Dying of neglect: the state of Iraq's children's hospitals

The wards are filthy, the sanitation shocking, the infections lethal. Sewage drips from the roof above cots of premature babies. This is the state of Baghdad's top children's hospital, 10 months after the fall of Saddam.

The Independent
21 February 2004
By Justin Huggler

In Iraq's hospitals, children are dying because of shockingly poor sanitation and a shortage of medical equipment. In Baghdad's premier children's hospital, Al-Iskan, sewage drips from the roof of the premature babies' ward, leaking from waste pipes above.

In the leukaemia ward, the lavatories overflow at times, spreading filthy water across the floor that carries potentially lethal infection.

Rubbish is piled on the stairs and in the corridors: old broken bits of machinery, discarded toilet cisterns, babies' cots filled with mountains of unwanted paperwork. The fire escape is blocked with discarded razor wire.

Nearby lie blankets still black with the blood of Iraqi soldiers wounded during the war - for months, they must have been fetid breeding grounds for disease.

This is the reality of life in Iraq under American occupation. Ten months after the fall of Saddam, the invasion that was supposed to have transformed the lives of ordinary Iraqis has done little for the children in Al-Iskan Hospital.

Of the billions of dollars the US is spending in Iraq, little seems to have found its way to Al-Iskan. In a country that sits on top of the second largest proven oil reserves in the world, children are dying in hospital beds because of a shortage of such basic equipment as oxygen cylinders.

The hospital is so short-staffed that the children's mothers have to do the work of nurses: there simply aren't enough nurses to go around. There is no hospital smell at Al-Iskan, because there is no disinfectant. We found a cleaner washing the floor, sprinkling meagre drops of water from a bucket as he went. Wasn't there any disinfectant, we asked. Not even soap, he answered.

"We have our own epidemic of diarrhoea in the hospital every two to three weeks," says Dr Ali Egab, a harried young doctor who stops to give advice to nurses as he shows us from ward to ward. "In December there was a serious epidemic of bronchitis in Baghdad," says Dr Egab. "The hospital was so crowded we had three children in each bed. We had to put some of the children on the floor."

With the overcrowding, cross-infection is a serious problem. "We cannot keep different types of cases apart. All sorts of infections are put together. And often, a patient arrives with a chest infection and ends up getting a stomach infection as well," says Dr Egab.

This sort of secondary infection is the leading cause of death in many of Iraq's hospitals. According to hospital statistics, the rate of secondary infections in Iraq is a shocking 80 per cent.

And yet half of Al-Iskan hospital is a building site. Entire wards that could alleviate the overcrowding are empty shells, with puddles of rancid water gathering on the floor A programme of renovation was abandoned at the time of the American invasion, and nothing has been done since.

Al-Iskan used to be called Saddam Hussein Central Children's Hospital. It was supposed to be the premier children's hospital for all of Iraq, but the staff say it was never any better than it is now.

The Americans inherited an Iraqi health system in a nightmarish state, the product of a combination of years of crippling sanctions imposed by the West, and criminal neglect by the Saddam regime.

But the Americans have had 10 months to improve things, and at Al-Iskan children are still dying because of the dire conditions.

Mohammed Hussein is a new arrival in the leukaemia ward. The two-year-old boy is a bad case: the disease has attacked his central nervous system and his face is twitching with convulsions. But in the ward he has joined, leukaemia will not be the only threat to him.

The success rate in treating leukaemia in children is good in the West. But at Al-Iskan, the leukaemia ward loses five or six patients a week, according to Dr Egab - a very high death rate. Secondary infection is even more of a risk for leukaemia patients, who have lowered immunity, and ideally should be kept in isolation. Here they are packed in six to a room.

According to Dr Egab, patients often come here to be treated for leukaemia, and end up dying of stomach infections.

That probably has something to do with the filthy toilets from which the stench is spreading across the ward. There are just three toilets for 30 patients, and they are crusted dark with filth. The ceiling tiles have gone, and a constant shower of dust falls from the exposed pipes above. Under the sink damp sandbags are slowly rotting.

"The doctors are good to us but we are suffering, especially because of the water," says Kadhimiya Murdan, watching over her 12-year-old Doa, whose toes are curled with pain. "There is only one tap, and it is broken." The staff have to send to other wards for clean water. In the corner of the ward, ten-year-old Zahra Jabar has a temperature, and her mother Henna Abbas needs to sponge her with constant supplies of water to keep her cool.

At least these are the cool winter months. The hospital's air conditioning system has been broken for months, and in the summer the staff had to battle to keep patients cool amid outside temperatures in excess of 50C.

Iraq has a high incidence of leukaemia in children and it is rising. That has been blamed on the use of depleted uranium by the US in the first Gulf War, and many of the cases at Al-Iskan came from areas that suffered heavy bombardment in 1991. But despite the high incidence, there are shortages of important equipment.

The hospital is short of intravenous sets with filters for blood transfusions, and patients often have to be sent out to buy their own on the black market. Supplies of chemotherapy drugs can be erratic. Though children patients are now given priority, sometimes the types of drugs in stock change, and changing the drug in the middle of treatment can be damaging.

Drug shortages are a serious problem in all of Iraq's hospitals. One doctor treating adult leukaemia patients at Baghdad Teaching Hospital told us he frequently had to send patients out to buy their own drugs on the black market, where they can be charged $300 for drugs that would cost the hospital $30. When they get back, he usually discovers from the label that the drugs they have been sold were stolen from his hospital in the first place.

There are other shortages at Al-Iskan. The hospital has only one nebuliser for asthma patients, and if two children suffer a severe attack at the same time, they have to share it, which means one could die. Often, doctors have to make do with giving oxygen to asthma patients instead.

But the hospital is short of oxygen cylinders, too. You can hear the oxygen cylinders coming at Al-Iskan, an ominous metallic rolling sound. The staff have no trolleys to carry them safely, so they roll the potentially explosive cylinders along the floor, bumping as they go. "To us, this has become a routine," laughs one of the porters."No one worries about it any more."

In the premature babies' ward, says Dr Ban al-Raaby, the shortage of oxygen is so acute that they often have to turn patients away. The rate of premature births in Iraq is soaring, fuelled, say doctors, by the stress of the war and the subsequent security situation on mothers. Dr Raaby stands over 21-day-old Hussein Hadi, who has developed septicaemia, an infection of the blood. "We are trying to do what we can with the facilities we have, but the situation ... well, it's not like other places," says Dr Raaby.

Sometimes the babies get these infections inside the ward because of the poor sanitation, says the doctor, sometimes they get it from unhygienic conditions at home, or home deliveries by unqualified midwives, who cut the umbilical cord with unsterilised instruments.

Outside the hospitals conditions are even more dire. A report by Physicians for Human Rights from southern Iraq found that at local maternity clinics, caesarean sections were being performed with unsterilised scalpels, needles were being reused, and staff did not even have clean water to wash the mother before she gave birth.

"In the hospitals, you're seeing the sickest 20 per cent of the populations," says Dr Lynn Amowitz, of Physicians for Human Rights. "But the health care for people who don't need to be hospitalised is even worse." Dr Amowitz singles out the lack of facilities for pregnant women. Local clinics are not supplied with specialised drugs used to treat complications in childbirth. The occupation authorities inherited this problem from the Saddam regime, which spent very little on women's health. But Dr Amowitz says the Americans have no plan to improve the situation.

"The problem is that there is no effort on the part of the coalition provisional authority to think about a long-term public health policy," she says. "The sort of people who have the expertise in this, the NGOs, the US Agency for International Development, have not been involved in Iraq. The US Department of Defence decided they're going to do everything and, well, they're not used to building things." As far as hospitals are concerned, Dr Amowitz says she did see a lot of improvements in some local hospitals in the south. "But it turned out it was all being done by the Shia clerics who'd come back from exile, not the coalition," she says.

Back at Al-Iskan, laundry is drying on a line in the premature babies' ward. The ward is so short of nurses that Dr Raaby and the other doctors have been teaching the mothers to carry out basic tasks. But teaching them the importance of hygiene is hard. "We cannot trust them. We try to do everything ourselves," says Dr Raaby.

"We are waiting for the Americans to do what they said they would," she says. "They made so many promises, such a long list. We are waiting for them to keep those promises."

© 2003 Independent Digital (UK) Ltd

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