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Hospitals destroyed, physicians gone: Iraqi doctors face dire situation

Despite the physician shortage and hobbled infrastructure, Iraq's military surgeon general sees signs of progress amid the chaos.

By David Glendinning — Posted Sept. 24, 2007

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When most physicians deal with life-and-death situations, the lives at stake are not their own. But despite some recent improvements, that's exactly what many doctors in Iraq continue to face.

Kidnappings and assassinations have claimed the lives of hundreds of Iraqi physicians and prompted thousands of doctors to leave the country to avoid similar fates. For those few who remain, daily violent attacks bring in scores of severely wounded Iraqi civilians and military personnel who must be treated with insufficient supplies in whatever facilities have survived the fighting so far.

On top of all of that, a board-certified general surgeon who is dedicated enough to stay can expect to make only about $300 per month working in an Iraqi hospital under the country's Ministry of Health.

Brig. Gen. Samir Abdullah Hassan, is trying to change the situation on the ground. Dr. Samir, an orthopedic surgeon by training, is the surgeon general for Iraq's more than 160,000 soldiers, sailors, airmen and special forces personnel. Working in Baghdad under the Iraqi health minister, he is considered by the U.S. Dept. of Defense to be the leading spokesman on the state of all health care in the country.

Speaking to reporters at the Pentagon earlier this month during a weeklong visit to the U.S., Dr. Samir said he did not have exact figures on how many physicians have been killed or have fled the country. But Iraq's civilian hospitals have only about 35% of the doctors that they need to be fully staffed, he said. The military medical situation is also bad, with the armed forces staffing only about 20% of the more than 700 physicians they need.

After the U.S. invaded Iraq in 2003, many hospitals and other health facilities were looted and destroyed. Out of the many military hospitals that existed before the war, for example, only four survived, Dr. Samir said.

The availability of medical supplies continues to be a problem in many areas. Although physicians working in hospitals in the secure areas of Baghdad report to the health ministry that they have access to many of the supplies they need, doctors in less stable provinces are not so fortunate. Often, hospital personnel in these areas must risk attacks on their lives by traveling to the remote warehouses that stock supplies, which are then prone to theft and sale on the black market.

The frequency of violent attacks on servicemen and civilians taxes the system to the point where people with clinically treatable conditions are dying despite physicians' best efforts, Dr. Samir said. Car or truck bombs often can wound 200 to 300 people at a time, in addition to however many they kill.

"In any hospital in the world ... if you brought 100 wounded casualties, they would be overwhelmed," he said.

Signs of hope

Despite all of the grim news, recent evidence of increased stability and security in some parts of Iraq are translating into optimistic signs for the health care system, Dr. Samir said.

With the securing of additional areas and the heightened role of the Iraqi military in protecting medical facilities, the rate of kidnappings and physician assassinations has declined, he said. He noted that increasing numbers of doctors who fled Iraq for such neighboring countries as Jordan and Syria are inquiring about coming back to their homes and jobs now that some progress is evident.

"If the security improves more and more, the majority of them will return," he said.

The Ministry of Health plans to invest $1.5 billion to build 15 new hospitals, replacing some of the facilities that have been ruined. Individual provinces are pitching in by planning hospital projects of their own. The ministry also is trying to procure funding to raise doctors' pay and create financial incentives for new and returning physicians.

The U.S. military may step up its work to help improve Iraq's health care infrastructure if security is indeed improving, said S. Ward Casscells, MD, assistant secretary of defense for health affairs. The Defense Dept. significantly scaled back its reconstruction efforts after the level of violence in Iraq escalated at the beginning of 2006.

"The military doesn't just break things, we also want to build things, we want to safeguard things ... particularly on the health care side," Dr. Casscells said.

For Iraq, the rebuilding of a once-strong health care system is a process that has been continuous since the system was ravaged during the trade embargo days after the 1991 Gulf War, Dr. Samir said.

Rebuilding always will face a challenge from terrorists who are dead set against seeing it happen, he said. "Sometimes you build, and one mortar will destroy everything that you built. They don't respect anything -- mosque, hospital, children's school, market, anywhere."

Then again, Drs. Samir and Casscells said, health care also has a unique ability to bring people together. In the Ministry of Health, for example, Shiites work alongside Sunnis and Kurds for the sake of the future.

"On graduation day from medical school, we swear that we will take care of everybody, every human being," Dr. Samir said. "Health is the most important area that can unify people."

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ADDITIONAL INFORMATION

Dr. Samir Abdullah Hassan

Rank: Brigadier general

Age: 41

Hometown: Al-Hurriya City, Iraq

Residence: Baghdad, Iraq

Education: Al-Mustansiriyah Medical School

Specialty: Orthopedic surgery

Training: Resident, Al-Rasheed Military Hospital, 1990-92; resident, Hammad Shihab Military Hospital, 1992-94; field medical surgeon, 5th Motorized Division, 1994-97; permanent physician, Hammad Shihab Military Hospital, 1997-98; outpatient services director, Saladin Military Hospital, 1998-2000; deputy commander, Hospital of the 1st Military College, 2000-02; senior medical adviser, New Iraqi Army, 2003-04; surgeon general, Iraqi Armed Forces, 2004-present

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