By Karin Brulliard
Washington Post Staff Writer
Saturday, May 5, 2007
BAGHDAD -- Iraq is hemorrhaging doctors as violence racks the nation. To stem the flow, the Iraqi government has recently taken a cue from Saddam Hussein: Medical schools are once again forbidden to issue diplomas and transcripts to new graduates.
Hussein built a fine medical system in part by withholding doctors' passports and diplomas. Although physicians can work in Iraq with a letter from a medical school verifying their graduation, they say they need certificates and transcripts to work abroad.
It is a common refrain among war-weary Iraqis that things were better before the U.S.-led invasion in 2003. Electricity in Baghdad was more reliable; sectarian hostility was rare; Iraq was safe -- except for the many victims of Hussein's tyranny. But rarely has the government embraced a policy that so harshly evokes the era of dictatorship. To some students and doctors, the diploma decision, like Iraq's crumbling medical system, provides clear proof of the government's helplessness and the nation's decline.
"I don't think anybody would think now to go back like
it was in Saddam's time. It would be a scandal," said an incredulous Akif al-Alousi, a leader of the Iraqi Medical Association, upon hearing about the measure from a reporter. After verifying it, Alousi said that the association would challenge the rule, which he called a violation of "basic rights."
Noor Jassem, 24, a fifth-year medical student at Mustansiriyah Medical College in Baghdad, agreed.
"They have no right to impose such a restriction," Jassem said. "If the government cannot provide security for the doctors, then why should it stand in their way to leave?"
Baghdad University medical students said a sign announcing the freeze on medical degrees was posted in late March at the office where they pick up their diplomas. The order was issued by the Ministry of Higher Education and cited a February letter from the office of Prime Minister Nouri al-Maliki.
Spokesmen for the ministry and the prime minister distanced themselves from the announcement.
"There is no legal grounds for stopping such a thing," said Higher Education spokesman Basil al-Khatib, who declined to produce a copy of the letter from Maliki's office.
Government spokesman Ali al-Dabbagh said the Hussein-era rule had never been changed. As they did in the past, he said, medical graduates can still get certificates upon completing service in public hospitals for six years -- one year of service for each year of their "free education."
Medical students and professors disputed those assertions, saying that since the fall of Hussein all new graduates have been given diplomas.
Khatib said the Health Ministry had come up with the proposal, noting that the agency that runs the nation's hospitals would be its principal beneficiary. Health Ministry spokesman Qasim Yahya denied the assertion.
Not that his ministry is complaining. "We welcome the decision, even though we know this is against the basic rights of individuals," Yahya said. "But it is in the interest of the Iraqi people."
Iraq's once top-notch medical system has been devastated by 1990s economic sanctions and present-day warfare. Hospitals often run out of such essentials as gauze, antibiotics and even blood, doctors say. Much of their equipment is outdated or broken.
Worst of all, they are running out of doctors, who like many of Iraq's intellectuals have been the frequent targets of kidnappings and assassinations.
The Iraqi Medical Association, with which all physicians must register to practice, estimates that at least one-third of the country's 40,000 or so doctors have fled to Jordan, Syria and other countries. Waleed Khalid, the association's vice president, said the organization issues 30 to 50 "certificates of good standing" to Iraqi physicians every day -- forms that any doctor must have to work abroad, he said.
Medical schools have also suffered. At Baghdad University's Kindi Teaching Hospital -- where 90 percent of surgeries are trauma cases, mostly involving bomb and shooting victims -- half the teaching positions are vacant, said Hameed Hussein al-Araji, head of the surgery department. General surgery instructors must fill in for specialists, such as the cardiothoracic surgery professor who was assassinated last year, he said.
Only about 25 percent of students are able to attend classes daily, Araji said. The rest, kept away by explosions and gunfire and roadblocks, use lecture notes to study at home and show up only for exams.
Even against that bleak backdrop, medical school enrollment remains high, officials said. The problem is that many graduates do not stay. Before the diploma freeze, the Ministry of Health estimates, about 50 percent of medical students were leaving the country upon graduation.
The Health Ministry has offered several perks to slow the exodus, said Yahya, the spokesman. Medical school graduates can choose where to complete their internships. Physicians are offered space for private clinics inside hospitals, with free equipment and cheap rent. Some hospitals provide on-campus lodging for doctors and their families, complete with security guards "to reduce the cases of assassinations," he said.
"But many of the doctors say: 'It's not a question of having consultative clinics or housing. We want to live a normal life, where we can take our families out,' " Yahya said.
Precisely, medical students say.
"The government should provide good conditions so that we could stay," said Nada Fadhil, 23, a student at Mustansiriyah who wants to be a radiologist.
Fadhil, who has dreamed of being a doctor since she was a child, said she feels sorry that Iraq is losing its physicians. Then again, she said, fear of leaving her house kept her away from classes for all but 10 days of the first three months of this year.
So even though she has no plans to leave Iraq after graduating, Fadhil admits she would not hesitate to flee if she felt threatened -- with or without her diploma. She would simply postpone her residency.
One senior medical school official in Baghdad has no sympathy with such arguments. In an interview in his central Baghdad office, he railed against what he views as "exploitation" by graduates, accusing them of stealing away with a "national treasure" -- a free medical education. The students have a duty to stay, he said.
"Let's put it right: What was happening in Saddam's time was better than what is happening now," said the official, who said he did not want his name published out of fear for his life. "There was order. There was discipline. This we are losing."
Although the medical association says it will dispute the diploma decision, doctors and students said they plan no public protest, fearing it could get them killed.
Besides, some said, Iraq's disorder could yield benefits -- corruption is rampant, so rules can be broken. Fadhil said there were rumors on campus that graduates could get their degrees from the Ministry of Higher Education by paying a bribe of about $5,700. Araji, the surgery professor, said he has heard it costs a mere $200.
"Look, in countries like Iraq, living in a chaos, everyone believes that everything is possible with money," said Araji, who graduated in the Hussein era and said he never did get his degree. "They pay, and they can get their certificate. Like a passport."
Special correspondents Saad al-Izzi and K.I. Ibrahim contributed to this report.