Wanted: More Than a Band-Aid

At first glance on a sunny day, Yarmouk Hospital looks like any medical center in the Middle East. But that impression only lasted until a woman in an abaya approached U.S. ArmyMaj. Amit Bhavsar, the division surgeon of the Second Brigade, 101st Airborne. Bhavsar was in the Baghdad facility to deliver one of a series of talks that he has arranged on topics like facial trauma and burn treatment. But just before he reached the lecture room, the mother showed him her son, a 2-year-old with disfiguring burn scars all over his back, neck and scalp that were causing his hair to grow in uneven patches. She claimed the injury was the result of an unspecified military operation and she begged for Bhavsar's help in getting her child the necessary treatment and medicine. The doctors at the hospital were unable to offer him either.

There is no shortage of desperate patients at Yarmouk. Because it services the surrounding mainly Sunni neighborhoods, hospital officials say that it gets little support from the Shia-run Ministry of Health (MoH), which is alleged to have ties to the Mahdi Army. There is some room to hope that the hospital's worst days might be behind it. Not too long ago, death squads roamed its halls, and some even followed the families of Sunni patients home to murder them. During an open house a couple of weeks ago, hospital director Haqqi Razuqi spoke openly about these problems for the first time, saying he wanted Yarmouk to be a place where people could "heal without fear." This was a bold move considering that the MoH director for western Baghdad was in the audience. "They know people are still watching them," says Bhavsar, "and physicians are high-value targets." Still, with the security situation somewhat improved over the past seven months, the hospital is trying, with the help of Bhavsar and the civil military operations platoon that visits here regularly, to step up the level of care it provides and demand funding equal to that received by hospitals that serve Shia communities.

In that regard, there's a long way to go. The Emergency Room lacks critical-care equipment, offering only an EKG and an oxygen machine, preventing ER doctors from doing little more than check for vital signs. Outpatients who require dialysis must pay for the use of the machines, 60,000 dinars (about $50) a turn. And the burn unit, which the MoH has promised to rebuild in 2010, is little more than a ward full of hospital beds. Its washroom should be one of the cleanest in the hospital--it's where burn victims, who are particularly susceptible to infection, have their wounds cleaned--but on my visit with Bhavsar, I could smell the mildew a few steps outside of its door.

Sectarianism even affects the distribution of pharmaceuticals. Because the MoH requires that it handle every request for supplies rather than let hospitals communicate with warehouses directly, it is able to control what goes where, often favoring Shia areas over Sunni ones. Bhavsar recalls a recent visit to Yarmouk during which he met a man in his 40s whose mother had been admitted for acute chest pain. The hospital had written him a prescription for several basic medications, including aspirin, and told him to go out into the city to buy them himself because it didn't have any in stock. Nasma Kamil, a medical resident working in the ER, says the lack of pain medications is her department's main concern. Even as she spoke, I could hear patients screaming in rooms nearby. Bhavsar agreed with her, adding that to do some of these necessary procedures without any anesthesia was unconscionable. (MoH officials have avoided responding to these ongoing accusations of corruption and favoritism from both the Army and hospital officials who work in Sunni areas. Bhavsar says that in his discussions with Dr. Jalil al-Shamary, the MoH director for western Baghdad, on the issue, Shamary has repeatedly tried to minimize the problems faced by hospitals that serve Sunni areas.)

By contrast, at the teaching hospital in Khadamiyah, a Shia area, Bhavsar says the equipment is close to what you'd find in a U.S. hospital. It has two neurosurgeons on staff, as well as CT and MRI machines. Its director also has complaints about medicine shortages, but these gripes are about chemotherapy drugs for children suffering from leukaemia rather than something as basic as aspirin. "This is sectarianism in its cruelest form," says Bhavsar.

And then there is the psychological toll all of this has taken on the hospital's staff. For Bhavsar, one of his most disturbing experiences at Yarmouk was meeting a mother who had been handed her stillborn child in a box in the maternity ward and told to bring it down to the morgue herself. As she dropped it off, the man at the desk didn't even pause his conversation as he put the box to one side. Bhavsar was shocked at the disregard for human life. "Yarmouk is one of these places you don't believe exist in the world," he told me. Sadly for Iraqis, it does.

© 2008