guards carrying Kalashnikov semi-automatic rifles regularly enter the ward. Others control the hospital entrance. They provide protection against looters and thieves, but their job is also to defend doctors from angry relatives if patients fail to recover quickly. "Family members should be told to sit in the foyer, but we can't stop them crowding in," says Dr Aws Wael, helplessly.

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The woman's pulse is getting weaker. Oxygen is pumped into her lungs. Two senior doctors who have been summoned from their rounds upstairs recommend she be taken to the neurosurgical hospital because of bleeding in her head.

A relative goes out and offers a fee to an ambulance driver to take her there. Relatives help the doctors lift the women on to the ambulance stretcher, leaving the oxygen supply behind. The doctors seem relieved when she is gone, hopeful that if she dies at the other hospital or on the way, they should be safe from any vengeful relatives.

Yarmuk's chaos is not unique. Visits to two other Baghdad hospitals, each the country's best in its field, reveal similar problems and shortages. At the central teaching hospital for children, all 24 beds in the gastroenteritis section are full and drug shortages are severe. "We have to ask parents to buy things for their children themselves," says Dr Rasha Jawed.

Only two of the ward's four rooms have air conditioners. The others have two fans, but they do little to reduce the 46C (115F) heat. Some parents bring their own. The surgical department's respiratory cardiological unit closed last month because one of its two ventilators broke, and it has not been replaced.

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Dirt
The floors and windows are dirty. "The hospital needs 100 cleaners, but we only have 20. They get a miserable 60,000 dinars [#22] a month. I don't know why it's so little," says Dr Mohamed Idris.

The four hospitals in Baghdad's Medical City complex used to be the pride of the Arab world. Patients came from all over the Gulf and beyond. A decade of sanctions started the slide, but little ground has been made up in the 15 months since Saddam Hussein was toppled.

At the surgical hospital, Dr Mohamed Ghiath, 28, an anaesthetist, has just finished attending an operation on a bodyguard for the minister of justice, whose convoy was attacked by a suicide bomber. The minister escaped unhurt, but the explosion killed four bodyguards and wounded several others.

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"We had no triangular needles for sutures. We only had one-way cannulas, which means you can put new blood in but not suck anything out," he says.

There have been two big changes since Saddam's time. Doctors' pay has gone up from $3 (#1.65) to $200 a month, and the medical fees which Saddam introduced five years ago have been scrapped. Now inpatient care is free. But drug supplies are still erratic, and the occupation authorities have spent little money to remedy the problem. Fear of corruption deters them and Britain's aid to Iraq concentrates on primary healthcare. Iraq's new UK-trained heath minister, Dr Ala'adin Alwan, acknowledges there is mismanagement and corruption, with drugs "leaking" out of hospitals to be sold in the street.

He says he needs to double the annual #550m budget to rebuild the health sector and tackle drug shortages after years of sanctions. "There are urgent issues that we need to address. One is the shortage we have in medicines and also in emergency supplies."

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He cites a lack of drugs for cardiovascular diseases, diabetes and cancer, as well as antibiotics and those medicines used to control communicable diseases. "There is a wide range of medicines where our stock is either zero or very, very small."

Under Saddam, says Dr Ghiath, monitoring of corruption was stricter and punishments were fierce. But "with a salary of $3 doctors learned to steal". The legacy of dishonesty has been compounded by the lawlessness, violence, and chaos of post-Saddam Iraq, he believes. "We're no longer a unified country. Individuals just take whatever they can. This generation is lost. It'll take a long time to change people's mentality."

Women doctors give the most pessimistic view. On top of their work problems, they have new security fears. "Patients' relatives see there is no order, and no government, and they feel they can do anything," says one who refused to give her name. "They swear, they smash windows, they hit doctors. We think this country has no future. We're tired of waiting. We want to get out."


Jonathan Steele

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