At Iraq’s hospitals, a man-made emergency

BAGHDAD — Outside Baghdad Hospital, the gates are freshly painted white these days. Sidewalks are being cemented and marigolds planted, gestures of civility virtually impossible during the war, when Iraq’s marquee public hospital was overwhelmed with casualties and itself targeted by mortar shells and bombs.

Inside, Iraqis marvel at the dispensers of blue hand sanitizer mounted at each door and the faint soapy smell of clean hallways. Health Ministry officials tout new medical equipment and facilities — an entire wing stocked with $10,000 machines to treat bone spurs, a multimillion-dollar cancer treatment center — evoking a proud era when Iraq had perhaps the finest health-care sector in the Middle East.

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But on a moderately busy day at the hospital’s emergency room, a newborn died because proper-size IV catheters, about $1 each, were not available. And as the first shift began on a slow Tuesday, Majid Abdullah lay unconscious on clean blue sheets, wrapped in white bandages covering blast wounds, in his 12th hour of waiting for a ventilator bed, as the ones promised to the ER were still words on paper.

“Maybe he will die,” doctor Layth Salim whispered. “Maybe we will find a bed.”

As security has improved and a semblance of calm has settled over Iraq, doctors say the biggest menace to patients these days is not so much a lack of money, basic training or even supplies. Rather, they say, it is the skewed priorities of a corrupt, often indifferent Health Ministry that has gone on spending sprees in certain realms while leaving basic health care to flounder.

The problems are emblematic of the wider dysfunction of the U.S.-backed Iraqi government as a whole, a bubble of elites for whom ministries are treated as spoils of bare-knuckled political battles, with key positions often going to the well connected rather than those with technical expertise. To some extent, such issues are common to developing nations, which is what Iraq essentially is, having been plunged backward by years of war.

But to a large extent, the dysfunction has been enabled and well modeled by the United States, whose $61 billion reconstruction effort included nearly $1 billion poured into the Iraqi health sector, spending followed by audits that documented huge cost overruns, delays, poor planning and waste.

In the U.S. campaign to win Iraqi hearts and minds, “the health sector was the worst,” said Stuart W. Bowen, the U.S. special inspector general for Iraq reconstruction. “It’s the sector that fell the farthest short of expectations.”

He noted that the United States spent about $150 million on advanced medical equipment that mostly sits idle because Iraqi doctors are not trained to use it, a pattern Iraq’s Health Ministry seems to be continuing.

At Baghdad Hospital’s ER, doctors feel the grim irony: They have a $40,000 Toshiba sonogram machine at their disposal, yet on any given day, patients die because antibiotics are not available.

“It’s an administrative problem of neglect,” doctor Nasrat Shakir said. “We call and say, ‘We need IVs!’ And they say, ‘You need IVs?’ And we say, ‘YES, YES, we need them!’ ”