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:: Article nr. 48055 sent on 19-oct-2008 07:07 ECT
In Iraq, The Doctors Are Out
Larry Kaplow, NEWSWEEK
A young patient waits at the entrance of a Baghdad medical complex
A country in dire need of professional help—can its wounds be healed?
October 18, 2008
Doctor Wasim Bickers with his wife over where to raise their three kids. A pharmacist by profession, she longs for her friends and relatives back home in Baghdad. He suggests she settle in where they live now, amid the gleaming skyscrapers and seaside confines of Abu Dhabi. "It's like building on sand," she answers, refusing to think of their new home as anything but temporary. Nevertheless, the 45-year-old internist isn't ready to risk returning to Iraq—or even to let his full name be used. Four years ago on a Baghdad street a gang of kidnappers dragged him from his car. "You're the doctor," they said. "We've been following you for months." They held him hostage for two weeks of drunken beatings and cigarette burns before receiving a $15,000 ransom, dumping him on a roadside and warning him to get out of Iraq. He found a good job at a hospital in Abu Dhabi. He likes the reliable air conditioning and the safe streets. And Baghdad scares him. "I have nightmares every night," he says.
Baghdad isn't quite as violent as it was when Wasim left. But bringing real stability to the city will require essentials that only educated professionals can deliver—things like dependable electricity, steady jobs, good schools and decent health care. The problem is that like Wasim, thousands of engineers, entrepreneurs, teachers, accountants and doctors have fled the country. Unlike most other refugees, they had the skills to land residence permits and good jobs elsewhere, and they have less incentive than most to return to a land where they could again be subject to the brutal dictates of gun-wielding illiterates. Even ordinary Iraqis have been slow to go home: out of roughly 1.5 million who fled the war and its aftermath, only 60,000 or so had returned from exile through September (the latest available figure), while about 150,000 of the roughly 1.8 million internally displaced had returned to their old neighborhoods.
The medical profession in particular has been hollowed out. Iraq's health-care system used to be the envy of the Arab world. Even in the 1990s, when sanctions and Saddam Hussein's worsening misrule crippled much of the country, people came from all over the region to study medicine or seek treatment. But after the U.S. invasion, doctors became targets for ransom kidnappings and assassination. Upwards of 120 physicians were killed. Some were gunned down in their own clinics. Things got worse than ever after 2005, when loyalists of the radical cleric Moqtada al-Sadr gained control of the Health Ministry. Hospitals turned into Shiite militia bases where Sunnis could be killed on sight.
The Sadrists are in retreat now, but the doctors are still missing. The current health minister, Salih Hasnawi, estimates that roughly half the country's doctors have fled, from a prewar total of as many as 30,000 or more. He says only about 800 health professionals have returned—and that number includes not only doctors but also dentists and pharmacists. Sunnis are especially hesitant about going back. Many leaders in their fields have abandoned their posts: Iraq's top neurosurgeon; the chief of Baghdad's central morgue and forensic center; the doctor who set up the country's postwar emergency coordination center to deal with bombing victims and other mass casualties. The wholesale disappearance of some specialties compounds the tragedy for a war-traumatized nation. There's a serious shortage of doctors and therapists familiar with advanced prosthetics. Worse yet, the country is down to 80 or so psychiatrists, from several hundred before the war.
A courtly man who drives his aides to exhaustion, regularly working past midnight, Hasnawi is a psychiatrist himself. He used to run the main hospital in Karbala, and former patients still call him for help when they find him there on weekend visits. When he got his current job late last year, the assignment was to clean up the 170,000-employee ministry. Corruption is still endemic and he has to keep his travel plans secret, for his own safety, but he gets high marks from doctors of all sects—Sunni and Shiite alike—and from American advisers. He's made the hospitals safer, and he's attracting foreign assistance.
Hasnawi is campaigning hard to bring doctors home. A budget overflowing with oil money has enabled him to double or triple their salaries. Some returnees receive back pay for time they spent away. Doctors who take assignments in rural areas can get free land. Using personal e-mails and professional connections, he urges physicians to come home. The ministry has sponsored conferences to spread the word and has flown doctors back so they can see for themselves how security has improved. A specialist can now draw a regionally competitive salary of $2,300 a month from the state—and boost that income with earnings from private practice, as nearly all doctors do in Iraq.
But money alone won't bring back many doctors. As much as they like higher salaries, what they want is freedom from fear. Just last week, doctors in the southern city of Karbala temporarily closed their clinics, seeking protection from families who threaten violence when their loved ones aren't cured. The Iraqi cabinet has tried to help medical workers feel safer, even ordering the police to exempt doctors from the law requiring a permit to carry firearms on Baghdad's streets. Cops have been getting tough with other violators.
Above all, many doctors just want normal lives. Hasnawi has pushed hospitals to build living quarters for doctors, and one Baghdad medical complex recently completed an ambitious "White Zone" of renovated apartments where returning physicians could live and work within a secure perimeter. But the minister is now offering the apartments to visiting doctors, having discovered that most returnees prefer to brave life in their old neighborhoods.
The streets have been safer this year than they were during the mayhem of 2006, when many doctors fled. Dr. Bashir Farhan didn't even tell his parents late last year when he decided to return from a year's stint at a desert oilfield in Oman. He was afraid they would tell him not to come. Today he's a resident at a government hospital, and he has opened a little clinic of his own with some rudimentary medical equipment and a generator to keep the lights on. In the old days he refused to treat strangers, but now he depends on walk-in business. (In case of trouble, his hobby is body-building.)
One thing bothers him: the state of Iraqi medicine. There are few mentors at the hospital where he works, he says, and the doctors he is supposed to consult have given him some wrong diagnoses. Younger residents and interns come to him for professional advice. "It's self-teaching," he complains. "We are studying the textbooks and searching the Net." To cope with the shortage of doctors at home, the Iraqi government often sends patients to neighboring countries—where many of the best physicians and surgeons are Iraqi expats.
Other patients aren't so lucky. At a Baghdad children's hospital, Dr. Rafid Hmood tells of a 12-year-old boy in the cancer ward, blind and waiting to die. The cancer could have been stopped if doctors had removed the eye where the disease began, but the family had no access to qualified surgeons and oncologists in their home city of Kut. For fear of the violence in Baghdad, they waited a year before seeking treatment there. By then the cancer had destroyed both eyes and spread to the boy's brain.
Nevertheless, thousands of Iraqi doctors like Wasim remain outside the country. They follow the news from home—every assassination, every car bombing—as intently as they study their patients' vital signs. Dr. Raad Yusufani, who left Iraq in 2003, says he still gets calls from tribal leaders in Anbar province, where he used to run a hospital. They promise him "everything, including security," he says. But his life keeps slipping farther from the land of his birth. At the hospital he now runs, in the United Arab Emirates, 24 of the 49 doctors are from Iraq. His children have gone off to college in Jordan and Canada. When his mother died in Iraq two years ago, the family insisted he not risk going home for the funeral. Now his brother is suffering from a seven-centimeter kidney stone, and the family is trying to get him a visa to Amman to have it removed. They can't find a doctor Yusufani trusts in Iraq.
With Salih Mehdi and Yassar Ghani in Baghdad
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