by Barbara Nimri Aziz
18 February 1997
The humanitarian toll caused by the UN embargo against Iraq is most notable from the deterioration in its hospitals. Iraqi children and adults lie in broken beds, without sheets or nursing care, and patients in critical condition are forced to endure operations without anesthesia or pain killer. The breakdown is particularly tragic because only 7 years ago, these Iraqis enjoyed excellent medical care and at no cost. Now this too is to change.
Iraq's high quality medical system was little known in the West. But since the early 70s, Baghdad maintained a policy of investing a substantial part of its oil revenues in two main social programs: education and health.
Medical education received heavy government support, and was conducted in English, as it is in most Arab states. This facilitated graduate studies abroad at government expense. It also allowed many of the country's capable medical graduates to find work in England and the USA.
Most doctors opted to stay in Iraq and they found good working conditions and ample rewards. "We had the best up to date equipment, and all the professional journals we wanted," says Aziz Ali, trained at Great Ormond Street Children's Hospital in the UK. He thought, when he returned to Kerbala, that a productive life as a surgeon awaited him. His salary of 500 dinars a month, then equal to $1,500. allowed him to enjoy a comfortable middle class life like most civil servants in the country.
Today, Dr. Ali's salary has been boosted to 3,500 dinars by the government, but this is equivalent to merely $2.50. Like other doctors across Iraq, he depends on an additional income from a small clinic he runs in the city center every afternoon. (He is required by law to continue to serve in the government hospital.)
The worst part of the embargo for him is the shortage of medical supplies. Medicines are almost unobtainable. Kerbala's Al-Husseini Hospital where Dr. Ali works can maintain only 100 out of 450 beds although the need is even greater than before the war. "We do not have sheets, or surgical equipment, or medicines to treat our people," says the young doctor. He requests a book from abroad. "Not even medical journals we had paid subscriptions to when the embargo was set, have be delivered," he says with annoyance. (Britain and the US do not permit mail over 12 oz to be shipped to Iraq and they embargo all business mail. ) "We see no professional literature and we cannot keep a breast of developments in our fields."
Most Iraqi doctors now run private clinics to supplement their income; others have been more enterprising. Particularly in Baghdad where leading medical experts and professors reside, new private hospitals are appearing. Al-Ferdos Hospital, a small center with 45 beds, was built in 1993 and is one of 40 that opened in these years in the capital. A group of specialists who include a professor of medicine, got it underway with some capital they jointly invested. "For a few years," says one staff member, "we managed well; all the beds were occupied, some of them by foreign patients. But in the past 2 years, many medicines became unavailable, and even private paying patients couldn't buy them. So they not all are beds are occupied nowadays."
UN Resolution 986 promised some relief, particularly for Iraq's health system. Called the "oil-for-food" deal, it allows Iraq to purchase limited medicines as well as food. But supplies are expected to have only limited value. "We hope we will soon be able to treat life-threatening diseases and alleviate some suffering," doctors in Iraq say. "But we cannot repair and rebuild our hospitals to their former level. Our hospitals had the best equipment, with central oxygen systems, modern beds, and well equipped diagnostic and monitoring machines." What we will get under Resolution 986 will buy some medicines and ambulances, and repair elevators; not much more."
Doctors in Iraq are even more dismayed that the government is now talking about privatizing its health system. "It is not yet implemented, but it is decided," said ENT specialist Dr. Haidar in Baghdad last month.
A ministry official asked about this rumor, replied that "the government is talking out loud about it, but nothing was yet on paper."
"We could move to a system more like you find in other parts of the world," he went on to suggest. "The previous system was very costly ($500 million a year before 1990); Iraq simply cannot afford to put this much into health care now." Health professionals here know that to repair the hospitals and bring health care back to a reasonable level, many billions of dollars would be needed. This is not possible unless UN sanctions are completely lifted. And no one sees that on the horizon.
How will Iraqis pay for health care? "From their pockets," says a high ranked health official; he points out that there are some rich people in Iraq; "or, as in other countries, our people will have to subscribe to an insurance policy."
Presently Iraq has no private health insurance companies but when enterprising medical specialists move in to purchase the hospitals, doubtless, insurance salesmen will be not far behind.