Iraq's ministries struggle to serve

Part of the problem has been constant leadership change - with first American and then Iraqi officials - coming in "with their own vision, and trying to change everything," says Dr. Awqati. "Before, despite the dictatorship, there was a system, but now there is chaos. You can't bring a whole country crumbling down, and then tell people to work."

The special baby-care unit has been fortunate. It was refurbished a year ago by the International Committee of the Red Cross, and has received six new incubators. Still, insecurity aggravates every problem. Awqati's 12-year-old son stays with her at the hospital during exam periods - no other option is safe. Infant mortality rates remain high, partly because "women can't reach the hospital at night," she says.

Doctors and their families have also been targeted, and often kidnapped for ransom. The son of one Yarmouk doctor is currently being held. Iraqi newspapers report that 130 doctors have been assassinated over the past two years. To protect themselves, doctors and clerics last week were given the right to carry weapons from the Ministry of Interior.

"America can control this situation, because America is the first country in the world - all Iraqis thought the US would solve every problem in Iraq, but it's just promises," says Dari al-Adwan, Yarmouk's deputy director. After Baghdad fell, an early stop of the first US administrator of Iraq, Gen. Jay Garner, was at Yarmouk.

"He promised us he would rehabilitate this hospital, and turn it into an Iraqi model for the Middle East," says Dr. al-Adwan, a staff doctor at the time. "But it was just words."

Nearly all health facilities have had makeovers - overdue paint jobs and clean-ups. Salaries have also risen from $20 per month before the war to $300 or even higher.

Officials point out that in 2002, Hussein budgeted $16 million for health, while last year the budget was $950 million. Still, that amount was less than half what the health minister wanted in his $2 billion request.

And lack of cash has meant that crucial infrastructure projects - such as replacing old water pipes and sewage systems at Yarmouk - go undone. New medical equipment is limited to "very simple things" like X-ray machines, says Dr. Adwan.

But the real frustration, health professionals say, is that past problems created by wars and a decade of sanctions are not being resolved.

"Salaries take half the ministry budget, and the rest is not enough to run facilities, so every day you see people go to hospitals and they don't get their medicines," says an Iraqi doctor working for a Western relief agency, who asked not to be named. He points to a case at Qaim, on the border with Syria, where medical deliveries are made every three months instead of every one, and distribution is "deficient and inefficient."

About a year ago, arrests were made after more than $10 million in medicine was stolen.

Addressing drug shortages, the new inspector-general of the health ministry was quoted as saying that "a lot of money is leaking out," and called for all warehouse workers to be fired.

"It's not better than Saddam's era," says the doctor. "Despite all this money in to the system, people see no change [in services]. A lot of people are dying, for lack of simple drugs."

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