For Iraqi Soldiers, A Medical Morass
Lack of Facilities Leaves Wounded To Seek Own Care

By Karin Brulliard
Washington Post Staff Writer
Sunday, May 6, 2007

BAGHDAD -- Mohammed Mizher Massen was a different man on the morning of Feb. 21. His muscles filled out his Iraqi army uniform. His posture radiated the confidence of a soldier who had helped capture insurgents. And his heart swelled: In a few hours, after his unit finished its shift guarding a Baghdad construction project, he was going to propose to his girlfriend.

Then the bomb in a cooking oil can on the roadside blew up, shredding his left leg and marking him with a constellation of shrapnel.

Now 1st Sgt. Massen, 22, is a one-legged man whose brothers carry him from his bed, where he has dreams of loud explosions, to his computer, where he researches prosthetic legs. He spends his $460 monthly soldier's salary on the $3,400 in medical expenses that he has accrued.

As the U.S. military prepares for an eventual handover of security duties to Iraqi forces, more of Iraq's 120,000 soldiers are advancing to the front lines of the war, and more are being wounded. But because there are no Iraqi military hospitals, thousands have been left to the mercy of overtaxed and corrupt civilian hospitals and a military compensation system paralyzed by red tape and disorganization, according to soldiers, family members, doctors and military officials. Many, feeling abandoned, turn to their families for help.

"I was fighting and going into combat missions for three years. When I was wounded, I was thrown out to my house," said Massen, a baby-faced man who slumped over a table, eyes downcast, during an interview at a Baghdad restaurant. "They did not provide me crutches or a wheelchair. They provided me with nothing."

Iraq's Defense Ministry has recorded 3,700 injured soldiers since the war began, but officials say the true figure is probably double that. The Congressional Research Service estimates that more than 33,000 Iraqi security force members -- about two-fifths of whom are soldiers -- were wounded by late April 2006. Last year, then-Defense Secretary Donald H. Rumsfeld said Iraqi forces were wounded at about twice the rate of American troops. About 25,000 U.S. soldiers had been injured as of this May 1, according to the Department of Defense.

U.S. military officials who work with the Defense Ministry say Iraq's capacity to care for its troops has greatly improved but remains hampered by its reliance on public hospitals, which deteriorated under economic sanctions in the 1990s.

Though Iraqis fight alongside Americans, their destinies diverge upon injury. Wounded U.S. soldiers are typically flown within one day to a first-class military hospital in Germany and arrive within 72 hours at Walter Reed Army Medical Center, where amputees receive extensive rehabilitation and prosthetic limbs at a cost to taxpayers of $58,000 to $157,000 per soldier, according to a 2006 study by the American Enterprise Institute-Brookings Institution.

Decent military hospitals existed under Saddam Hussein, but they were looted during the war and their doctors fled. So while some seriously injured Iraqi soldiers now receive initial treatment at sophisticated U.S. military facilities in Iraq, they must recover in public hospitals where medicines and highly trained staff are scarce. There is one military prosthetics clinic in the country, little in the way of mental health services and no burn center.

"U.S. soldiers have access to rehab and prosthetics that are obviously better than what Iraqis have," said Maj. Brian Krakover, 32, emergency room physician at the U.S. military hospital in Baghdad's Green Zone. "It really makes the sacrifice that these guys make so significant, knowing that if they get hurt they don't have the potential future that, say, a 20-year-old U.S. soldier who gets his legs blown off would have. They are really sticking their necks out here."

While several aid organizations focus on the civilian victims of Iraq's violence, none has stood up for injured soldiers.

"No one is paying attention, unfortunately," said Said Arikat, a spokesman for the United Nations in Baghdad.

Limited Options

When the new Iraqi army formed in 2003, Massen was among the first to sign up. He loved working with American soldiers and was thrilled with his job as a .50-caliber gunner. Catching suspected insurgents and liberating hostages was exhilarating.

That ended after the bombing in February. Because he was with an American unit, Massen was rushed to the U.S. military hospital in the Green Zone, called Ibn Sina. According to his medical report, doctors quickly amputated his left leg above the knee and two right toes. "The electric saw was used to flatten and bevel the bone," the report reads. "The toe amputations were done without complication."

Twenty-two hours later, the report says, Massen was stable enough to be transferred to Medical City, a sprawling complex in central Baghdad. Quick dismissals are routine at the 74-bed Ibn Sina, where officials say they keep unstable Iraqi patients as long as possible but must maintain space for the next wave of casualties.

Massen's two brothers followed his ambulance in their car with their guns ready -- insurgents are known to ambush ambulances carrying soldiers, they said. An hour later, Massen's brothers took him to Kadhimiyah Hospital, which they felt was safer.

But it was dismal, Massen and his two brothers said. They said there were few doctors, so they hired a private physician to stitch up Massen's stump, which they discovered had not been fully closed. Relatives scrubbed Massen's room daily, because no janitors came. The hospital did not have the painkillers and antibiotics Massen needed, so family members bought them -- at $15 a day -- from outside pharmacies. They had to "tip" a nurse $6 a day to administer injections and clean Massen's wounds.

"We had to buy him everything," said Massen's brother, Ali Mizher Massen, 37. "Starting with the water, the juice."

After 11 days, Massen went home, where he says he has continued to spend all his salary on treatment. His other brother, Ibrahim Mizher Massen, 32, said he sought aid at the Defense Ministry and was told requests for reimbursement must start at a soldier's unit. The unit sent him back to the ministry, he said.

"You know the bureaucracy -- this is all time and money," he said, sighing. "We gave up."

Still, Ali Mizher Massen keeps a neat spreadsheet tallying his brother's medical expenses, in hopes they might eventually be reimbursed. Among the items are 120 gauze bandages, 10 tubes of ointment and three surgeries.

Red Tape

Brig. Gen. Samir Hassan, surgeon general for Iraq's Defense Ministry, said that public hospitals are supposed to be free and that soldiers can be reimbursed for private services that are unavailable publicly. But he said public hospitals often do not restock medicines because their supply warehouse is in one of Baghdad's most dangerous districts. And the military does not yet have a solid system for compensation, which must be collected in person, he said.

"Certain people can reach us and we can pay for some of them, and others, it's very difficult. There is no exact policy. We are in the process of that -- how to refund, how to reimburse the soldiers," Hassan said, though he insisted his office, in the highly secured Green Zone, is open to soldiers who need help.

The system has progressed in the last year, said Hassan and Col. Amir Adolphe Edward, a U.S. Air Force surgeon who works with Iraqi security forces to improve health care. Last year, Hassan said, the prime minister's office approved $23 million for a military hospital in Baghdad. But the funds have been stalled by financial analyses and bidding, and Hassan predicted the hospital would not open until 2008. A temporary field hospital in central Baghdad could open within six months, he said.

The Defense Ministry, working with the U.S. military, has opened 14 outpatient clinics around Iraq. Liaisons have been placed in four of more than a dozen public hospitals in Baghdad to assist wounded soldiers, Hassan said. Seven "follow-up" stations were established two months ago; staffers there track patients and committees judge whether disabled soldiers should be retired, he said.

"In 2005, soldiers would die outside of hospitals because they were not allowed in because of people standing outside the gates saying we're not taking any more patients," Edward said. "The fact that they're actually receiving the care and that there are medical follow-up sections that are running and clinics that are capable of taking care of them -- you really can't ignore those facts."

A proposed military retirement law -- which would grant retirees a pension worth 80 percent of their salaries -- has been stuck in Iraq's cabinet for a year, Hassan said. Under current law, injured soldiers can retain their salaries if they regularly submit notes from their doctor.

The salaries -- starting at around $400 a month -- go only so far. Mohammed Hamis Jassem, 24, was outside a Baghdad bank last August when a car bomber slammed into his military police unit's checkpoint, spewing shrapnel that broke his left leg and sliced through his small intestine. After doctors at Kindi Hospital said his injuries required treatment at Medical City, Jassem said, he spent one hour outside under the summer sun, his innards exposed, waiting for an ambulance to take him there.

Since then, Jassem's parents have sold a plot of Baghdad land for $13,000, which they used to buy two dairy cows and to pay his medical bills, including $5,000 for eye surgery in Iran. Jassem still needs another operation to repair his intestine, which now empties waste through a hole in his lower abdomen and into a bag that he changes three times a day.

"I wish I died in that explosion," said Jassem, wearing a baggy sweat shirt on a recent warm day so that no one would think the bulge on his belly was a suicide belt. "Right now I can't do anything. I am spending money. This is not a good situation."

But the sense of abandonment is worse, soldiers said. Most acknowledged they never asked what care they would receive if wounded. They simply expected easy access to the care they needed, or even the option to fly out of Iraq for treatment. Hassan, the surgeon general, said Iraq has sent fewer than 30 soldiers outside the country for treatment since the war began.

'My Life Was Destroyed'

The car bomb that wounded Jassem enveloped fellow military policeman Mussen Abbas Khadim, 20, in a ball of fire. He wrote a request to the Defense Ministry to be sent outside the country for plastic surgery, because Iraqi doctors have told him they cannot repair his deformed face and what he calls his "melted-off" ears. Khadim said he has not received a response.

"No one from the government or the military came to at least say, 'Thank God for your safety.' These words -- 'Thank God for your safety' -- could raise my morale," said Khadim, 20, weeping during a phone interview from his home in Hilla, 60 miles south of Baghdad. "I would never join the military again. . . . My life was destroyed."

Massen, meanwhile, spends days tinkering on his computer and avoiding sleep, which brings nightmares and electrifying pain. He e-mailed inquiries about prosthetics to hospitals in Germany and was told that the best leg in the world could be his -- for the impossible sum of $25,000.

There is a prosthetics clinic for Iraqis in the Green Zone, but Massen said he was never told about it. The liaison for Iraqis treated at the Green Zone's military hospital -- an Iraqi-born physician who gives his name only as "Dr. Abraham" out of fear -- scoffed when told this.

"All Iraqis find some kind of excuse to get out of the country -- trust me," he said.

Massen said that was not his intention. On a recent day, he narrated a photo album filled with pictures of himself -- buffer, tanner and smiling -- striking menacing poses with fellow soldiers.

"He's dead. He's dead. One IED. One kidnapped," Massen narrated in vacant, halting English. "Ameer. He's dead. Sniper."

Once he gets a new leg, Massen said, he will get married. And then, if the army will have him, he will rush back to his .50-caliber rifle.

"The army is beautiful," he said, breaking into a rare smile. "It's not in their hands. The government is bad."

Special correspondent Naseer Nouri in Baghdad and staff researcher Robert E. Thomason in Washington contributed to this report.

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