Violence pushing Iraq’s medical sector to the brink

Health Ministry officials can no longer deny the physical harm doctors are subjected to daily but have offered few policy responses.
Saturday 17/08/2019
Doctors treat a patient in Mosul.(AFP)
Under threat. Doctors treat a patient in Mosul.(AFP)

LONDON - The violence that Iraqi physicians and medical staff encounter on the job is creating a serious medical brain drain and may phase out medicine in the battered country altogether, reports indicate.

Gun violence, extortion, acts of vengeance, alongside physical and verbal abuse and chronic shortages of supplies are pushing the country’s medical sector to the brink.

“Health Care in Danger” was the title of an International Committee of the Red Cross (ICRC) campaign begun last November to kick-start a nationwide public awareness crusade but to little avail.

The issue of violence against doctors, nurses and hospital staff has become an immovable reality, said Dr Fadhel Mustafa, a member of the Iraqi Physicians Union. “The violence doctors face is an old story,” Mustafa said, conceding that “new methods like kidnappings and extortion grew up after 2003.”

A local survey revealed an overwhelming desire among junior graduates to abandon their country in favour of settling abroad. An estimated 70% of those asked said they wished to flee and 98% said they believed violence would continue to gnaw at the very core of health care — its practitioners.

Shaymaa al Kamili, a practising doctor in Basra who graduated from Baghdad’s University College of Medicine in 2009, told France 24 that out of the 348 classmates she graduated alongside, 285 had left the country. From 2004-07, Baghdad saw a 22% drop in the number of medical specialists, a study published in the Social Science and Medicine Journal stated.

Doctors are often threatened by a patient’s family members. Outbursts of violence and mobster-like attacks are commonplace, as widely shared videos displayed to a global audience.

Observers who have monitored attacks on doctors offer various readings but emerging consensus blames reactionary tribalism.

The pace at which state resources and funding have shrunk has stunted the state and paralysed various sectors. This has emboldened tribes to exact their own versions of justice. A 32-year-old doctor who spoke on condition of anonymity said: “Tribal assailants will invent medical negligence claims to hold us [physicians] responsible for a family member’s passing, even if he died outside hospital grounds.”

The biggest rupture for national health care was in 2003, as Iraq was thrown under the weight of US-led occupation. The fallout from the US-sponsored regime change still lurks.

“Few people value the work we do nor are we hailed like we once were,” the Baghdad Medical City-based doctor said. As a young man, he dreams of a life in Europe where he can earn the respect he said he lost and develop professionally.

Health Ministry officials can no longer deny the physical harm doctors are subjected to daily but have offered few policy responses. A recent suggestion — which drew nationwide ridicule — was a policy that promised to arm physicians and doctors with weapons that are only to be wielded when they need to protect themselves. Others cite Iraq’s Penal Code of 1969, which offers protections that exist on paper but which few hospitals implement out of fear of provoking powerful tribes.

A resident doctor, Mohannad, said that to be a doctor in Iraq today “is to be paid $4.50 an hour, to be offered no protection on the job and to face the possibility of being killed by a patient’s relative an hour after their death.”

No official in the new Iraqi state has actively lobbied parliament to introduce a protection act for health-care workers who are feeling worn down by a decade of being left out in the cold. Although violence is nothing new, its use as recourse is catalysing Iraq’s medical brain drain in a country desensitised to violence.

ICRC’s campaign drummed up much-needed noise but not enough to reverse the tide of Iraqis fleeing the country. The steady perpetration of violence — from gun violence to verbal abuse — is fuelling patient-physician mistrust and encouraging behavioural patterns that undermine Iraq’s health-care system and the wellbeing of its staff.

Online campaigns introduced over the years have attempted to raise awareness locally but international solidarity is lacking — despite this being a global phenomenon — as noted by those interviewed.

As problems stack up, Iraq’s political elite voiced concern but have done comparatively less to interrogate its causes.

“As a doctor in Iraq, I don’t want to be the next victim. Save our lives. We are under threat,” one Iraqi doctor wrote on Twitter. Similar messages can be read online but it’s uncertain to what degree the world is listening.