Association of Humanitarian Lawyers

New report by Dahr Jamail: “Iraqi hospitals ailing under occupation”
Bert De Belder

From April, 2004 through January, 2005, Dahr Jamail surveyed 13 hospitals in Iraq in order to research how the healthcare system was faring under the US-led occupation. While the horrendous security situation in Iraq caused him to confine the survey to hospitals primarily in Baghdad, hospitals west, north, and south of the capital are included in the report.

The report documents the desperate supply shortages facing hospitals, the disastrous effect that the lack of basic services like water and electricity have on hospitals and the disruption of medical services at Iraqi hospitals by US military forces. In almost all hospitals surveyed the situation is critical concerning the availability and the fuctioning of X-ray, ventilation and ambulances, while pharmaceuticals and lab supplies are delivered but sporadically. Three out of the eleven hospitals surveyed are frequently raided by the US military, five others sporadically.

Although the Iraq Ministry of Health claims its independence and has received promises of over $1 billion of US funding, hospitals in Iraq continue to face ongoing medicine, equipment, and staffing shortages under the US-led occupation.

Ample testimony from medical practitioners in the interim in fact confirms this crisis. A general practitioner at the prosthetics workshop at Al-Kena Hospital in Baghdad, Dr. Thamiz Aziz Abul Rahman, said, “Eleven months ago we submitted an emergency order for prosthetic materials to the Ministry of Health, and still we have nothing,” said Dr. Rahman. After a pause he added, “This is worse than even during the sanctions.”

Dr. Qasim al-Nuwesri, the chief manager at Chuwader General Hospital, one of two hospitals in the sprawling slum area of Sadr City, Baghdad, an area of nearly 2 million people, added that there, too, was a shortage of most supplies and, most critically, of ambulances. But for his hospital, the lack of potable water was the major problem. The hospital needs at least 2000 liters of water per day to function with basic sterilization practices. According to Dr. al-Nuwesri, they received 15% of this amount. “The rest of the water is contaminated and causing problems, as are the electricity cuts,” added al-Nuwesri, “Without electricity our instruments in the operating room cannot work and we have no pumps to bring us water.”

In November 2004, shortly after razing Nazzal Emergency Hospital to the ground, US forces entered Fallujah General Hospital, the city’s only healthcare facility for trauma victims, detaining employees and patients alike. According to medics on the scene, water and electricity were “cut off,” ambulances confiscated, and surgeons, without exception, kept out of the besieged city.

“I was with a woman in labor, the umbilical cord had not yet been cut,” said Asma Khamis al-Muhannadi, a doctor who was present during the US and Iraqi National Guard raid on Fallujah General Hospital. “At that time, a US soldier shouted at one of the (Iraqi) national guards to arrest me and tie my hands while I was helping the mother to deliver.”

At Fallujah General Hospital, Dr. Mohammed - he asked that only his first name be used, due to his fear of military reprisals – said there has been virtually no assistance from foreign contractors, and of the US military he commented, “They send only bombs, not medicine.”

International aid has been in short supply due primarily to the horrendous security situation in Iraq After the UN headquarters was bombed in Baghdad in August 2003, killing 20 people, aid agencies and non-governmental organizations either reduced their staffing or pulled out entirely.

The report also contains an interview with Dr. Amer Al Khuzaie, the Deputy Minister of Health of Iraq. He blamed the medicine and equipment shortages on the US-led coalition’s failure to provide funds requested by the Ministry of Health. We have requested over $500 million for equipment and only have $300 million of this amount promised,” he said, “Yet we still only have promises.”

Dahr Jamail also tackles the problem of the brain drain among Iraqi health professionals, as well as the specific health situation of the Fallujah refugees and of the prisoners.

The report supports the conclusion of many observers that the war and occupation -- and sanctions prior to that -- are primarily to blame for the appalling state of healthcare in Iraq today. As an occupying power. In any case, the US was the occupying power in Iraq for the period covered by this report. As such, the US was responsible for conforming with all international law, especially humanitarian law and human rights law, regarding the situation of healthcare in Iraq. The Fourth Geneva Convention contains specific provisions pertaining to the delivery of healthcare services.

The report clearly illustrates the abject failure of the US to carry out even minimal humanitarian duties as occupying power. More importantly, it paints a picture of a healthcare system that has deteriorated since the start of the war, and of a failure to fundamentally reverse this decline. From a public health point of view, an end to occupation, with a scheduled withdrawal of all foreign troops, appears to be a major requirement.

(The report has been published by the BRussells Tribunal, Medical Aid for the Third World, El Taller International, the Asian Women’s Human Rights Council, the Association of Humanitarian Lawyers and SOS Iraq. It was launched at a press conference in Brussels on June 21, 2005.)