Iraq's ministries struggle to serve

Amid a wave of attacks in Baghdad, the health ministry, like others, grapples with shortages and corruption.

Moments after another car bomb rocks the Iraqi capital, a badly wounded policeman is wheeled into the emergency ward of Baghdad's Yarmouk Hospital.

The officer lives. But doctors who are working to save his life and the lives of many others are frustrated that they can provide only limited services.

Two years since the US started spending hundreds of millions on Iraqi healthcare, the country's health ministry is plagued by shortages and corruption that marked Saddam Hussein's rule, say health professionals and officials.

The results are broad reaching - and are affecting Iraqi lives for the worse, they say. With six leadership changes in two years, and steady insecurity and corruption, the ministry is unable to distribute medicines or repair facilities overwhelmed by decades of neglect.

"From day to day, the situation is getting worse, but it should be getting better," says Luay Farhan, head of the emergency ward at Yarmouk, which receives scores of cases from attacks every day. "We hear every [promise], but we do not see anything. There is stealing from this ministry, starting with the highest people."

Officials say that the problems of the health ministry are emblematic of those that dog many Iraqi ministries. The approval of new Iraqi cabinet two weeks ago sparked a wave of attacks that have left more than 400 dead. Thursday, militants exploded car bombs in Baghdad, killing at least 21 and wounding more than 70.

A further burden on the new health minister, Abdel Mutalib Mohammad, and the other newly appointed heads of the Iraqi bureaucracy, is endemic corruption, which some estimate to be as high as 70 percent.

"That's a very high figure," says Shakir al-Ainachy, chief of operations for the health ministry. "You can see that services are not improving well ... there is definitely a negative impact."

That impact is being felt across the board, according to a study of living conditions in Iraq in 2004, released Thursday by the Ministry of Planning and the United Nations Development Program (UNDP). The survey of 21,668 households found that many vital statistics have hardly changed since the Hussein era. Almost a quarter of children under five are chronically malnourished; pediatricians say that infant mortality remains among the highest, at 40 per 1,000 live births.

The UN data indicates that, in the aftermath of the 2003 war to spring 2004, some 24,000 Iraqis "with a 95 percent confidence interval from 18,000 to 29,000 deaths"died a war-related death.

"While many aspects of living conditions in Iraq in 2004 are dismal, most reflect the courage, endurance and determination of the Iraqi people to overcome the hurdles they are facing," said Staffan de Mistura, the UNDP representative in Iraq.

As casualties from two weeks of constant attacks roll into freshly painted but underfunded facilities, the impact of two years of uneven rebuilding is felt on the ward level. At Yarmouk, the 1,000-bed hospital that carries the biggest caseload in Baghdad, money has run out.

"The health ministry does not have money to spend until July ... a lot of things have stopped; we have been hurt by this," says Tala al-Awqati, a pediatrician in charge of the special-care baby unit. "People are not getting what they need from the health services. Money for disinfectant is not there anymore; sometimes we must buy it ourselves."

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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