Baghdad, Iraq – Nursing Activity Manager Maxime Pirard is visibly tired. The young healthcare provider has been working tirelessly in one of Baghdad’s COVID-19 intensive care units, as the country sinks further under the weight of a second wave of the coronavirus.
The clinic, run by the medical organisation Doctors Without Borders (MSF) in cooperation with the Iraqi Ministry of Health, expanded its capacity from 36 to 51 beds at the beginning of last month, as reported daily cases soared across the country from about 800 in February to more than 5,000 in March. On March 25, the country recorded 6,513 infections.
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“The biggest challenge is that the flow of patients is really high and the staff is really tired,” Nurse Pirard told Al Jazeera. “We have a lot of staff also getting sick, so a lot of colleagues are doing extra duties.”
Pirard is part of a team of 102 local and international nurses and doctors working in the MSF clinic, a brand-new structure inside al Kindi public hospital, a quiet compound near Baghdad’s frenzied Palestine street.
Fatigued and overloaded, the calm murmur of the healthcare workers going about their daily rounds inside the clinic belied the gravity of the situation. Not one room down the long corridor was empty in late March, as patients connected to breathing machines lay silently under blankets.
In early February, the bed occupancy was below 50 percent, Pirard said, but now there’s only space for a “one in, one out” policy.
“The centre is full, we have three patients waiting in the emergency room and we know as soon as we discharge someone the bed will be filled by a new critical patient,” said Pirard.
Unlike during the country’s first wave last year, most people seeking medical help at the MSF clinic are in need of critical care. “In the past, it was more severe to moderate patients coming in with mild symptoms. Now, it’s more patients coming in in respiratory distress and needing a lot of oxygen,” said Pirard.
According to the Ministry of Health, since the beginning of the pandemic, Iraq has increased the number of intensive care unit (ICU) beds equipped with ventilators from 700 to 10,000. On Wednesday, 468 of them were being used, the spokesperson for the Ministry of Health Dr Sayf al-Badr told Al Jazeera.
But some medical workers remain unconvinced by these figures. “The number of true ICU beds in the country is nowhere near that figure,” said a medical source who asked to remain anonymous. “All the hospitals I’m talking to in Baghdad to are reporting a bed occupancy rate of 95 percent or more.”
On Tuesday, British charity Save the Children warned that a rising number of infections were being reported among infants and children. Health ministry figures show that the number of children under 10 diagnosed with COVID-19 jumped from 11,699 to 13,546 in just two weeks in March.
The ministry says that more than half of the recent cases in the country are from the highly infectious UK variant, first reported in Iraq in February. Dr Abdulameer Mohsin Hussein, president of the Iraqi Medical Association, says this could be why more young people are contracting the virus.
In a country where more than 60 percent of the population is under the age of 25, according to the UN, the rise in cases among young people has been particularly worrying.
“This wave is more aggressive, but hopefully we are prepared for it,” said Saif Khalid Abdulrahman, an Iraqi resident doctor. “The first wave it was old-aged [patients], this wave there are more young-age patients.”
Dr Abdulrahman said his youngest patient to die from COVID-19 was just 23-years-old and died within 10 days of being admitted to hospital.
Unlike older patients, the younger ones tend to wait longer before seeking medical help, explained MSF nurse Pedro Miguel Conde Coelho Da Silva.
“Because you do end up tolerating more … when they come, sometimes it’s a little bit too late. You try to put all your efforts into that person and the outcome most of the time is not very good,” said the Portuguese nurse. By that evening, four patients were pronounced dead.
Vaccines on the way
On Tuesday, the minister of health warned that cases across the country would continue to rise and that the country would soon receive more vaccines.
The inoculation programme kicked off in early March with the arrival of the first 50,000 doses of vaccine from Sinopharm, a Chinese state-owned company, followed by 336,000 doses of the Oxford-AstraZeneca vaccine. All Iraqis are eligible to sign up for the vaccine via an online portal, though the elderly and front-line workers are being prioritised.
The health minister said on Tuesday that an additional 200,000 Sinopharm doses were expected within the next 14 days and three million Pfizer over the coming months.
But even with the inoculation campaign under way, there are mounting concerns among healthcare professionals.
“It is very difficult and may be impossible to stop the spreading of COVID-19 in Iraq at the time being,” said Dr Abdulameer Mohsin Hussein. “Most of the people, even some health workers, they are neglecting the preventive measures related to COVID-19 infection prevention.”
Widespread vaccine scepticism and a lack of trust in Iraq’s healthcare system are added hurdles in the country’s fight against the virus. Years of sanctions, conflict and mismanagement have left a once advanced public healthcare system and doctor-patient relationships in tatters.
“Trust is everything in the management of a pandemic,” Mac Skelton, a medical sociologist at the American University of Iraq in Sulaimaniyah, told Al Jazeera. “If you don’t have that, then what little fixes, what good do they really mean?”
By Thursday, Iraq surpassed 851,000 reported cases. But the real number, said Dr Hussein, is likely to be much higher “because a lot of people, a lot of patients, they refuse to go to the hospital.”
And with the start of Ramadan less than two weeks away healthcare workers are expecting a further rise in reported numbers.
“We need to prevent the gathering of more people, to ask the people to wear masks,” said Dr Abdulrahman. “If we keep on like this each year or each six months, we’ll have some big wave like this.”
But many Iraqis are still disregarding social distancing and mask wearing. Inside the al Kindi public hospital emergency room Ahmed watched over his sick sister, his white mask resting on his chin.
“Iraq doesn’t have the structure or know how to cope with this, so people are getting infected and dying,” said Ahmed, who asked that his full name not be used. “This place is loaded, the doctors – they are doing their best but they cannot keep up with the number of patients.”
The dreary corridors and commotion in the al Kindi ER building are worlds away from the nearby MSF clinic, a relative sanctuary amid Iraq’s rundown hospitals and overburdened staff.
“In the scheme of things [Iraqis] have dealt with so many problems over the past 15 years and so a lot of the ‘blase-ness’ you see is just stacked up against all the challenges that they’re facing in their lives,” said Skelton.
“I think they’ll be resilient in it, but it won’t end quickly. It’ll probably be a longer road than in a lot of places.”