One year after the World Health Organization (WHO) declared COVID-19 a pandemic, Iraq’s health sector remains unable to adequately respond to the crisis. Iraq has struggled to deal with the COVID-19 emergency since the first case appeared in the country in late February 2020. Weakened by more than three decades of conflict, international sanctions, corruption, and social and economic neglect, the country and its health system were ill-equipped to respond to a pandemic.
As of late March 2021, following another major surge in infections, more than 844,000 Iraqis have contracted the novel coronavirus, and more than 14,200 have died. The number of cases is about 22 per 1,000 people, a rate that places Iraq among the hardest-hit countries in the Middle East. The official figures, which are based on limited testing and poor data systems, are almost certainly lower than the actual number of cases and deaths.
A crisis waiting to unfold
In many respects, Iraq was a public health crisis waiting to unfold. Decades of conflicts, coupled with international sanctions and lack of attention to the health sector, have severely damaged Iraq’s health care system, shaping an environment that led many qualified doctors and other medical professionals to leave the country.
Iraq spends less than many of its neighbors on health. The country’s annual budget in 2019 was 133 trillion Iraqi dinar (ID); of that, only six trillion ID (4.5 percent of the annual budget) were spent on health and the environment. The World Health Organization notes that Iraq spent only $154 per person for health services in 2015, compared to neighboring Iran’s $366 and Jordan’s $257.
Iraq’s weak, under-resourced public health system has had a deep and widespread negative impact on public health. Non-communicable diseases, such as cancer, heart disease, diabetes, and chronic lung diseases, account for 55 percent of deaths in Iraq. More than 30 percent of the population suffers from hypertension, 14 percent from diabetes, and more than 30 percent is obese. In the last three decades, the Iraqi population has increased significantly, to more than 39 million in 2019 from 7.28 million in 1960. However, the health system has not kept pace. According to the World Bank, for every 1,000 Iraqis, there are 1.3 hospital beds, a drop from 1.9 in 1980, and 0.8 physicians, a significant drop from 1.0 in 2014. This is far fewer than other countries in the Middle East.
According to Dr. Abdulameer al-Shammary, the former head of the Iraqi Medical Association, which regulates, oversees, and advocates for the rights of doctors, these challenges are multifold. He notes, “The public health sector is suffering. The numbers of health professionals and centers are very low and do not match the increase in population. There is a lack of medical supplies and mismanagement of human resources. The waiting list in public hospitals is very long. Patients prefer to go to the private sector. There are no guidelines for treatment or proper sanitation or disposal of waste.”
The long-term neglect of the health sector has also had a demonstrably negative impact on the country’s health infrastructure. Health centers suffer from chronic shortages of medical supplies and resources. For Iraqis, accessing public medical care is inexpensive. However, the quality of care is so substandard that many resort to private medical care if they have the financial means to do so. Because there is no private health insurance, the average Iraqi covers about 70 percent of their out-of-pocket health expenditures, making quality health care an expensive proposition for most people. Many Iraqis seek medical care in other countries, such as Indian, Iran, Jordan, Lebanon, and Turkey.