A Sept. 17 article incorrectly said that one person who helped manage Iraq's budget had no background in accounting. The woman, described as the daughter of a prominent neoconservative commentator, has a background in accounting but lacked experience managing the finances of a large organization.
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Ties to GOP Trumped Know-How Among Staff Sent to Rebuild Iraq
He urged the Health Ministry to mount an anti-smoking campaign, and he assigned an American from the CPA team -- who turned out to be a closet smoker himself -- to lead the public education effort. Several members of Haveman's staff noted wryly that Iraqis faced far greater dangers in their daily lives than tobacco. The CPA's limited resources, they argued, would be better used raising awareness about how to prevent childhood diarrhea and other fatal maladies.
Haveman didn't like the idea that medical care in Iraq was free. He figured Iraqis should pay a small fee every time they saw a doctor. He also decided to allocate almost all of the Health Ministry's $793 million share of U.S. reconstruction funds to renovating maternity hospitals and building new community medical clinics. His intention, he said, was "to shift the mind-set of the Iraqis that you don't get health care unless you go to a hospital."
But his decision meant there were no reconstruction funds set aside to rehabilitate the emergency rooms and operating theaters at Iraqi hospitals, even though injuries from insurgent attacks were the country's single largest public health challenge.
Haveman also wanted to apply American medicine to other parts of the Health Ministry. Instead of trying to restructure the dysfunctional state-owned firm that imported and distributed drugs and medical supplies to hospitals, he decided to try to sell it to a private company.
To prepare it for a sale, he wanted to attempt something he had done in Michigan. When he was the state's director of community health, he sought to slash the huge amount of money Michigan spent on prescription drugs for the poor by limiting the medications doctors could prescribe for Medicaid patients. Unless they received an exemption, physicians could only prescribe drugs that were on an approved list, known as a formulary.
Haveman figured the same strategy could bring down the cost of medicine in Iraq. The country had 4,500 items on its drug formulary. Haveman deemed it too large. If private firms were going to bid for the job of supplying drugs to government hospitals, they needed a smaller, more manageable list. A new formulary would also outline new requirements about where approved drugs could be manufactured, forcing Iraq to stop buying medicines from Syria, Iran and Russia, and start buying from the United States.
He asked the people who had drawn up the formulary in Michigan whether they wanted to come to Baghdad. They declined. So he beseeched the Pentagon for help. His request made its way to the Defense Department's Pharmacoeconomic Center in San Antonio.
A few weeks later, three formulary experts were on their way to Iraq.
The group was led by Theodore Briski, a balding, middle-aged pharmacist who held the rank of lieutenant commander in the U.S. Navy. Haveman's order, as Briski remembered it, was: "Build us a formulary in two weeks and then go home." By his second day in Iraq, Briski came to three conclusions. First, the existing formulary "really wasn't that bad." Second, his mission was really about "redesigning the entire Iraqi pharmaceutical procurement and delivery system, and that was a complete change of scope -- on a grand scale." Third, Haveman and his advisers "really didn't know what they were doing."
Haveman "viewed Iraq as Michigan after a huge attack," said George Guszcza, an Army captain who worked on the CPA's health team. "Somehow if you went into the ghettos and projects of Michigan and just extended it out for the entire state -- that's what he was coming to save."
Haveman's critics, including more than a dozen people who worked for him in Baghdad, contend that rewriting the formulary was a distraction. Instead, they said, the CPA should have focused on restructuring, but not privatizing, the drug-delivery system and on ordering more emergency shipments of medicine to address shortages of essential medicines. The first emergency procurement did not occur until early 2004, after the Americans had been in Iraq for more than eight months.
Haveman insisted that revising the formulary was a crucial first step in improving the distribution of medicines. "It was unwieldy to order 4,500 different drugs, and to test and distribute them," he said.
When Haveman left Iraq, Baghdad's hospitals were as decrepit as the day the Americans arrived. At Yarmouk Hospital, the city's largest, rooms lacked the most basic equipment to monitor a patient's blood pressure and heart rate, operating theaters were without modern surgical tools and sterile implements, and the pharmacy's shelves were bare.
Nationwide, the Health Ministry reported that 40 percent of the 900 drugs it deemed essential were out of stock in hospitals. Of the 32 medicines used in public clinics for the management of chronic diseases, 26 were unavailable.
The new health minister, Aladin Alwan, beseeched the United Nations for help, and he asked neighboring nations to share what they could. He sought to increase production at a state-run manufacturing plant in the city of Samarra. And he put the creation of a new formulary on hold. To him, it was a fool's errand.
"We didn't need a new formulary. We needed drugs," he said. "But the Americans did not understand that."
A 9/11 Hero's Public Relations Blitz
In May 2003, a team of law enforcement experts from the Justice Department concluded that more than 6,600 foreign advisers were needed to help rehabilitate Iraq's police forces.
The White House dispatched just one: Bernie Kerik.
Bernard Kerik had more star power than Bremer and everyone else in the CPA combined. Soldiers stopped him in the halls of the Republican Palace to ask for his autograph or, if they had a camera, a picture. Reporters were more interested in interviewing him than they were the viceroy.
Kerik had been New York City's police commissioner when terrorists attacked the World Trade Center on Sept. 11, 2001. His courage (he shouted evacuation orders from a block away as the south tower collapsed), his stamina (he worked around the clock and catnapped in his office for weeks), and his charisma (he was a master of the television interview) turned him into a national hero. When White House officials were casting about for a prominent individual to take charge of Iraq's Interior Ministry and assume the challenge of rebuilding the Iraqi police, Kerik's name came up. Bush pronounced it an excellent idea.
Kerik had worked in the Middle East before, as the security director for a government hospital in Saudi Arabia, but he was expelled from the country amid a government investigation into his surveillance of the medical staff. He lacked postwar policing experience, but the White House viewed that as an asset.
Veteran Middle East hands were regarded as insufficiently committed to the goal of democratizing the region. Post-conflict experts, many of whom worked for the State Department, the United Nations or nongovernmental organizations, were deemed too liberal. Men such as Kerik -- committed Republicans with an accomplished career in business or government -- were ideal. They were loyal, and they shared the Bush administration's goal of rebuilding Iraq in an American image. With Kerik, there were bonuses: The media loved him, and the American public trusted him.
Robert Gifford, a State Department expert in international law enforcement, was one of the first CPA staff members to meet Kerik when he arrived in Baghdad. Gifford was the senior adviser to the Interior Ministry, which oversaw the police. Kerik was to take over Gifford's job.
"I understand you are going to be the man, and we are here to support you," Gifford told Kerik.
"I'm here to bring more media attention to the good work on police because the situation is probably not as bad as people think it is," Kerik replied.
As they entered the Interior Ministry office in the palace, Gifford offered to brief Kerik. "It was during that period I realized he wasn't with me," Gifford recalled. "He didn't listen to anything. He hadn't read anything except his e-mails. I don't think he read a single one of our proposals."
Kerik wasn't a details guy. He was content to let Gifford figure out how to train Iraqi officers to work in a democratic society. Kerik would take care of briefing the viceroy and the media. And he'd be going out for a few missions himself.
Kerik's first order of business, less than a week after he arrived, was to give a slew of interviews saying the situation was improving. He told the Associated Press that security in Baghdad "is not as bad as I thought. Are bad things going on? Yes. But is it out of control? No. Is it getting better? Yes." He went on NBC's "Today" show to pronounce the situation "better than I expected." To Time magazine, he said that "people are starting to feel more confident. They're coming back out. Markets and shops that I saw closed one week ago have opened."
When it came to his own safety, Kerik took no chances. He hired a team of South African bodyguards, and he packed a 9mm handgun under his safari vest.
The first months after liberation were a critical period for Iraq's police. Officers needed to be called back to work and screened for Baath Party connections. They'd have to learn about due process, how to interrogate without torture, how to walk the beat. They required new weapons. New chiefs had to be selected. Tens of thousands more officers would have to be hired to put the genie of anarchy back in the bottle.
Kerik held only two staff meetings while in Iraq, one when he arrived and the other when he was being shadowed by a New York Times reporter, according to Gerald Burke, a former Massachusetts State Police commander who participated in the initial Justice Department assessment mission. Despite his White House connections, Kerik did not secure funding for the desperately needed police advisers. With no help on the way, the task of organizing and training Iraqi officers fell to U.S. military police soldiers, many of whom had no experience in civilian law enforcement.
"He was the wrong guy at the wrong time," Burke said later. "Bernie didn't have the skills. What we needed was a chief executive-level person. . . . Bernie came in with a street-cop mentality."
Kerik authorized the formation of a hundred-man Iraqi police paramilitary unit to pursue criminal syndicates that had formed since the war, and he often joined the group on nighttime raids, departing the Green Zone at midnight and returning at dawn, in time to attend Bremer's senior staff meeting, where he would crack a few jokes, describe the night's adventures and read off the latest crime statistics prepared by an aide. The unit did bust a few kidnapping gangs and car-theft rings, generating a stream of positive news stories that Kerik basked in and Bremer applauded. But the all-nighters meant Kerik wasn't around to supervise the Interior Ministry during the day. He was sleeping.
Several members of the CPA's Interior Ministry team wanted to blow the whistle on Kerik, but they concluded any complaints would be brushed off. "Bremer's staff thought he was the silver bullet," a member of the Justice Department assessment mission said. "Nobody wanted to question the [man who was] police chief during 9/11."
Kerik contended that he did his best in what was, ultimately, an untenable situation. He said he wasn't given sufficient funding to hire foreign police advisers or establish large-scale training programs.
Three months after he arrived, Kerik attended a meeting of local police chiefs in Baghdad's Convention Center. When it was his turn to address the group, he stood and bid everyone farewell. Although he had informed Bremer of his decision a few days earlier, Kerik hadn't told most of the people who worked for him. He flew out of Iraq a few hours later.
"I was in my own world," he said later. "I did my own thing."