BAGHDAD — Thousands of Iraqis are believed to have died from shortages of medicine, vital equipment and qualified doctors, despite an infusion of nearly half a billion dollars from U.S. coffers into this country's healthcare system, Iraqi officials and American observers say.
Raging sectarian violence as well as theft, corruption and mismanagement have drained health resources and made deliveries of supplies difficult. Exacerbating the crisis, hundreds of doctors have been killed, and thousands have fled Iraq. The child mortality rate, a key indicator of a nation's health, has worsened since the U.S.-led invasion in 2003, according to Iraqi government figures.
In the most sinister reported development, provincial Sunni Muslim doctors charge that Shiite Muslims who control the Health Ministry deliberately withhold medicines and other vital supplies. Privately, some U.S. officials say that hard-line Shiites use the ministry for political and sectarian ends.
This fall, U.S. troops raided the ministry, arresting employees suspected of kidnapping and killing patients at the Medical City Hospital in Baghdad. Afterward, ministry officials severed ties with the Americans and refused to open an $800,000 clinic built by the U.S. Army Corps of Engineers in a deprived Sunni neighborhood in the capital.
The clinic has since been opened, but relations are still strained between U.S. military officials and the ministry, which is staffed by Shiites loyal to anti-American cleric Muqtada Sadr.
Across Iraq, a country whose healthcare was once the envy of the region, many hospitals have neither computers nor meaningful patient files. Functioning X-ray machines and MRI scanners are few and far between.
At one of the busiest hospitals in Baghdad, five people die on average every day because the staff does not have the equipment to treat heart attacks and other commonplace illnesses and injuries, said Husam Abud, a doctor at Yarmouk Hospital. That translates to more than 1,800 preventable deaths a year at that hospital alone.
"Frankly speaking, if we get cases of cancer, we can't treat them," he said. "They'll probably end their days here. We don't have the adequate medication or the adequate equipment, and specialized doctors are not available."
A pharmacist in the town of Taji, north of Baghdad, described a looming "humanitarian catastrophe" as medicine, blood bags, oxygen, anesthetics, vaccines and IV fluid run out. Taji has a hospital, but the surgical room contains little medicine and fewer instruments. In September, doctors there were forced to turn away a pregnant woman who was experiencing labor complications. She died on her way to another hospital.
Already overburdened by large numbers of civilian victims of the civil war, hospitals also are stretched by Iraqi military and police casualties. Because the security forces have no emergency facilities, soldiers take wounded comrades to hospitals for care, often forcing doctors at gunpoint to treat them first, U.S. military officials say.
Healthcare in Iraq once was first rate. Medicine and hospital care were free, doctors well-educated and respected. But neglect by former President Saddam Hussein and years of United Nations sanctions laid waste to the system.
Since 2003, U.S. agencies have spent at least $493 million of Iraqi reconstruction funds on healthcare, but no new hospitals and only a few clinics have been built. With reconstruction funds running out, officials can point to few success stories beyond a child vaccination campaign. Hospitals looted in the first days after the invasion remain decrepit, without vital equipment and supplies. The hospital rehabilitation program has been plagued by cost overruns and complaints of shoddy but expensive work.
A flagship $50-million children's hospital in the southern city of Basra, a pet project of First Lady Laura Bush, has run far behind schedule and over budget. If it is ever finished, the hospital probably will end up costing at least $40 million more than planned, not including medical equipment, according to a congressional report by the special inspector general for Iraq reconstruction.
The largest U.S.-funded construction program in the healthcare sector has fallen far short. A project to build 150 primary healthcare centers in Iraq was initially scaled back to 142 because of cost overruns. But only six clinics are open to the public, five of them in Shiite neighborhoods of Baghdad, according to information provided by the U.S. Agency for International Development.
In Sunni-dominated Al Anbar province, the poorest, most dangerous part of the country, it has become increasingly difficult to get medical care. Several clinics have shut down in Ramadi, Hit, Haditha and Fallouja as doctors have fled and supplies have dwindled, local officials say.
The nation's health has deteriorated to a level not seen since the 1950s, said Joseph Chamie, former director of the U.N. Population Division and an Iraq specialist.