BAGHDAD, Iraq - Amaal Hameed sat hunched over on a chair, sobbing quietly. Her 2-month-old baby lay dead on the hospital bed, wrapped in a black robe.
Flies buzzed about. Blood stained the floor. The nearby toilets were backed up with feces.
This was the cardiac unit of Iraq's premier children's hospital, but there were no nurses around to comfort Hameed, no orderlies to help pack her belongings.
Six-year-old Raheem Hatham lies in the burn unit of Yarmuk Hospital, Baghdad's main teaching facility. (Mandi Wright / Detroit Free Press)
A young off-duty physician happened to be showing journalists around, so he stopped to review the dead baby's chart. The boy had a heart defect, the kind fixed by a simple operation in developed countries. Even in Iraq, the operation is sometimes possible, the doctor said; it wasn't clear why it wasn't performed.
What is clear is that 10 months after the U.S.-led coalition promised to make things better, Iraq's shattered medical system - from Baghdad to Basra, from Kirkuk to Karbala - remains a mess.
Basics such as pain pills or latex gloves are often unavailable. Doctors routinely are threatened or attacked. Facilities are overrun with administrative staff who chat over tea while bathrooms clog with filth, resulting in the spread of lethal infections.
One in 10 babies born don't make it, experts say, about the same rate as before the war.
U.S. Health and Human Services Secretary Tommy Thompson, who visited a filthy hospital in Baghdad last week, remarked that conditions would improve "if they just washed their hands and cleaned the crap off the walls."
But Dr. Mahdi Jasim Moosa, the director of another Baghdad hospital, Yarmuk, said that was easier said than done. For one thing, there are shortages of cleaning supplies. For another, he can't fire maintenance workers who don't follow his orders, he said, "because they might shoot me."
Although many hospitals were looted in the aftermath of the U.S.-led war, it wasn't the war that wrecked Iraqi health care. Once the Middle East's gem, the system was starved of resources by Saddam Hussein under 12 years of international sanctions.
Doctors were paid next to nothing and cut off from outside knowledge. In 2002, Saddam's regime spent just $16 million on health, American officials say. Only Saddam's cronies got decent care.
So Iraqi doctors don't blame the United States for creating the dreadful conditions under which they work each day. But they don't understand, with all the billions of dollars being spent on reconstruction in this country, why very little in their world has changed.
"We are disappointed, because we thought the conditions and the situation would improve a lot faster," said Dr. Esam Khalaf, 28.
James Haveman, the senior U.S. health-care adviser for Iraq, said such criticisms made him angry. He pointed out that the American military, the Coalition Provisional Authority and aid agencies have spent hundreds of millions of dollars on Iraqi health care, and he said conditions had indeed gotten better.
The coalition has hired thousands of security guards, bought tons of drugs, repaired dozens of hospitals and generally returned the system to its prewar status.
Haveman noted that Iraq's 2004 health-care budget is $950 million, mainly funded by oil revenues. He acknowledged that that's insufficient to fix what's broken, but another $793 million has been budgeted - though none of it has been spent yet - out of the $18.6 billion in U.S. money that Congress appropriated to rebuild Iraq.
Haveman said he was impatient for the congressional appropriation to be released, but that it hadn't been yet. And that it was unrealistic to expect an immediate turnaround.
Yet there are those who wonder why, for example, a $26.3 million renovation of Iraq's Umm Qasr naval base near Basra, which is under way, took precedence over fixing the sewage system at the country's biggest children's hospital, al Iskan, where toilets sometimes overflow into the leukemia ward.
Haveman said renovations began Monday at the hospital, under a $9 million grant from Spain.
But the U.S.-led coalition clearly isn't tackling Iraq's health-care system the way, for example, it's fixing the electrical grid. Hundreds of Western engineers and contractors are working furiously to improve electricity before the summer, and by year's end the coalition will have spent $7 billion on electricity, officials said last week. By contrast, Haveman said he began with a staff of 37 that's dwindled to 15.
In the wake of news reports on Iraq's health-care woes, Haveman met reporters at Iraq's Health Ministry, an 11-story building that looters had gutted and burned after the war.
From 1991 to 2002, Haveman worked for John Engler, the Republican governor of Michigan, as state health director. Previously, he was a social worker with International Aid, a Christian relief organization that combines health work with proselytizing.
Haveman said he'd seen "amazing" improvements since he arrived last June. Told that doctors were complaining of shortages, he appeared to grow flustered, saying at one point, "Logistics isn't easy, folks; it's only been 10 months."
One major accomplishment, Haveman said, is the $1.7 million refurbishment of the Health Ministry headquarters. The building's interior was freshly painted, and new office furniture was stacked in the hallways. Haveman boasted that a wireless Internet network was planned.
The building teemed with well-dressed bureaucrats. According to doctors, many of the bureaucrats have very little work to do, even as hospitals suffer dire nursing shortages. The ministry will spend $157 million to pay 105,000 employees in 2004, according to Iraq's budget.
This is a countrywide dilemma: It was decided not to downsize bloated government ministries for fear of unrest. Haveman acknowledged that no one could be laid off from the Health Ministry.
His Iraqi counterpart, Health Minister Dr. Khudair Abbas, walked into the room moments later, and said, "We know, definitely, that we've got inflation in our staff." He said he was working on a plan to reassign bureaucrats to short-staffed hospitals.
A few days later, 6-year-old Raheem Hatham lay in the burn unit of Yarmuk Hospital, Baghdad's main teaching facility. His legs and genitals were covered with severe burns from an accident involving a kerosene heater. He needed skin grafts, but the hospital didn't have the proper equipment, doctors said. Nor did it have the drugs to relieve his suffering.
"This whole situation is a mess," said a hospital pharmacist, Raghed Yonis. "It makes you angry, when you see they're in so much pain."
The toilets that serve the crowded room were covered in human waste. "We clean it lots of times, but what can you do?" a hospital worker said, walking away.
Moosa, Yarmuk's administrator, acknowledged that part of the health-care crisis is due to the anarchic, every-man-for-himself ethic that's take hold in postwar Iraq. At Yarmuk, patients' relatives routinely threaten doctors. At least two patients were murdered in disputes at the hospital in the months after the war.
But doctors say there are basic shortcomings that could be fixed with an emergency-spending program.
"We don't have ointments," said Dr. Muhammad Hihad, standing in Yarmuk's crowded emergency room. "We don't have bandages.
"Why do they die? They die because of things we don't have."