Hesham Abdullah says he quit his office job to care for his son Mostafa, 14, and sold his house and all the family’s valuables to pay for treatment. With no medical insurance, he estimates he has spent at least $120,000 on black market medicines and trips to overseas clinics. His family of five had to move in with his brother.
“It’s worth it. I’d sleep in the street in return for a pain-free moment for him,” said Abdullah. “But this is not something any individual can afford. This is something the state should handle.”
Iraq’s healthcare system is in crisis. There’s a shortage of drugs and the medical staff to administer them. Doctors are fleeing in their thousands, and life expectancy and child mortality rates are far below average for the region. This year, a new threat has emerged: across the border in Iran, coronavirus has killed scores of people and infected many more, including a deputy health minister, prompting the Iraqi government to close the frontier. Iraq reported its first cases in recent days.
To understand the collapse of Iraq’s healthcare, Reuters spoke to dozens of doctors, patients, officials and private investors and analysed government and World Health Organization data. The story that emerges is complex. Over the past three decades the country has been ravaged – by war and U.N. sanctions, by sectarian conflict and the rise of Islamic State. Yet even in times of relative stability, Iraq has missed opportunities to expand and rebuild its healthcare system.
For example in 2019, a year of relative peace, the government allocated just 2.5% of the state’s $106.5 billion budget to its health ministry, a fraction of spending elsewhere in the Middle East. By comparison, security forces received 18% and the oil ministry 13.5%. Over the past decade, data from the World Health Organization shows, Iraq’s central government has consistently spent far less per capita on healthcare than its much poorer neighbours – $161 per citizen each year on average, compared to Jordan’s $304 and Lebanon’s $649.
“Health is not a priority and the indicators show that. The government did not give healthcare what it deserves,” Alaa Alwan, Iraq’s health minister, told Reuters in August. Alwan, who has also served in senior roles at the World Health Organization, resigned as minister the following month, after just one year in office, citing insurmountable corruption and threats from people opposed to his reform efforts.
Mass protests broke out in Baghdad and across much of southern Iraq, including in Basra, late last year as thousands clamoured for an overhaul of a political system they say has plundered state resources and pushed ordinary people into poverty. Poor healthcare is among the core grievances, and a lack of access to cancer treatment is a flashpoint. Stories of anguished parents who cannot get cancer drugs for their children fill the television news programs almost daily. Public pressure is building on political leaders at all levels.
“I am here today because my mother is suffering from cancer and she cannot find even the most basic treatment,” said teacher Karrar Mohamed, 25 years old, who also lost his father to the disease.
Mohamed was speaking in early November, surrounded by dozens of young men brandishing sticks and wearing gas masks. They’d blocked a central Baghdad bridge and were getting ready to square off against heavily armed police. Since Oct. 1, security forces have killed almost 500 protesters and wounded thousands, according to a Reuters tally. The protests led Prime Minister Adel Abdul Mahdi to resign in December.
OVERCROWDED WARDS, OVERWORKED DOCTORS
Mostafa lay on a bed in his uncle’s living room in Basra when a Reuters reporter visited in the spring of 2019. His face contorted with silent pain. He couldn’t sit comfortably because of the lump on his back. It began with a simple leg pain in 2016. Mostafa was initially misdiagnosed with joint inflammation. By the time the tumour was detected, his health was worse. Doctors determined he was suffering from sarcoma, a cancer of the connective tissue.
Mostafa started treatment at the Basra children’s cancer hospital.
The hospital is very short of space. Six beds are crammed into each room and every bed is occupied. With just 1.2 hospital beds per 1,000 people, Iraq lags the region. Mothers sleep on the floor, beside their sick children. Fathers sleep in an adjacent trailer – Iraqis call it a caravan. Even the emergency rooms have been repurposed to accommodate more patients. Administrators say the hospital may soon have to expand into storage sites.