BASRA, Iraq — Laura Bush's gift to the people of Iraq is rising in a dirt lot across from a sheep market here, hidden behind high concrete walls and towers with armed guards.
Behind the walls, hundreds of Iraqi workers in blue jumpsuits scurry around a construction site filled with rebar, dirt and trailers. The project, funded by the U.S. government and donations raised with the first lady's help, will someday be a hospital equipped to treat pediatric cancer patients.
But today, international health experts and Iraqi doctors say, it's an emblem of the problems with U.S. efforts to rebuild Iraq's shattered healthcare system.
Nobody denies that Iraq needs new hospitals, but the experts questioned the priorities of Washington's $1-billion rebuilding plan, which has focused on construction instead of basic needs such as better training for doctors and public healthcare campaigns.
"We have more important priorities to solve our urgent health problems," said Abdulamir Khafaji, the chief pediatrician at Basra's largest hospital, citing the need for additional equipment in his emergency room.
Although reliable statistics are scarce, it does not appear that U.S. spending has markedly improved Iraq's bleak healthcare landscape.
Easily treatable conditions such as diarrhea and respiratory illness account for 70% of deaths among children, according to a 2004 Iraqi Health Ministry study. A third of rural Iraqis skip treatment because it's too costly. The Health Ministry estimates that as many as 25% of Iraq's 18,000 physicians have fled the country since the U.S.-led invasion in March 2003.
A U.N. study this year found that a third of the children in southern and central Iraq are malnourished, the same as in 2003. And the American contractor in charge of revamping the healthcare system completed less than half its goals, according to a scathing U.S. audit.
Meanwhile, the number of clinics to be built has been reduced because of security costs and other problems. It is uncertain whether Iraqis will be able to staff and maintain the health centers that are being constructed. The U.S. spent funds on equipment that is now sitting in warehouses and on medications that later disappeared, presumably stolen, according to interviews and federal reports.
Iraqis and health experts said more attention should have been paid to refurbishing the country's dilapidated network of 1,700 clinics and nearly 200 hospitals. A 2004 survey of 214 clinics found that only 10% had a regular water supply, only half had electric generators, and less than a third had "functional and relatively clean" toilets.
"I saw enormous incompetence which was more costly than even Iraqi corruption," said Richard Garfield, a Columbia University health expert who worked with U.S. and international officials in Iraq last year. The U.S. "was pouring money down the drain."
Officials with the U.S. Agency for International Development said U.S. efforts were beginning to show results. For instance, a United Nations campaign, to which the U.S. has contributed, has resulted in polio vaccinations for 98% of Iraqi children.
The U.S. also dramatically increased pay for doctors and nurses, raised the Health Ministry budget from $16 million under Saddam Hussein to $210 million in 2003 and recently implemented a training program for nurses and doctors.
The U.S. focus on buildings such as the Basra Children's Hospital, which is projected to cost $50 million, will also pay off, the officials said.
"We're building for the future," said Heather Layman, a USAID spokeswoman. "Our belief is that planning for the future and setting ambitious goals ultimately helps the Iraqis achieve their goals."
Other U.S. officials acknowledge early missteps. They say they regret that the U.S. did not do a better job of rapidly improving medical care in Iraq, especially for women and children, because it would have helped build goodwill.
"If the amount of child mortality under Saddam and since the conflict [had] happened in the States, things would be in an uproar," said one U.S. official, who declined to be identified because he was not a designated spokesman. "You have to do more. We could be doing more than we are."
After the invasion, U.S. officials hoped to rapidly improve Iraq's healthcare system, which had collapsed under endemic corruption, a decade of U.N.-imposed sanctions and looting.
To improve things, the U.S. issued a $43-million contract in April 2003 to Abt Associates Inc., a Massachusetts-based consulting firm, to modernize the Iraqi Health Ministry and provide needed supplies.