One night last week, as the medical clinic in the Shaab neighborhood of Baghdad was shutting down, Sadiq Abady left the second-floor office in the cement block building and walked a few paces to his silver Toyota. The doctor had just put his bag in the trunk when a car pulled up close beside him, a witness said.
Two shots ticked out of a pistol outfitted with a silencer, and Abady was struck in the head and back. He crumpled to the pavement. His coworkers at the clinic ran to his aid, but Abady, 34, was already dead, said Hameed Naser, a paramedic who had worked with him for a decade.
Abady's death was a shock to his colleagues, but also a forceful warning of the dangers of practicing medicine in Baghdad.
In the past year, many groups of highly educated Iraqis have been targeted in killings -- professors, scientists and businesspeople. But since about April, doctors in Baghdad report, they have also been singled out for kidnappings, extortion and death threats.
As a result, doctors said, their colleagues are reducing their work hours or staying at home, and some are so fearful that they are leaving the country.
Many high-level doctors are perceived as being wealthy, and some may have had privileged connections to the ousted government of former president Saddam Hussein. That makes them easy targets for theft, extortion and revenge shakedowns.
Fear is skimming the top off the Iraqi medical establishment, and dozens of specialists have left for Jordan, Libya, the Persian Gulf, Britain and North America, according to medical directors. So far, in 2004, 301 doctors have applied for certificates of good standing to work outside of Iraq, said Mohammed Jaf, president of the Iraqi Doctors' Association. Others have taken extended leaves of absence because they feel unsafe at work, according to hospital directors across Baghdad.
"The situation is not safe. Threats have become normal," said Ahmed Nadim, a doctor and professor at Baghdad University's College of Medicine.
On Tuesday, the director of Al Karama Hospital in Baghdad was shot and killed by unknown gunmen, according to the Health Ministry.
It is difficult to estimate the numbers of those killed. The Shaab police station, just down the street from Abady's clinic, is barricaded by 10-foot-tall cement barriers to ward off attacks by insurgents.
Abady's family did not even bother to file a complaint immediately, said Lt. Col. Abdelrazeq Mohammed, the commander of the station.
Without reliable police records, estimates by doctors of how many of their coworkers have been killed in recent months range from a half-dozen to several dozen.
Jaf said there have been about 50 kidnappings in recent months, but he added that many doctors don't report the incidents. In the past few months, the number could actually be double that, many doctors said. Every doctor interviewed for this article could name friends or relatives who had been kidnapped and ransomed.
Decades ago, Iraq was known for the quality of its medical care. Doctors labored through years of sanctions and declining medical supplies during Hussein's reign.
But now, the shortage of doctors puts more pressure on a health care system already dealing with aging equipment, drug shortages and increased numbers of emergency cases from the violence that has gripped Iraq in the aftermath of the U.S. invasion.
Nawad Ali, 50, a radiologist, said he fled Baghdad for Amman, Jordan, two months ago after an armed gang smashed through his windows at 5 a.m. and blindfolded and bound him and his wife, a gynecologist, in their bed. Their two children were held in another room.
The intruders knew they were doctors, showing that the break-in was not random, Ali said in a telephone interview from Amman. They took money, gold and every other valuable in the house, he said, and warned they would be back.
"Before this, I was threatened many times," Ali said. "It wasn't my desire or that of my family to leave. But it wasn't my desire to put my family at risk."
He said that five or six top Iraq radiologists also have fled to Jordan, along with dozens more senior Iraqi doctors from other specialties.
At Medical City, a complex of hospitals in central Baghdad, junior radiologists have been left behind to fill the gaps.
"More people are misdiagnosed," said Thair S. Abdullah, a former colleague of Ali's, speaking in the office of the director, where he had come to discuss the search for a new department head.
"You can feel the difference," said Abdullah. "It doubles the length of the waiting list -- it now takes two months to get a simple appointment."
At the entrance to the administrative building, guards pat down visitors and stand by with Kalashnikov rifles. Seated in front of windows covered in tape in case of shelling outside, Ameir Mukhtar, the director of Medical City, ticked off his own family members who have been kidnapped.
One brother, Ahmed, also a doctor, was threatened and shot. He fled the country but his son stayed to take his exams. The son was kidnapped. A second brother, Mohamad, a dietician in Medical City, was also kidnapped.
Mukhtar said his brother sent a written letter and a tape from captivity: "Do whatever they ask. I will start again from zero."
His release cost more than $40,000.
After at least a half-dozen doctors had been beaten or kidnapped from the hospital complex, said Mukhtar, specialists began to leave the country. Most doctors have shifted schedules, reducing their night hours, he said.
Altogether, said Mukhtar, 15 senior doctors have left the hospital, and about 20 other doctors have asked for leaves of three to six months because they fear going to work, he said. Each month now, he gets eight to 10 requests for one-month leaves, he said.
It's difficult to run a hospital this way, Mukhtar said, and he now faces a shortage of neurosurgeons, eye doctors, anesthetists and radiologists. The problem isn't just the number of doctors who are leaving, he said. The problem is the loss of expertise.
In the late 1960s and throughout the 1970s, Iraq sent its medical students abroad to acquire specialties. A generation came back well trained. Later generations of doctors who came of age during war do not have this kind of training.
"There's a big gap," said Mukhtar. "There is no replacement for them."
The crisis is so acute that when doctors are injured in attacks, they don't have anywhere to turn for care.
One general practitioner who was shot three times by gunmen needs surgery for a hernia, but he can't find an anesthetist he trusts, he said. In frequent pain, he has retired to his home, waiting to travel abroad for surgery -- or for some of the Iraqi doctors to return.
At a Health Ministry conference in the heavily fortified Baghdad Convention Center, friends approached one doctor, Abdelhadi Khalily, for hugs and kisses after his confinement and his kidnapping.
Khalily, a neurosurgeon who was voted Best Arab Doctor in 1998 by the Pan Arab Medical Association, survived a kidnapping in April, after being attacked while driving through a narrow street with friends. A BMW swerved and cut his car off.
"Three people came out of the car wearing police badges," the doctor said. The men said "Dr. Abdelhadi," shooting around the car, and forcing him into their vehicle.
In the back of the car, the doctor's head was crammed flat on the seat under the thigh of the kidnapper. Later he was forced into the trunk.
He whispered to himself the Muslim ritual words for facing death.
But instead of being killed, he was taken to a house and held captive for three days. His kidnappers asked in Iraqi slang for "50 books," or $500,000. He laughed. Later, negotiators paid $26,000 on his behalf, and he was dumped, blindfolded, at night, on a Baghdad highway.
"It is more than money -- that's the goal, but not the whole goal," Khalily said. "The goal is the destruction of Iraqi society. It's organized disorganization and disruption of society."
"It's depressing," said Dr. Mahmoud Ali, the director of Habibiya Maternity Hospital, who said he met with representatives of Shiite cleric Moqtada Sadr to defuse threats to his staff. "If I thought too deeply about the risk, I wouldn't go to work," he said.
Special correspondent Khalid Saffar contributed to this report.