As thousands of doctors leave Iraq, those who remain to heal the sick say they need more security and less corruption.
"The hospital is crowded, the medical staff are overloaded, and we are deficient of medical staff because doctors continue to leave Iraq," Dr Yehiyah Karim, a general surgeon at Baghdad Medical City, told Al Jazeera, "There is still the targeting of doctors."
Dr Karim said that many Iraqi doctors are continuing to flee the country because kidnappings and assassinations are ongoing problems. Since the US invasion in 2003, doctors and other professionals in Iraq have been targets of these crimes in staggering numbers.
According to the Brookings Institute, prior to the US-led invasion in 2003, Iraq had 34,000 registered physicians. It is estimated 20,000 of those have left the country, and between 2007 and April 2009 only 1,525 had returned.
"Many doctors are still leaving the country because we are in danger," Dr Karim, whose hospital is the largest medical center in the country, added. "Last week we had three doctors kidnapped in Kirkuk. Following this, doctors there didn't go to work for two days. We always feel insecure about our safety."
Dr Haidar Ali, a neurological consultant at Baghdad's neurosurgery hospital, told Al Jazeera he often searches his car for sticky bombs, explosive devices that are usually attached to the bottom of a vehicle.
"Many of my colleagues have died this way," he said, "A couple of months ago the dean of Mustansiriya University got into his car, it blew up, and he died. He was one of the best surgeons of Baghdad. He was dean of a college and a university professor."
Dr Ali knows many colleagues who have been kidnapped or assassinated going to and from work. While Iraq's professional class seems to be singled out for kidnappings, Dr Ali thinks the situation is similar for all Iraqis.
"Most Iraqis are targeted. Nobody is protected, and nobody is beyond danger or risk. There are lots of professionals, and normal people and army officers and police, are all being targeted."
Insecurity and corruption
Dr Zi'aad Tariq, a spokesman for Iraq's Ministry of Health, acknowledges the ongoing security problems for doctors.
"Definitely there is a security problem in Iraq," Dr Tariq told Al Jazeera. "There are a lot of attacks regarding Iraqi doctors. This forces doctors to leave to Jordan, Dubai, or sometimes the US, and we have thousands of doctors now outside of Iraq, and we've lost them and their services."
During Iraq's bloodletting in 2005 to 2006, an average of more than 1,000 Iraqis were slaughtered every month. While the level of violence is now lower, it remains far above pre-invasion levels.
In May, the last full month for which data is available, 377 civilians were killed, which is the highest level since last August. The same month, 65 members of Iraq's army and police force were killed, also the highest level since August, and an average of six civilians per day are killed by suicide bombings and car bombs.
In addition to the ongoing lack of security, Dr Karim said corruption within Iraq's Ministry of Health continues to plague doctors.
"Distribution of medical supplies should be equal and proficient, and it is not," he added, "There is favoritism for some hospitals to get medications, while others do not. Sometimes we get expired medications, or medications that are just about to expire. It is a faulty distribution problem, and mismanagement within the Ministry of Health."
Last year, Transparency International's annual corruption perceptions index ranked Iraq a dismal 175 out of 178 countries surveyed.
It is well known in Iraq that Baghdad's US-backed government has been ripe with corruption for years. Yet critics say this trend was allowed by the US, who supposedly poured $61bn into Iraq's reconstruction effort, which included roughly $1bn for Iraq's health sector.
Dr Ali told Al Jazeera that the Ministry of Health is "full of corruption."
"You can go to the hospital and find simple drugs like aspirin and pain killers that are lacking, while you can find medicines worth tens of thousands of dollars, like medications for multiple sclerosis that are available," he explained, "The people [in the Ministry of Health] in charge of making these contracts are making crazy money out of this from kickbacks."
Failed model
Osama al-Nujaifi, the Iraqi parliament speaker, told Al Jazeera that the amount of Iraqi money unaccounted for by the US is $18.7bn.
"There is a lot of money missing during the first American administration of Iraqi money in the first year of occupation," he said. "Iraq's development fund has lost around $18bn of Iraqi money in these operations - their location is unknown."
The Bush administration flew a total of $20bn in cash into the country in 2004. This was money that had come from Iraqi oil sales, surplus funds from the UN oil-for-food program and seized Iraqi assets. Pentagon officials have contended for the last six years that they could account for the money if given enough time to track down the records.
The US has audited the money three times, but has still not been able to say exactly where it went.
Iraq's Ministry of Health has earned itself a reputation for engaging in massive spending in certain areas, while basic medical supplies and medicines are left unfunded and lacking.
"Sometimes we lack medications for chemotherapy or oncology, but we also lack for general surgery medications and instruments," Dr Karim said.
Sporadic and infrequent availability of basic medical supplies, like IV needles and fluid bags, are a daily affliction for doctors trying to serve their patients.
The health ministry is having so much trouble buying and distributing medicine that it is discussing having UNICEF take over some of its work.
Dr Tariq blames structural flaws in Iraq's antiquated medical system and a lack of privatization for the problems.
"We have a problem in the Iraqi health system," he said, "It belongs to a British system and there are no changes in this system since 1952 for the health services in Iraq. It is old fashioned and there is corruption in the system."
He blames the patients and Iraqi doctors for much of the corruption.
"Since Iraq's health services are geared for the public sector and provides free medicine and medical consultation, it is abused by patients, and there is no incentive for doctors to work in a proper way. We want to have the private sector have an increased role, and we think this will help address all of these problems."
Dr Ali explained that the Iraqi people are dependent on the socialist medical system, particularly since there are a large number of people working for the state, as public employees, and there is a very small private sector.
"Most of our system is in shambles," he said. "Most of the privately owned businesses are not functioning, so people are dependent on the state and the state is giving salaries that are not enough for people to be able to be independent of the state. Who can afford their own health insurance? They cannot afford the privatization now. Maybe in the future it could work, but not now."
But before the possibility of introducing wider privatization, Dr Ali feels the problem of corruption within the Ministry of Health itself must be dealt with.
"The Ministry of Health is in the middle of this bad system and it has to change, but the change takes time and effort and I don't think the officials are in the mood to change because they are making good business and money out of the system as it is." he said. "They are making lots of money, contracts, kickbacks, making deals, and getting payoffs, so why would they want to change this?"
PHOTO CAPTION
Residents receive oxygen at a hospital during a severe dust storm in Baghdad June 2, 2011.
Source: Aljazeera.net