The U.S. built a hospital for Iraqi children with cancer. Corruption ravaged it.

The troubled fate of Basra Children’s Hospital reflects the epidemic of graft and fraud crippling Iraq’s health-care system

Hussein Sami, 15, was diagnosed with cancer at age 2. To protect his immune system, he spent years living in isolation in a room in the family's house in Basra. (Emilienne Malfatto for The Washington Post)

BASRA, Iraq — Basra’s Children’s Hospital was meant to be the best. After the United States invaded Iraq in 2003, first lady Laura Bush took a personal interest in its establishment as a world-class hospital for children with cancer, and the U.S. government spent more than $100 million toward its completion.

Eighteen years later, the hospital is a casualty of an Iraqi health-care system so riddled with corruption and damaged by neglect that World Bank figures put it among the region’s worst. After decades of war and sanctions battered the medical sector, today an army of crooks is robbing Iraqis of their aspirations for a healthy life, acknowledge former and current Iraqi officials.

Count 15-year-old Hussein Sami as one of the victims. From his bed in the oncology ward, he watched the doctor examining his medical chart. The physician’s face quivered momentarily as he tapped his finger on the section he was looking for.

Later, the doctor delivered a grim pronouncement to the teenager’s father. “He’s not responding to the treatment,” he told him. “If you keep him in Iraq, there’s no hope.”

For the teenager in the hospital bed, so slender under his blanket that he looked no more than 10, corruption undercut his treatment and pushed medical bills so high that his family risked bankruptcy. Medical devices he needed are often missing or out of service, doctors say. Prescriptions are padded with drugs that are neither required nor affordable.

Hussein, diagnosed with cancer at 2, was among the first patients at Children’s Hospital when it opened in 2011, six years behind schedule. Hussein’s family was relieved it was there. In Iraq, they had no access to the positron emission tomography scans that are vital for detecting diseased cells, so instead they had spent thousands of dollars to take the toddler to Jordan to find a diagnostic machine.

But even today, Iraq has only a handful of publicly available PET machines — none of them at the Basra hospital — and waiting lists are long.

Slipping Hussein’s medical chart back in its folder at the end of the bed, the doctor said the boy’s only chance of survival was a bone-marrow transplant. Where could they get one? The doctor inhaled sharply. “Not in Iraq,” he said.

Pilfering the cash

The Health Ministry, however, has no shortage of money. According to Iraq’s 2021 budget, at least $1.3 billion has been allocated in recent years for the building of hospitals alone.The ministry is dominated by the party of populist Shiite cleric Moqtada al-Sadr, who emerged as the winner in national elections in October, and is a cash cow for those who run it.

Current and former Iraqi officials, speaking on the condition of anonymity out of fear of retribution, say corruption is endemic. Money meant for everything from drug procurement to hospital construction is skimmed off by Sadrist officials and business executives, as well as individuals from other political groups.

“That party has infiltrated everything,” one former official said. Upon entering his office for the first time, he said, he found bags filled with contracts awaiting his sign-off for the purchase of goods at vastly inflated sums.

The Health Ministry did not respond to requests for comment.

Iraq’s anti-corruption commission routinely publishes reports with allegations of malfeasance in the purchase and maintenance of medical equipment. Last month, the commission said officials in the southern province of Maysan were under investigation for buying overpriced scanning devices, and in October, it accused an official in Babil province of extorting money from a foreign company supplying a similar machine.

At Baghdad’s largest public hospital complex, parking fees come to tens of thousands of dollars each day, but little of that makes it into government accounts, according to Iraqi researchers who monitor the health system. They spoke on the condition of anonymity because of security concerns.

After a Turkish construction company was tapped in 2010 to build five medical facilities around the country, the $750 million budget ran dry before two of them were completed. “They couldn’t finish them because of the corruption,” said a former government official. “Someone got paid such huge costs upfront, and the money disappeared.”

Kadhim al-Shimmari, a member of the Iraqi parliamentary committee that monitors corruption, said the construction money had been used partly for kickbacks to Health Ministry officials who awarded the contract, as well as for bribes to inspectors and local armed groups. The Turkish company, Universal Acarsan Healthcare and Construction, did not respond to a request for comment.

Corruption over care

Every bed in Hussein’s ward was full. There were not enough chairs for all of the parents. At night, some slept on the floor.

The boy’s father, Sami Haddad, looked exhausted. “When your child is sick, you’ll do anything. But the system here is not good. It’s been very hard for us,” he said.

Once known as the Laura Bush Hospital, the facility had been envisioned as a first-class acute- and referral-care hospital specializing in pediatric oncology. “Iraqi parents and children are hopeful for a bright future,” Bush told a gala dinner for Project Hope in 2005. Congress allocated more than $80 million to the Iraq Relief and Reconstruction Fund for the hospital’s construction, and the U.S. Agency for International Development chipped in more, with the entire U.S. contribution reaching $103 million.

But by the time the 101-bed hospital opened at a total cost of $166 million, the Office of the Special Inspector General for Iraq Reconstruction, a U.S. government agency, had revised those expectations downward. “The end result would not be the state-of-the-art medical facility envisioned at project inception,” the American inspectors wrote.

Since then, current and former hospital workers said, corruption has routinely deprived them of money for the procurement of cancer medication and the upkeep of vital medical devices.

Former hospital staff said that political operatives monitored the procurement process and sought to secure a steady flow of contracts for their allies. When hospital personnel tried to reduce contract costs, these efforts were reported unfavorably to the representatives of powerful political figures.

“It felt like I was between two fires,” said one former hospital official. “I wanted to serve those children, but on the other hand, I was fighting corrupted people who wanted to steal their treatment, their money and their lives.”

Mounting bills

About four years ago, after several rounds of chemotherapy, Hussein had seemed to turn the corner. He was getting better, and doctors told his father that Hussein would be in the clear if he stayed healthy for five years. The tumors crept back just shy of that.

The teenager was devastated. His father was in shock.

And they had no idea how they would afford the bills.

Hussein’s mother, Azhar, had already sold her jewelry to fund his early treatments. Most of the other valuables in their home, down a dirt track in one of Basra’s slums, are also gone now. The trip to Jordan alone had cost $5,000, they said. Repeated trips to the southern city of Najaf for diagnostic tests and scans unavailable in Basra cost $700 each time.

The bill for his drugs had been rising, too.

Hussein’s father rustled through the paper bag that contained his son’s medicines, plucking out vials one by one and laying them carefully on the table. “This is what they told us to buy for him,” he said.

In the case of at least one of the packets, it was not clear why. Several oncologists later said they never would have prescribed such a medicine for a patient at home, citing a high risk of complications.

Smuggling prescriptions

Iraq’s pharmaceutical market is worth an estimated $4 billion a year. But only about a quarter of the drugs enter the country through legal channels, according to health, finance and customs officials. Pharmacies instead sell medicines that enter Iraq from neighboring countries through unofficial border crossings, where officials allied with major political parties take a cut of the smugglers’ profits, according to importers and health officials.

These medicines are often more expensive, and the cancer drugs cost more than most others. Some arrive on the shelves near their expiration date. In some cases, importers and officials say, the drugs are fake.

“This trade isn’t taking place in secret,” said an official working with pharmaceuticals. “It takes place with the agreement of political parties and militias that operate in the area. The corruption isn’t an aberration, it’s the system.”

Customs and health officials in Baghdad say that the majority of smuggled medicines enter Iraq across its porous border with Iran. Trucks cross with prearranged permission, according to several customs and security officials, in return for about $30,000 per vehicle.

So lucrative is this illicit trade that government customs positions can change hands for up to half a million dollars each, according to officials in Baghdad.

Once the medicines arrive in Iraq, a network of middlemen brings them to market. According to doctors and pharmacists, companies offer commissions and bribes to often poorly paid medical professionals to prescribe the contraband drugs. “The system is so organized that we rank our doctors by A, B and C grades,” said one importer, who works for a private company in Baghdad.

“We start them with anywhere from 50 cents to 15 dollars for each prescription, and then there are perks. The C- and B-grade doctors might get a paid holiday to Turkey. An A-plus doctor might get one to Europe,” the importer said.

Iraqi Prime Minister Mustafa al-Kadhimi has vowed to limit smuggling by redeploying forces and replacing senior officials at key border points.

But an official from the state agency that regulates pharmaceuticals said the government will be hard-pressed to stop smuggling operations because they are so profitable. “Believe me, this is a big mafia,” he said. “The result is that we are giving people medicine but we don’t know the quality, so we don’t even know whether it’s effective or safe.”

As he spoke during an interview, his phone rang. He said the caller was a politician, asking for kickbacks from a shipment.

No more

As Hussein sat quietly on his bed at home last summer, he looked thinner than ever. The midday temperature in Basra was nearing 122 degrees, but he still felt shivery.

The latest round of chemotherapy had been exhausting. His siblings were doing their best to look after him. His mother was visibly weighed down with worry.

Hussein told his parents he was tired. “He wanted to come off chemotherapy,” Azhar said. “He wanted to die.”

After a devastating hospital fire a month later in the nearby city of Nasiriyah, Hussein and his family had had enough. The blaze, which killed scores, spread quickly as a result of flammable sandwich panels used illegally in construction because of corrupt contracting, according to health and civil defense officials, and Hussein’s father said he knew the same material was used at Basra Children’s Hospital.

Hussein never went back to chemotherapy. He died in October.

In his final months, the family had watched the boy’s spirit fade along with his body. He was quiet and withdrawn. His anger had dampened into resignation.

“The candle of our house is gone,” his father said days after Hussein’s death.

But in those last months, there had been one day the father remembered when things had been different. They had visitors, the house was abuzz, and for the first time in a long time, Hussein’s eyes were bright, and he was laughing.

“How beautiful he was,” the father recalled.

Emilienne Malfatto in Basra, Iraq, contributed to this report.

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