Doctors in the Cross Hairs

Abu Mohammed can't go near a hospital now. The Iraqi bone specialist, 37, has lived in fear since August, when his younger brother, also a doctor, was shot dead one night while walking home from his clinic in Baghdad. Abu Mohammed bought a pistol after that, but he still doesn't feel safe. Recently he was offered a managerial job at one of the city's biggest hospitals. He's scared to accept it. His wife owned a pharmacy; she sold it in November. A week or so ago a doctor friend of theirs was kidnapped from his clinic in the city's Mansour district--the latest of their friends to vanish. "My brother was killed when the terrorists started a campaign against doctors," says Abu Mohammed. "He was one of their victims."

Iraq's troubles just keep getting crueler. The same American officials who used to promise imminent victory are now saying openly that the insurgency seems likely to continue indefinitely. The recent elections, rather than creating a sense of common ground, only emphasized the country's deepening rifts. And all the while, the insurgents are attacking the social structure wherever its defenses are weakest, aiming to create chaos so hopeless that America will finally give up and go home. Now they are targeting the health-care system with murders, kidnappings and scare tactics. According to the Iraqi Doctors Association, at least 65 physicians were killed in 2005--more than double the total for either of the previous two years--while others were kidnapped or threatened with death. Hundreds have fled the country.

Doctors at Baghdad's al-Kindi and Yarmouk hospitals have been getting threatening letters with messages like "It is your turn now" and "You should leave the country." One physician, asking not to be named for fear of reprisals, says he was kidnapped last summer, held for 14 days and tortured before his family paid a $45,000 ransom. Shihab Ahmed al-Azawi runs the Central Pediatric Hospital and a private clinic in Baghdad. Last week one of his colleagues was kidnapped. "I examine patients with my eyes facing the door," says al-Azawi. "I even changed the place where I sit, to be facing the door." Doctors can't do their best work under such conditions, he adds.

Washington has committed about $1 billion to refurbishing clinics and Iraqi hospitals, but health care only gets worse. "In the past, it was rare to have a uterine operation followed by removal of the uterus, or death following an appendectomy," says Nadhum Abdul Hameed Qasim, chairman of the Iraqi Doctors Association. "Nowadays it's very common--including death." Students in Baghdad are dropping out of medical school because their professors have disappeared. Specialists are getting scarce. And hospitals are increasingly sending patients out of the country for major surgery. "At this rate," says Qasim, "within a year we will find ourselves in an intolerable situation."

Hospitals are not sanctuaries. Doctors and staff have been hit when U.S. airstrikes and ground assaults came too close. Insurgents in the town of Al Hadithah, in western Iraq, have used hospital grounds and patient wards to stage attacks on U.S. forces. Insurgent leaders in Baghdad issued a "death warrant" against the staff of Al Nour hospital last May when fighters seeking treatment there were spotted and captured by Iraqi National Guard soldiers. Administrators at Baghdad's sprawling City of Medicine complex recently banned all military weapons from the hospital following a gun battle there between insurgents and Iraqi National Guard troops.

Many doctors remain at their posts, but they're terrified. After a doctor at Baghdad's Yarmouk hospital was wounded on the job in November, the staff staged a one-day strike for better protection. What did it get them? Practically nothing. The government has put out a pamphlet on "self-protection" that's being given to doctors. Gun laws have been loosened so they can arm themselves more easily. Iraq's Kurdish president, Jalal Talabani, suggested relocating to relatively peaceful Kurdistan. There was talk of setting up self-defense courses for doctors, but the idea was scrapped. "We can't guarantee who is going to train them and whether these trainers are infiltrated by the insurgency," says Amir al-Khuzaee, Iraq's deputy minister of Health. Never mind the guarantees. Many doctors would settle for better odds.