SPECIAL REPORT
Second part in our series on life in post-ISIS Iraq
Not far from the banks of Iraq’s winding Euphrates River, in one of Ramadi’s northern neighbourhoods, the city’s general hospital looms over the surrounding sand-coloured homes, wrecked and unfit for use.
It has been more than two years since the Iraqi military recaptured the capital of Anbar province from ISIS, in a gruelling battle that destroyed huge parts of the city.
The liberation was hailed as a major victory for the central government, but today homes still lie in ruins, roads are punctured by craters, and basic services like water and electricity are largely non-existent. The hospital did not escape the devastation.
In 2016, the UN described the destruction in Ramadi as “staggering” in their first assessment of the newly liberated city.
During their time in Ramadi, ISIS members commandeered the hospital, where they treated their wounded fighters. Some local doctors operated on patients in their own homes, including a surgeon who said he carried out an appendectomy without anaesthesia, using only painkillers and sedatives.
Before losing the city in February 2016, the militants detonated explosives causing three of the hospital’s six floors to collapse on top of each other. A huge fissure cuts through one of the external walls, leaving the building teetering on the verge of collapse.
On the charred ground floor, where minor surgeries were once carried out, medical equipment lies strewn on the ground and twisted metal rebar pierces the ceilings. The building has yet to be inspected for IEDs and booby traps.
In a region of Iraq where widespread uncertainty about the future and the threat of a resurgent ISIS is ever-present, a crippled healthcare system has left many Anbaris wanting for basic treatments.
“Nothing has been fixed in the main building,” said Chief of Staff Dr Mazin Al Dulaimy, sitting in one of the offices of the temporary emergency department.
Medical units that were once housed in the hospital now fit uneasily in prefabricated cabins and buildings used as accommodation for single male doctors.
“We’ve had different organisations visit and received donations from Kuwait – but nothing major,” Dr Al Dulaimy said. “Since the main building was destroyed, the doctors’ apartments changed into the departments for medicine and surgery but they are not qualified to be CCU and ICUs,” he said referring to the coronary care and intensive care units.
Deemed less essential, the burns department has been transformed into a surgery unit. As a result, burns patients face travelling to Baghdad for treatment – a two-hour drive that often takes much longer because of delays at security checkpoints.
Sometimes, Dr Al Dulaimy said, patients die waiting for treatment. Last month a man was injured when a sticky bomb was placed on the underside of his car and detonated. “The patient died because we didn’t have time to transfer him to Baghdad.”
Before ISIS, Ramadi’s hospital had 446 bed spaces but today they can only accommodate 200 patients and are the only hospital in the region with a CT scan machine. “For surgery we have more than 30 patients every single day,” Dr Al Dulaimy said.
On the first day of Eid, they received 300 patients. About 50 kilometres east of Ramadi, the equally overburdened and less-equipped Fallujah hospital often refers patients, further overwhelming Ramadi’s hospital.
Outside the office, the hustle and bustle of people resounds through the lobby where flimsy blue curtains separate patients from visitors.
“The problem is that this is a general hospital, so the whole region counts on us,” said Dr Al Dulaimy.
The heavy patient load is exacerbated by a shortage of staff. The orthopaedic unit is manned by one resident doctor and a general practitioner from the government health department who agreed to volunteer temporarily.
“I work four continuous days, 24 hours a day,” said 28-yearold resident orthopaedic specialist Dr Ahmed Hamud.
Young educated doctors have already left Iraq, with many more planning to do so soon.
Resident surgeon Mostafa Saleh, 28, wants to relocate to Sudan. “I am quite frustrated to be here,” Dr Saleh said. “We don’t do much to help because we are limited, we don’t have a building fit for a hospital.”
According to the young doctor, the Ministry of Education is demanding a payment of US$150,000 (Dh550,800) to release their doctor certificates. This, he says, is a government strategy to keep young medical residents from leaving the country and to mitigate Iraq’s ongoing brain drain.
Dr Saleh is disillusioned with the rundown system. The hospital, he said, was taking only emergency cases. “We’re in the centre of the province and have too many cases.”
Medication is also scarce, with not nearly enough drugs making it through Al Suqoor, the checkpoint that links Anbar province to Baghdad. Despite Iraq’s free healthcare system, doctors often have to ask their patients to buy their own medication, which many are unable to afford.
Al Suqoor is manned by members of the Iraqi military and the Popular Mobilisation Forces – an umbrella organisation that includes a number of Iran-backed Shiite militia groups. Anbaris say they are being punished by the central government, who they say blame the Sunni-majority province for the rise of ISIS. Fallujah, Anbar’s second-largest city, was the first in Iraq to be overrun by the militant group in December 2013.
“The medicine should be coming from the Ministry of Health,” said one young doctor in charge of the hospital pharmacy. But basic drugs like aspirin, hydrocortisone and tramadol are not readily available.
Hadi Muslah lies in the dark in one of the makeshift patient rooms in what was once a doctors’ residence. In her fifties, she has been told she has an irregular heartbeat, only to find that the hospital was out of the drugs she needed.
“It cost me $50, I borrowed money to buy the drugs,” she said. “I can’t continue taking them because I don’t have the financial capability. But if I don’t take drugs this condition will continue.”
With Ramadi residents facing social, political and financial challenges, the slow reconstruction of the hospital exacerbates these existing problems.
As is often the case with so many of Iraq’s ills, some cite corruption as the main problem.
“People are stealing and they are highly organised,” said one doctor, who asked that his name was not used. “The former head of the hospital told me there is an organisation, they’re inside the hospital and the Ministry of Health, but he can’t control them so he quit.”