Iraq's public health service is being replaced by American-inspired private care. The poor may turn to the mosques for medical helpby Jonathan Kaplan / November 20, 2003 / Leave a comment
Baghdad in April 2003 was a difficult place to do effective humanitarian work, and things have become more awkward since. I was in the city as a surgeon with an international medical organisation. US forces had declared the Iraqi capital conquered, but buildings continued to burn and not an hour was free of gunfire.
The city’s hospitals had treated many casualties during the bombing, emptying emergency stores of medical supplies. After the arrival of the Americans, much of the remainder was looted, with the pillage continuing even as staff tried to deal with arriving casualties. Operating rooms looked like charnel houses, caked underfoot with discarded surgeons’ gloves, dressings and bloody clothes cut from the wounded. In the 1970s and 1980s, Iraq had boasted the most advanced healthcare in the middle east, but now limited electricity and water made cleaning difficult. Instruments could not be sterilised. Because of the risk of sepsis, Iraqi surgeons were operating only when it was unavoidable. There seemed little use for my surgical skills.
Doctors working in the emergency rooms made me welcome, but as the afternoons advanced, staff steadily deserted the treatment areas, until by nightfall the hospitals were abandoned to gangs of armed looters. Gun-wielding relatives of patients defended the wards, trying to stop the theft of the beds themselves. In the mornings, doctors would return, patching the casualties that had been dumped at the entrance in the night, while the local mosque saw to the bodies of those that had bled to death where they lay.
Instead of doing hospital surgery, I found myself working with my medical organisation at the opposite end of the clinical spectrum: primary healthcare – basic, low-tech intervention to try to prevent disease rather than the resource-intensive treatment of injuries in which I was experienced.
Every conflict area I have worked in has suffered its own particular horrors, but Baghdad was among the most complicated. Mozambique and Angola endured long-running wars of destabilisation; rebels rampaged in the countryside, attacking villages and sometimes mutilating captives – cutting off ears, lips and eyelids – before releasing them to wander like the ghouls of tribal folklore, spreading terror ahead of the rebel advance. In government-held towns, I treated people for wounds incurred in crossfire or by stepping on mines. In a mountain enclave in Burma, I operated on the boy soldiers of an opium warlord under siege by the Burmese…