His colleagues warned it was too soon to return. Iraq was still dangerous, they said, especially for a doctor whose driver was killed in a failed assassination attempt.
But Ghazwan al-Badawi could stay away no longer. His family is here and this is where his work was needed most. "Now, day by day, it is getting better," he says. "We've started to have optimism again. It is the beginning of a new hope."
Other doctors and health professionals who fled Iraq are slowly returning as violence declines, and quantities of medicine and equipment are available as never before. While Iraq's healthcare system is still plagued with problems that come from war, dictatorship, and years of sanctions, signs of recovery abound – and fill the halls of the hospital where Dr. Badawi now works.
The Central Teaching Hospital for Children is the largest pediatric hospital in Baghdad and has long been a barometer for Iraq's overall well-being – from the dark days of Saddam Hussein to sectarian violence during the war to the latest security gains.
But current progress is tentative, says Badawi, who remains torn by his decision. Optimism after Mr. Hussein's fall was buoyed by high hopes "of the US coming with all its facilities and equipment," says Badawi. "But we were wrong."
Professionals instead became targets for killing and kidnapping when sectarian violence surged in early 2006. After the attempt on his life, Badawi left Iraq for Jordan and then the US.
Now, his colleagues ask: 'Why are you back? It's not the right time – maybe four or five years,'" says Badawi. "But I can't live in peace while my family is suffering. We must all live in peace, or we all suffer."
Still, Badawi opts to see the hope in Iraq. Food security has improved in the past two years, for example, and Iraq has been able to import all the medicine and equipment the Health Ministry needs.
"The situation is not a humanitarian crisis [anymore]," says Staffan de Mistura, the United Nations special representative for Iraq who worked here in the late 1990s during the sanctions and oil-for-food period. But poverty persists. Four million Iraqis live in poverty in a nation with a large, $78 billion budget. And 4.8 million Iraqis no longer live in their homes or have fled abroad because of the war.
"The worst cases are the internally displaced Iraqis," says Mr. de Mistura. "They are on the edge, they need assistance." But on the plus side is that Iraqi income is growing annually by 7 percent.
As a bellwether for Iraq's health crisis a decade ago, few places were as grim as what was then called the Saddam Central Teaching Hospital for Children.
Back then, this correspondent witnessed two newborn babies, from two different families and younger than 15 days old, die within 30 minutes of each other. They were born too malnourished to survive, one more UN statistic in a 2002 report that noted an "increase in the number of low birth-weight babies from 4.5 percent in 1990 to 23.8 percent in 1998."
"The impact of sanctions has been horrendous," UN humanitarian chief Denis Halliday said in 1998. He resigned in protest, one of two in that position who took that step. "They have turned Iraq into a ruin."
Saddam Hussein's name has since been dropped from the hospital. Officials say it now works at 70 to 80 percent capacity, up from 30 to 40 percent a decade ago. It is still recovering from sectarian violence in 2006 and 2007 that caused it to lose nine of 24 doctors. Two were killed; others left Iraq.
"We are trying to reach a new world," says hospital director Kassim Rahi Essa. "I don't think the situation will turn back to that violence. People are fed up with such conditions."
The kind of tentative optimism expressed by Badawi and others pervades the hospital – and can be found in the maternity ward where a black-clad grandmother, Zam-Zam, sat beside the incubator in which slept her sleeping grandson Mustafa, just 6 days old.
His recovery is "up to my God," she says. But staff here say that they, too, are doing what they can to improve every child's chances. For all Iraqis, the health problems that burdened them 10 years ago are less prevalent today.
Still, the 2009 UN Humanitarian Appeal, released Nov. 19, asks for $547.3 million for Iraq and Iraqi refugees in the region. Hundreds of thousands of Iraqi families are "still struggling with acute poverty, displacement, and the continuing effects of conflict," the appeal notes, while the impact of past sanctions, conflict, and neglect are "still extensive and severe."
Corruption and an inability to distribute aid remain key government problems. A 2002 report from the UN Children's Fund (UNICEF), based on government figures, found that mortality of children under 5 years old had increased 2-½ times in the previous decade. More than one-fifth of children, the report noted, "still experience stunted growth."
While those Hussein-era numbers have been questioned, today the government spends $5.9 billion on an outdated ration system created in the 1980s that was once lauded by UN officials as a lifesaver and model of efficiency. But Iraq's needs have changed. That system is an "extremely inefficient way to meet basic needs," says David Shearer, the UN humanitarian coordinator for Iraq.
"We are seeing pockets of fairly intense humanitarian need, and with Iraq, it is such a mosaic of different levels of under-development, both from the early days and the last few years," he says. "Our challenge is to work on those really acute areas."
The system needs reform, experts say, because rations are handed out not according to need, but as an entitlement to every Iraqi. But getting poor Iraqis food is only one area needing improvement.
Figures for 2006, for example, show that 79 percent of Iraqis are connected to water lines, but only 40 percent have regular flow into their homes. Often water lines are tapped into by others along the way and become contaminated – which leads to rising infant mortality rates.
Until now, poor security has limited the types of infrastructure improvements that could better the country's overall health. Until earlier this year, some 600 municipal and public works employees had been killed across Iraq in efforts to fix water and sanitation problems.
"With this focus on security, sometimes I think we are missing it a bit," says Shearer, "missing the deprivation."