By an IWPR reporter in Baghdad (ICR No. 222, 29-May-07)
Conditions in Baghdad hospitals are never pleasant, but on certain days they can only be described as infernal.
April 18 was such a day. A total of five car bombs and suicide attacks across the city killed 191 people and injured several hundred others. Hospitals swelled with victims suffering from internal bleeding, severe burns, and broken bones.
Hadi Ahmed, a physician at Kindi hospital, in the Rusafa district of east Baghdad, recalls that on that particular day, more than 600 casualties were brought in.
A shortage of beds meant bodies lay strewn in corridors, and even spilled out in the hospital's garden, he said.
Throughout the wards and in the emergency room, over-stretched medical staff struggled to treat the hundreds of injured and traumatised Iraqis caught up in the blast.
With car bombings and suicide attacks a frequent occurrence in Baghdad, the massively under-resourced state hospitals are struggling to cope with the resulting carnage.
Of the 14 public hospitals scattered throughout the city, most of them are old, cramped and dirty. They lack the staff and equipment to deal with the often-critical injuries sustained by bombing victims.
Kindi, the second largest hospital in Baghdad, is located on the quieter eastern side of Baghdad.
It receives the bulk of bomb-blast victims, as many injured Baghdadis and taxi drivers refuse to go to hospitals in more volatile areas - such as the largest hospital Madinat al-Tub on Haifa Street, which is an infamous insurgent hotbed.
But when people are brought to Kindi with severe burns, mutilated bodies or organs punctured by shrapnel, there is very little doctors can do, as they lack the means to perform sophisticated surgery.
"Many of them die because of the small number of staff and the lack of medical supplies," one doctor there, who wished to remain anonymous, told IWPR.
"We even lack the basics to provide first aid," said Ahmed.
Anaesthetics and intravenous fluids are often not available - meaning patients go through terrible pain and lack adequate nourishment, while specialist medication to treat diabetes, tracheitis or respiratory diseases is also in short supply.
Under-stocked warehouses can't meet the constant demand for medical supplies, said Ahmed, adding that when he orders supplies, he often receives just half of the requested consignment.
Not enough even for ten diabetic cases, he complained.
Supplies are also diminished because hospital drivers refuse to go to those warehouses based in the more dangerous areas of the city.
Without these vital supplies, Baghdad hospitals bear an extraordinary burden, and medical staff are often pushed to their limits.
These problems have grave consequences for patients.
A recent World Health Organisation, WHO, report stated that an overwhelming number of conflict-related casualties die due to insufficient medical supplies at the hospitals.
Barely a day goes by without another bombing in the capital, bringing more severely injured patients to already overcrowded wards. The skeleton staff left at most hospitals struggle to cope with the ever-growing demands.
Incoming patients are given emergency treatment and then sent home to make way for others - sometimes with tragic results. Ahmed recalled one case where a bombing victim was quickly treated for broken bones and allowed to leave. He died at home shortly after, because in their haste to patch him up and send him on his way, doctors had failed to detect internal bleeding.
Staff shortages become even more pronounced at night, when many are not prepared to risk coming to work. Unable to ensure their safety and security, health officials do not oblige medical staff to work night shifts.
Just a few doctors are prepared to do so, out of a commitment to their patients or, in some cases, because patients' relatives have paid them. They're assisted by medical students, who stay at night as part of their on-the-job training.
At Kindi, 60 employees provide healthcare during the day, falling to 20 at night.
And it's little wonder that doctors feel threatened.
Two hundred specialist physicians have been killed since 2003, according to figures from the ministry of health. Other estimates put the figure higher.
With hundreds more doctors fleeing the country to escape threats of kidnapping and murder, Iraqi health care is rapidly deteriorating.
And the effects can be seen in hospitals throughout Baghdad.
When Hana Mohammed, 35, a housewife, took her pregnant sister-in-law to Yarmuk hospital on April 20, she was appalled at the conditions.
That day, a car bomb had exploded in Elam, a mixed neighborhood south of Baghdad, leaving tens of people killed and injured.
The scene Mohammed faced when she came to the hospital was horrendous. There was blood everywhere, casualties filled the corridors all the way out to the garden, and people wailed in agony as they waited to be treated by one of the exhausted doctors.
She observed how staff sent patients home to make way for the newly arrived injured from the bombing.
Dr Qasim Daud, a member of the health and environment committee of the Iraqi parliament, admitted that the shortage of staff and supplies "put us and the officials at the ministry of health in a critical situation".
Daud sees two main factors underlying the deterioration of Iraqi health care - the continuous emigration of medical staff and the absence of a good strategic administrative plan.
The parliamentary health committee is trying to come up with a plan to improve the health sector in Iraq, and a health conference is scheduled for July, he said.
There does seem to be the will - as well as the resources - to improve things.
Health officials announced that out of this year's 2.1 billion US dollar budget allocated to the ministry of health, 25 million dollars has been set aside to overhaul the health sector, and rehabilitate and renovate hospitals.
But it remains to be seen whether the capacity and expertise exists to ensure that the money is spent wisely.