The havoc and destruction of war compounded that mismanagement. After the US-led invasion last year, US occupation chief Paul Bremer repeatedly offered a positive prognosis, claiming the health service was "better than before the war".

 

"Yes, it's better than before," says Dr Hasan Muhammad Abbas, a manager at Medical City’s Educational Hospital. "We have the freedom to request what we need from any country, we’re getting new equipment and we’re paid more."

 

But many doctors working in Iraq's roughly 240 health centres offer a second opinion: the sector remains in a critical condition.

 

"Getting better? The situation is getting worse every day," says Dr Ahmad Farooq, a urologist at Medical City. He agrees that corruption and mismanagement in previous decades was damaging.

 

"Spending was haphazard, yes, but we still had some new equipment and staff coming in. Now, we see nothing being spent in the hospitals; we lack basic equipment."

 

His observations chime with the findings of an official US report released on 29 June, which says many aspects of Iraqi life are worse now than before the war and blames Bremer’s administration for mismanagement.

 

Slow recovery

 

The General Accounting Office says only a quarter of the $58 billion of the money donated internationally for the reconstruction of Iraq has been spent. The largest chunk has disappeared into ministry operations.

 

Dr Ahmad Farooq says monthly
salaries were just $3 in 2003

Iraq spent a reported $20 million on its health service in 2002 - around 68 cents per person. The budget for this year is $900 million - around $40 per person. But many medics see little improvement.

 

"It's true, salaries have risen," Dr Farooq says, "but I don't know where the rest of the money has gone."

 

Punitively low monthly salaries under the ousted regime, from around $1.50 in 1995 rising to $3 for a specialist in 2003, caused 9000 doctor to emigrate after the war - worsening the situation, he adds.

 

Improvements are on their way. Dr Abbas shows me new and refurbished wards with modern devices that are due to open soon. X-ray equipment lies in storage crates at the hospital. Other items are still with the Health Ministry awaiting distribution, he says.

 

"It will take about a year for all the rehabilitation to be complete," says Dr Abbas.

 

Catastrophic consequences

 

But the failure to improve services quickly is having catastrophic consequences. One in 10 infants will die before they are a year old, according to the Health Ministry, while nearly eight per cent of the survivors will perish before they reach five years of age.

 

With the supply of basic medicines such as antibiotics still unreliable, Iraqis are dying from easily treatable infections. About three in 1000 mothers die after childbirth, often from preventable infections, the Health Ministry says.

 

"The situation in the villages is even worse," says Dr Farooq. "There is little sanitation or access to clean water." He says poor sanitation generally has led to a rise in diseases such as tuberculosis, while the war disrupted immunisation programmes.

 

Some also report abnormally high rates of cancer in younger people, which some blame on US-led forces' use of radioactive ammunition during the invasion. Shells coated with depleted uranium were used because they penetrated armour more easily.

 

Collapse

 

Although decades of war, poor management and UN sanctions stunted Iraq's health service, the US-led invasion saw its near total destruction.

 

Doctors from the Union of
Islamic Clinics have joined forces

"There was total chaos. People couldn't reach the hospitals because of the fighting," says Dr Farooq.

 

"But we anticipated the collapse of the system and made an emergency plan. We contacted medical staff across Baghdad and set up small clinics."

 

He and a few other medics used mosques - seen as relatively safe - to treat residents nearer their homes. The doctors then discovered that other physicians were doing similar work across the city.

 

"Later, we tried to organise ourselves more, so we invited doctors to come together, discuss and plan a larger administration," he explains. The result was a new non-governmental organisation (NGO) - the Union of Islamic Clinics (UIC).

 

Serving communities

 

The UIC now operates six clinics in Baghdad and continues to assist smaller mosque-based programmes in remote areas. The largest clinic, in the district of Aadamiya, occupies an austere two-storey building once owned by the ousted Baath party.

 

Medical services are hampered
by years of underfunding

In the first six months of operation, it treated more than 17,000 patients. Staffed by around 25 doctors and 40 support staff, the polyclinic offers a range of services from dentistry to obstetrics and sees about 5600 patients a month.

 

"All our staff are volunteers," says Dr Alaa Alani, head of the UIC. "We receive our drugs from relief organisations, both Iraqi and international." Patients pay a nominal 50 US cents for treatment, which is invested in related projects and equipment.

 

UIC doctors also visit the village of Hamidiya, a 30-minute drive east of Baghdad, where a makeshift clinic operates in primitive conditions. Its water supply is drawn from a well and carried indoors by hand.

 

The long-term aim of groups such as the UIC is to work with the Health Ministry, expand its services and raise professional medical standards. In the meantime, however, doctors continue to face severe obstacles.

 

Urgent needs

 

"We were forbidden from going abroad by Saddam Hussein, so we lack new information and we need training according to our specialities," says Dr Alani, who is also a senior physician at al-Kindy hospital.

 

Dr Alani says the Iraqi health
system needs international aid

He also complains of chronic drug shortages and an absence of post-graduate study programmes. For the UIC and the similarly new Iraqi League for Medical Professionals, another problem is their lack of organisational experience.

 

"We're new to this. As an NGO we lack knowledge - how to write a proposal, how to research communities," Dr Farooq says. "We need other NGOs to contact us."

 

Dr Abbas echoes the need for international help to train and advise Iraqi staff, and calls on hospitals in other countries to "twin" with their Iraqi counterparts.

 

The Italian Red Cross, among others, has helped upgrade facilities at Medical City, while the Red Crescent in Qatar has provided the UIC with training and education.

 

But Dr Alani ends with an urgent plea for direct international aid.

 

"We can't continue unless we are helped from other parts of the world. And if all the money goes to the Health Ministry, not all of it will reach the people it should."

 

The Union of Islamic Clinics can be contacted at: islamclinics@hotmail.com, alaalani01@yahoo.com and alkaram71@yahoo.com