Witness: Desperate struggle to survive in starved Iraqi hospitals

This report has been sent to the OneWorld News Service by a health worker in Iraq

Wed, 16 Jul 97

The UN embargo on is having a terrible effect on ordinary Iraqi people. Malnutrition is now so widespread among children that it is no longer thought worth admission to a hospital. And it is all completely unnecessary, according to a Health and Development worker who has sent us this eye-witness report. She (we are not able to reveal her identity for safety reasons) has just returned from a fact-finding mission to Iraqi hospitals. This is her personal testimony.

May 1996 Iraq

My role during the trip was to visit hospitals, and I did visit some 15 of them. Some places I visited more than once and some I spent several hours in.

As someone who has worked in hospitals for many years, my overwhelming impression when I first walked into a hospital was the absence of that characteristic smell of antiseptic. It isn't there simply because there are hardly any antiseptics available. Hospitals are usually very bright places which I think gives them a cheerful, hopeful air. But in Iraq the hospitals, as with all buildings, are very dark because of the shortage of bulbs, and fluorescent lights which are difficult to import because of cost and restrictions.

The hospitals also felt very familiar to me because many of them have been built and designed by British companies. It is clear that these places were well designed, purpose built hospitals that would have been comparable to many British hospitals. In fact prior to the Gulf war, Iraqi hospitals acted as referral centres for many Middle Eastern countries as they were performing advanced surgery including cardiac and transplant surgery and even IVF.

It was like going back to Victorian times. There was no monitor during the operation, there were hardly any sterile towels, the scissors they were using to cut the skin were blunt, the artery forceps or skin clamps no longer had teeth...

However the hospitals are now just a shadow of what they were. They are falling apart at every level because the UN embarago prevents the import of supplies and spare parts, and the sale of oil. Rooms lie full of equipment that has been out of order for several years including cardiac monitors, defibrillators, laboratory equipment, wheelchairs etc.

I saw a 45 year old man brought into a casualty unit with respiratory problems following which he had a cardiac arrest. The department had no cardiac monitor, no defibrillator, and only one emergency drug - atropine. The man of course died.

I observed an emergency appendicectomy in one hospital and is was like going back to Victorian times. There was no monitor during the operation, there were hardly any sterile towels, the scissors they were using to cut the skin were blunt, the artery forceps or skin clamps no longer had teeth, the sutures being used were ophthalmic sutures and kept breaking. The two theatre lights which between them should have had 15 bulbs had two, and it was clearly difficult for the surgeons to see. The intravenous infusion set for a drip had been used for previous patients which is how all wards deal with the shortage.

In a maternity hospital delivery room, the sterile gloves had been washed and hung up to dry for re-use, they only have three sets of delivery instruments which cannot always be sterilised between patients. Most episiotomy wounds get infected.

One of the doctors asked me: "Have you just come to look at your victim or are you going to do something?"

In the premature baby unit of the same hospital, oxygen shortages meant that several babies are put in the same incubator. In another hospital I saw two women sharing an oxygen cylinder for half an hour each and many staff in different places told us of very acutely ill patients in need of oxygen who do not receive it because there often is none available at all.

The post-natal ward of the Maternity hospital has no water supplies, and in no hospital can patients shower during their stay. Staff use creative ways of overcoming shortages like draining urine into a glove and draining a chest drain into an old IV fluid bottle. X-ray films are cut up to make them go further, surgeons have developed new stitching techniques to save on suture material, senior surgeons operate more as they are quicker than less experienced doctors and speed saves on anaesthetic agents, spare parts are taken from some lifts to repair the others, old patients' notes are used for new patients because of the shortage of paper.

Many of the doctors trained in Britain and Europe and spoke often of their frustrations of being well qualified and yet so unable to treat their patients. One of them asked me: "Have you just come to look at your victim or are you going to do something?"

The shortage of drugs is the biggest problem for doctors. Prior to 1990 $360m drugs were imported every year, in 1996 just $13m will be imported. Staff are choosing which patients to operate on. At one hospital when 8 patients required emergency surgery they had to choose only four because that is the only amount of anaesthetic agent they have for the day.

Very few patients receive painkillers, I saw a man with real pain from renal colic in a casualty unit who was given sterile water. The same night a man with a fractured wrist was sent home in just a bandage because there was no Plaster of Paris.

The worst example of the drug shortages that I saw was in the psychiatric hospital where ECT (shock treatment) was being given without any anaesthetic; it was barbaric but it is the only form of treatment for the schizophrenics as there are so few drugs. The sick rarely receive the right drugs because of the shortages; one clinic I visited had 1500 registered asthmatics on its books, each requiring at least 1 inhaler per month. The monthly supply to the clinic is only 50.

The British government denied a British pharmaceutical company an export license for the angina drug glycerine trinitrate on the basis that it contains the explosive agent nitroglycerine! The Americans did a similar thing with an anticancer drug Mustine because it contains Mustard!

I did see children's wards full of malnourished children. Some of the children were a third of their normal body weight... The astonishing thing is that moderate malnutrition is so widespread that it is no longer a criteria for admission to hospital.

I did not get to visit people's homes so I personally did not see the conditions that many people are living in (the team carrying out the nutrition survey did tell me of cases of sewage flooding through people's homes and people having sold literally everything in their house).

However I did see children's wards full of malnourished children. Some of the children were a third of their normal body weight and looked as pitiful as any of those images that come out of an African famine.

The astonishing thing is that moderate malnutrition is so widespread that it is no longer a criteria for admission to hospital. Prior to the war there was no malnutrition in Iraq, but of those patients admitted with other problems over half were malnourished. Simple things like diarrhoea kills children when they are malnourished.

I saw a 5 month old baby that had just died from gastroenteritis and was severely malnourished. Only those children that are severely malnourished can be brought to hospital for feeding because of the limited resources.

I find it surprising that there is not more starvation given the absolute impoverishment of many people. The average salary is 3000-5000 Iraqi Dinars per month but a kilo of potatoes costs 200 and a kilo of meat 1000 dinars. I talked to a young girl selling cigarettes at the side of the road who had been taken out of school when she was 9 to help provide for the family. She works 10 hours a day every day and looked like she had walked straight out of a Dickens novel.

The saddest thing of all is that it is so needless. As one parent of a sick child said to me "We are rich, we are sitting on a pool of oil, but our children are starving and people are dying"...

I think it is the words of a woman doctor Su'ad Ali that will stay with me for the longest time - she said "We read many things but we are nothing. This is not like the 20th century. We cannot work scientifically, we have read everything in the books but we do not work logically. Sometimes there is a breech delivery and we cannot resuscitate the baby because we have no drugs. Is this logical? Are we human beings? I say to you we are human beings, why do you not treat us like human beings? We Iraqis are people, we are not an animals so why are we treated like animals?

'I cannot buy books, I cannot even buy a toy for my daughter and I am a doctor, I am highly educated and I work but still I cannot do this. I do not want to be rich. I just want to be a doctor. Will things change? I do not think that you can help us, only God can help us."

I could write so much more especially about the country, how beautiful it is, how nice the people were to us, and other more positive things, but it is hard for me to detach myself right now.

It really is heart wrenching and the saddest thing of all is that it is so needless. As one parent of a sick child said to me "We are rich, we are sitting on a pool of oil, but our children are starving and people are dying" and he is right.