The full extent of the destruction of Iraq's healthcare system and the devastating impact it has had on its people is documented today in a new report which indicts the allied invasion force for failing in its duty to protect medical institutions and staff.
The report, by an independent team of researchers and advisers from Iraq, the UK, the US and elsewhere, says the provision of healthcare "has become increasingly difficult" since the invasion. "Doctors and nurses have emigrated en masse, exacerbating existing staff shortages.
"The health system is in disarray owing to the lack of an institutional framework, intermittent electricity, unsafe water, and frequent violations of medical neutrality. The ministry of health and local health authorities are mostly unable to meet these huge challenges, while the activities of UN agencies and non-governmental organisations are severely limited."
The report, by the organisation Medact, tells how the charges for healthcare, abolished by the coalition forces in a flurry of idealism, have been quietly reinstated by health authorities unable to pay salaries and buy the drugs they need. Worse, patients now have to pay bribes to get into hospital. The report tells of one young woman, Aseel, in labour for three days with no pain relief, doctor or midwife. Her family decided they would have to find the money to get her into hospital.
"After parting with my first bank note to secure petrol from my neighbour, we prayed for safety during our long trip to Diwaniyah maternity hospital," said Aseel's husband. "Thankfully we arrived safely, and were greeted by the open hand of the security guard. We parted with another note to get in. It took a long time to find a midwife. Eventually a sleepy midwife answered my pleas and we exchanged papers, notes and promises to bring more notes. Amin was born the next morning.
"Aseel developed a serious kidney infection and needed antibiotics, but we couldn't get them in Diwaniyah. Amin had to be fed powdered milk diluted with tap water. There wasn't enough money to buy formula milk, so we had to make it last.
"Amin survived one of the toughest milestones of life - birth. By Iraqi standards his life of hardship had just started."
The provision of basic health services is very challenging, the report says, quoting Dr Ali Haydar Azize at Sadr City hospital: "Iraqi hospitals are not equipped to handle high numbers of injured people at the same time." Junior staff frequently carry out procedures beyond their competence, the report says.
Medact, an organisation of health professionals that exists to highlight the consequences of war, poverty and other threats to global health, says the occupying powers had a duty under the Geneva convention to protect health services even after the establishment of the interim Iraqi government in 2004. "Yet these rules and obligations have been routinely ignored." Health facilities, it says, were not protected during and after the invasion. Reconstruction contracts were more often awarded to the private sector than to expert health bodies.
The report makes a number of recommendations for the future, including giving Iraqis the leadership role in the reconstruction of their health services.
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