Minding the Emergency Rooms of Iraq

Dr. Ali Shuwetij cannot remember the last night no patients arrived in the emergency room of his small hospital in eastern Baghdad. Just two years ago, when the things were more normal, Shuwetij or other doctors working night shifts would pass many evenings snoozing or watching television as nothing happened. Not any more. Now Shuwetij, the senior doctor on staff at the al-Kindy Teaching Hospital, works the overnight shift most every night. Usually about five or six patients arrive in Shuwetij's emergency room every evening. Most have gunshot wounds. Others have burns and lacerations from explosions. Shuwetij rarely asks what happened, in any case. "Most of the patients are exhausted when they come in," says Shuwetij, whose deep brown eyes sag heavily as he describes his days and nights at work as a trauma surgeon. "We try not to talk to them too much."

At age 38, Shuwetij is one of a shrinking number of doctors who remain in Iraq. Thousands of physicians have fled the unrelenting violence in Iraq, where militants have murdered hundreds of doctors in recent years. The World Health Organization estimates that Iraq has less than seven doctors per 10,000 people. In neighboring Jordan, where many Iraqis have resettled, the number of physicians per person is more than double that, with at least two doctors per 1,000 people. Iraq's health care infrastructure is crumbling, too. Iraq's health ministry has estimated that nearly 90% of the country's medical facilities need repairs or reconstruction.

The lack of caregivers, medicine and medical equipment in Iraq is taking an increasing toll on the overall wellness of the country, which had the best health care system in the Middle East for decades prior to 1991. But more than a decade of international sanctions followed by years of war since 2003 have left health care in Iraq little better than many of the least developed countries in the world. Infant mortality, a key indicator of public health, has risen in Iraq since the U.S. invasion of 2003. The most recent statistics from the Iraqi Health Ministry puts infant mortality at 130 deaths per 1,000 births, up from 125 deaths per 1,000 births in 2002. Perhaps most tellingly, life expectancy in Iraq is now is only 58, on average just a year and a half longer than a life in Sudan.

Some successes have come from the estimated $493 million U.S. agencies have spent on health care reconstruction projects in Iraq nonetheless. Child immunization campaigns have made impressive gains, with more than 80% of one-year-olds vaccinated against polio and other easily preventable diseases. But on the whole, the health care picture in Iraq remains bleak. Hospitals like Shuwetij's face chronic shortages as medicine and supplies. And of course the doctors keep leaving. Shuwetij says 10 of the doctors on his staff have fled Iraq in recent years after getting threats. The remaining doctors at the hospital, which has about 200 beds, often will not work overnight shifts because the neighborhood is unsafe. At night, Shuwetij usually hears the sound of gunfire close by, and mortars have fallen near the hospital grounds. Shuwetij, who's been a surgeon at the hospital for the last 14 years, picks up the slack on the night shifts along with his wife, another doctor at the hospital. The two have turned one of hospital's side rooms into a tiny bedroom. They stay on overnight at the hospital five or six nights a week, taking only the occasional break to stay with family elsewhere in Baghdad.

"If I go home and all the other doctors go home, who will be there for the patients?" says Shuwetij, who did his residency at the hospital shortly after earning his medical degree. "The whole reason my colleagues and I keep working as we do these days is for the patients. We don't do it for the money, and we don't expect protection. We do just do what we were trained to do."

But even Shuwetij has moments when his sense of dedication falters. At times he too considers abandoning his hospital and leaving Iraq. On the rare days when Shuwetij and his wife get together with other friends who are doctors, almost all the talk is of who is leaving, when and how. Shuwetij is still unsure whether he could make such a decision himself. "Maybe," Shuwetij says when asked if he will one day go as well. For now, though, he stays. "We keep working the best we can."