With chaos reigning supreme in Iraq, the humanitarian crisis looms even larger, writes Rasha Saad from Baghdad Almost two months have passed since the end of the military campaign in Iraq, and Baghdad's hospitals are striving to get back into shape. "The overall situation in Iraqi hospitals is not catastrophic, but critical," Nada Doumani, spokesperson for the International Committee of the Red Cross (ICRC) in Baghdad, told Al-Ahram Weekly. Speaking about the many obstacles preventing normal performance in hospitals, Doumani explained the problem is due to a combination of both technical and management problems. "Hospital management is far from being back to what it should be. Wages are not being paid in full, water and electricity supplies are still a problem and there is no chain of command to assume clear responsibilities," she said. After the fall of Baghdad on 9 April, many hospitals were looted and damaged. Al-Yarmouk hospital, which suffered damage in cross-fire between coalition and Iraqi forces, is one of the hospitals trying to retrieve many of its damaged assets from the rubble. According to Ali Hafez, head of the emergency department, everything was stolen, from beds to air- conditioning units. The damage, he says, was total, not even the intensive care units were spared. "[Because of the chaos] the hospital was evacuated and patients were transferred to safer hospitals such as Al-Karama and Al-Shahid Adnan," Hafez said. During the war, the director appointed by the Ba'th regime to run Al-Yarmouk Hospital, the second largest public hospital in Iraq after Baghdad Medical Centre, disappeared. The current head is Dr Zaid Abdul-Latif, who had been hospital director before the disappearance of the previous appointee. Dr Abdul-Latif had to ask the US army to protect the hospital from looters and there are still two tanks guarding the main entrance. About 20 US soldiers patrol the hospital on a 24-hour basis. US soldiers, along with a few Iraqi guards, search each car coming in and out of the hospital. Al-Yarmouk Hospital, like most other Iraqi institutions, is attempting to make the best of a bad lot. The day I visited the hospital they were selecting a new management team, and Dr Abdul-Latif was expected to be returned to his position as director of the hospital. Emergency units, which normally never operated after 9pm, even with American troops on guard, returned to their normal round- the-clock operations just last week, and beds and some air- conditioning units had been provided by international and Arab humanitarian groups. Many of the in-patients of the various units of Al-Yarmouk Hospital are victims of post-war anarchical conditions. Most patients sustained their injuries during armed robberies and car hijackings, two of the most common crimes in Iraq today. Sitting in the waiting room is Bushra Saadoun, crying loudly. Her brother Wahad had been driving his Volvo through the Al-Alawi district when three car hijackers attacked, shooting five bullets into his stomach. He is still in a critical condition. Gamara Jaber is a 50-year-old woman from Al-Youssefiya who has been shot in her leg while trying to prevent her sheep from being stolen. Despite the pain of her injuries, Gamara remained proud of the fact that she kept her sheep. I saw another unconscious patient surrounded by his relatives, who were using hand-held fans to cool him since the electricity was still cut off. The man was a victim of an armed fight over water. This hospital witnesses hundreds of similar cases daily. Normal cases of illness such as appendicitis have dropped off sharply, the main emergencies now resulting from stabbing and gunshots. According to doctors in the emergency unit there has been a large spate of stabbings in fights over petrol; there is still a major shortage here. Bara' Ibrahim is a nine-year-old girl born in Iraq of an Egyptian father and Palestinian mother. Ibrahim and her brother were admitted to Al-Yarmouk Hospital with tumours in their legs; Ibrahim underwent an operation to have hers removed. "First I had high temperature, then I felt a tumour in my left thigh and my mother told me I would be cured soon. However, another tumour appeared in my right thigh, and now they've both became as hard as a stone," she said. While I was speaking to Ibrahim, she was called into the operating theatre for surgery, but she had to wait for many hours to be operated on as the pre-operative area was completely full of patients. She is believed to be a victim of the weapons used by the coalition forces in the battle for Baghdad Airport, weapons which are banned internationally. This girl lives in the densely populated lower- middle class area of Al-Jihad a few kilometres from the airport. Some Iraqis speculate that contaminated dust from the airport area has blown to nearby residential areas and that there are more cases similar to that of Ibrahim and her brother. While most of Baghdad's nearly 12 hospitals were subject to looting and damage, Ibn Al-Haitham Hospital is one of the few lucky ones. Hospital Manager Dr Faris El-Bakri told the Weekly that, "seven doctors joined me on the first day after the fall of Baghdad, and we sat outside the hospital dressed in our white coats to prevent any looting." However, Dr Bakri recounts that the incidences of looting started to increase three days after the fall of the city. "I went to a US lieutenant in the nearby Al-Fardos Square and asked him to guard the hospital as part of his obligations under the Geneva Conventions. He sent four jeeps to guard the hospital for the following ten days." But this privilege did not last for long. "When the US Marines left, none of the ground forces replaced them, and the Health Ministry told us to hire Iraqi security instead," said Dr Bakri, who can only pray that looters will keep away from his hospital. Dr Bakri also complained of the total chaos within the health sector. Bakri criticised the fact that the Americans have not yet decided who to appoint as Iraqi health minister; the post has changed hands more than once in less than a month. Before the war, Iraqi hospitals charged low fees in return for the medical services -- a form of self-financing. This money was used to pay wages and bonuses. According to Bakri, after meeting with Jay Garner, head of the Office of Reconstruction and Humanitarian Assistance (ORHA), the minister of health ordered hospitals to start offering free services instead of charging for their services. "But we were not told exactly how to cover maintenance costs or other hospital overheads, whether or not the [Ministry of Health] would allocate a budget for this, how much it would be and when we could access it. The hospital has been able to cover its basic overheads up to now, but if we don't get more medicine in the near future, we will start suffering," he added. The Health Ministry and ORHA have also assessed all health sector staff, from civil workers to doctors, and specified remuneration ranging from $100 to $1,000. "We should be optimistic, but we expected improvement at a faster pace," said Bakri. The chaos within this sector means Iraq will not be represented at international medical conferences for a long time to come, and not at the Arab and African conference for ophthalmic surgery which is due to take place in Tunisia. "I have no idea where I'll get a visa; my passport papers were burnt in the fire in the Iraqi Foreign Ministry. We always attended this conference, even during the 12 years of sanctions. We only had to present a request two months before the conference and we could go. We have survived one siege only to walk into another." The Iraqis are also dealing with the explosive legacy of the war. According to an ICRC report published earlier this month, a large number of military equipment and weapons have been abandoned in various areas, which are now threatening the lives of Iraqi citizens. "We are launching an awareness campaign and gathering information on the most dangerous places," the ICRC report read. Yet another legacy of the war is the alarming increase in the number of children living on the street. According to Haidar Nasser, head of the medical department at UNICEF, before the war there were about 4,000 orphans living in roughly 12 institutions, which were supervised by the Iraqi Ministry of Labour and Social Affairs. The institutions were also aided by UNICEF and other non- governmental organisations (NGOs). These organisations used to provide shelter for children living and begging on the streets of Baghdad. "After the war, staff from these institutions fled to their homes leaving the doors open. Many of the children left and are now living on the streets. Most of them are now controlled by gangs," Nasser said. UNICEF, along with Medicines Du Monde (MDM) and Enfants Du Monde (EDM) provide the street children with councelling and food, which is dispensed from mobile caravans. According to Valerie Dominique, a member of MDM, many of these street children refuse to go back to orphanages because of the abysmal treatment, tantamount to torture, meted out in the past. According to Dominique, some children escaped from orphanages during the war, but their whereabouts remain unknown. "Seventy per cent of the children that were housed in The Iraqi Family Orphanage went to their relatives in governorates around Baghdad, and have not returned since. Nobody knows their whereabouts or whether they are dead or alive," she said. The Iraqi Family Orphanage in Al- Amereya was itself looted and completely destroyed. The orphanage, which sheltered up to 1,000 girls, boys and teachers, also comprised a health centre, school and had buses, is now occupied by armed gangs who prevent anyone, including journalists, from entering. The disappearance of staff has been followed by reports of incidences of rape of the girls by thugs who occupied many of Baghdad's orphanages. Humanitarian NGOs apparently wish to prevent girls from returning to these institutions for fear of being raped.
