I have lost my brother, but can Iraq's health sector still be saved?

Last week I found myself mourning two great losses; one of them personal: losing my younger brother due to a poorly trained and ill-equipped healthcare system. The other was national, witnessing my fellow Iraqis lose their lives in hospital wards that increasingly amount to little more than death chambers due to rampant corruption and mismanagement. I am not speaking in the capacity as a former federal minister of Iraq, but as an ordinary member of the Iraqi public, from Baghdad itself, among millions of Iraqis who now have to weigh up the agonising decision of visiting a public hospital if themselves or a loved one is ill. My personal loss is my younger brother, Kusay, a healthy and highly educated 51-year-old married man and father of three young, angelic children. He was an energetic man who was full of passion to serve Iraq, with a wealth of experience, three academic degrees, an outstanding record of service to his country in the public and private sector. His deep experience working on the ground in difficult parts of Iraq during times of severe insecurity was considered a rare asset by experts in the energy field. When he fell ill, my brother was not able to access even basic health care promptly. To an extent this was due to hesitancy on his part, as he told me: "I don’t want to go to hospital because I don’t want to die due to medical negligence." His worst fears were confirmed. His health status dictated that he should be admitted to hospital to receive basic care including oxygen, painkillers and antibiotics to cure his Covid-19 infection. Yet his experience was that of millions of Iraqis who are shocked to find hospitals lacking basic equipment, staffed by badly trained health workers, where negligence has become expected as standard. Before his passing, he called me in desperation to say the hospital's systems were shutting down as the national electricity grid shut down. There was no functioning back-up generator to maintain vital life support systems including oxygen distribution. It was far quicker to have a doctor see my brother to certify his death, compared to their response when his condition was deteriorating. As he got worse, we were simply told "only call the doctor when he has a cardiac arrest". Even after he died, the medical team did not express basic human empathy. Patients and their loved ones are mere objects . Which leaves me to mourn a national loss, the collapse of the Iraqi health sector that has seen hospital wards turn into incineration chambers that burn patients alive. In the space of less than four months this year, four major fires erupted in three hospitals and in the ministry of health itself, killing around 200 people and injuring double this number, leaving their families in a state of long-lasting trauma. This is all due to failing health and safety measures and catastrophic mismanagement of a primitive oxygen system, largely supplied from factory-owned industrial oxygen compressors instead of medical providers, and stored with no thought for health and safety. The most notable accidents are those of Ibn Al Khatib Hospital in Baghdad and Al Hussein Teaching Hospital in Dhi Qar province. The second is all the more shocking because it seems no lessons were implemented following the first. Before the coronavirus pandemic , there were already multiple epidemics that should have been tackled as a matter of national emergency. These include rampant corruption in the Iraqi health sector, the lack of standard management procedures and the provision of key equipment to sustain daily operations, the lack of professionally operating intensive care units in compliance with international standards, the poor standard of clinical practice among healthcare workers, the lack of any vision to regulate the sector and low ethical standards when dealing with grieving members of the public. The eroded trust between the Iraqi public and the health sector cannot be overstated. In fact, the Iraqi health sector should have declared a public health emergency since regime change in 2003. Well-established health sectors in developed countries enjoy a very high percentage of financial allocation in national budgets – around 20 per cent of government spending in the UK in 2020. Across the Organisation for Economic Co-operation and Development (OECD), governments have responded to the Covid-19 pandemic by raising health spending to almost 10 per cent of GDP on average. In Iraq, despite its petrodollar wealth and revenues, health care is allocated little more than four per cent of GDP, much of which is then chopped up in an inefficient, corrupt political quota system. Even putting to one side the inefficiency of endemic corruption, this compares badly with regional countries that have not experienced war, such as Jordan, which consistently allocated between eight and 10 per cent of GDP to health before Covid-19, and Saudi Arabia, which allocates around six per cent of a much higher GDP. Until these issues are addressed, Iraq’s health system will remain in terminal decline. The pandemic has tested many healthcare systems around the world, and it is abundantly clear that the Iraqi health system – public and private – has failed and is on the brink of collapse . It is a matter of when, not if. International support will be urgently needed to save the Iraqi people from the fate that awaits them when preventable illnesses become life-threatening and care for the sick becomes non-existent. For this reason, the World Health Organisation is required to resuscitate it. The Iraqi government should take immediate action to develop a national plan for health in co-operation with the various medical associations in the diaspora. There are thousands of well-trained doctors and healthcare management experts among the millions of Iraqis living abroad who would be willing to provide support to their home country. The health sector should completely be isolated and safeguarded from political interference including the political quota-system, known as Muhasasa, to ensure ministerial appointments and high-ranking management should be nominated by merit to recognise leadership based on international standards. Immediate attention is needed to resolve health and safety failures and train medical staff on responsibility and accountability, beside other technical and professional skills. As oil revenues rise once more, this could be the last chance for Iraq to steer away from the abyss. Our family of 30 medical specialists and consultants – all abroad – feel bitter for failing to rescue my brother, and all are denied the opportunity to contribute their years of expertise to assist Iraq’s collapsing healthcare system. It’s about time this fiasco ends. Dr Luay al-Khatteeb is a distinguished fellow at Columbia University and a former energy minister of Iraq