21 July 2006

The doctors who are too afraid to care for patients

Many of Iraq's wounded can no longer be saved as the healthcare system collapses amid violent intimidation

By James Hider and Ali al-Hamdani
The Times, UK, 20 July 2006

THE number of violent deaths in Iraq topped 100 a day last month as the country descended into open sectarian warfare.

Almost as shocking is that the number killed in May and June was greater than the number of injured: Iraq’s health care system is close to collapse and can no longer care for the wounded.

The statistics were compiled by the United Nations mission that monitors Iraq from outside the country because its headquarters were blown up by terrorists almost three years ago.

They show that the death toll reached 2,669 in May and 3,149 in June, and that 14,338 civilians have been killed this year.

"The emerging phenomenon of Iraqis killing Iraqis on a daily basis is nothing less than a catastrophe," said Ashraf Qazi, the UN envoy to Baghdad.

The figures also show that in May and June 5,762 civilians were wounded, fractionally less than the number killed.

The reason, according to Iraqi medical officials, is that doctors are too terrified to do their jobs following a deliberate campaign of murder, kidnap and intimidation.

Baghdad’s medical facilities are simply overwhelmed by the daily carnage. They were stripped down by a decade of UN sanctions, looted after the US invasion and then slowly rebuilt to cope with a peacetime city than never materialised. There are only 30 intensive care beds in the capital.

The Ministry of Health has been taken over by supporters of Moqtada al-Sadr, the rebel Shia cleric, who have little medical experience.

Adel Abdel-Mohsin, the Deputy Health Minister, told The Times that 190 medical staff had been murdered and 400 doctors kidnapped and that 1,000 doctors had fled the country.

"They are soft targets, easy to get and that’s why the hospitals are out of control in some areas. There have been raids or insults by gunmen or security forces storming the place and beating the doctors because there is no proper protection," Mr Abdel-Mohsin said.

Doctors have been kidnapped for money by criminals, murdered by insurgents because they are viewed as government workers, or shot by militias because they work in hospitals in areas dominated by a different sectarian community, be it Sunni or Shia.

In this country full of guns, grieving relatives or angry comrades-in-arms have been known to beat or even murder doctors when a patient dies on the operating table.

"Doctors are all afraid of showing up in the wards because of the recent threats to us," a doctor from Baghdad’s main hospital complex at Medical City told The Times yesterday.

"I have started telling families after surgery that their relative will die soon because there is no proper follow-up,” he said. “I can’t do anything about it. At least I am honest."

Doctors in Baghdad’s hospitals no longer even wear white coats or carry stethoscopes for fear that gunmen might storm their hospital. Instead they try to mingle with relatives whenever armed men enter the building. "We are afraid of going near a patient because if he dies we’ll be kidnapped or killed," said the doctor, who wished to remain anonymous.

Last week the Medical City administration received a threat that any staff going to work would be kidnapped — a clear attempt by militants to bring the service to its knees.

Two days later, a woman doctor who ignored the alert was kidnapped with her father, who was driving her to work at Medical City.

Since then, few have shown up for duty. Yesterday in the hospital canteen, 15 medical staff were present where once 500 would have gathered to eat.

Alaa Muti, a Sunni doctor working at a hospital in the Shia area of Qaddumiyah, recently discovered that his name was on a list of 35 doctors marked for execution by a local Shia militia. In the previous months two Sunni specialists have been killed and two resident doctors have fled after receiving similar threats.

"When I saw my name I didn’t hesitate for second, I just rushed to my room at the doctors’ accommodation and packed all my stuff, and left the place because I know they are serious. Now I’m leaving for Kurdistan as my friends told me I can find a job there and it’s safer."

Ziyad, an anaesthetist who declined to give his surname, said that nothing was being done to protect the country’s vital health workers. "It’s unbelievable. Every day we lose another doctor and neither the Health Ministry nor the Government does anything. They fail to provide protection [for doctors] while they managed to provide their illiterate MPs with 30 guards each."

Doctors have frequently staged strikes in the past to protest about beatings by government security forces, who often insist that their wounded are treated before anyone else. Now, with death threats proliferating, the doctors are simply getting out.

As medical staff flee they are often replaced by barely qualified workers affiliated to powerful militias. The doctor at Medical City said that he was too scared to reprimand subordinates for failing to do their jobs properly, for fear of violent reprisals.

"The Ministry of Health collapsed ages ago, but they are afraid to admit it," he said.

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Citation: James Hider and Ali al-Hamdani. "The doctors who are too afraid to care for patients," The Times, UK, 20 July 2006.
Original URL: http://www.timesonline.co.uk/article/0,,7374-2277619,00.html
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