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Karbala Mirrors Countrywide Crisis

Dire shortage of drugs and doctors reflects catastrophic effect of war and corruption on the country’s healthcare system.
By an IWPR
Muhammed Ali Hussein, 55, has had diabetes for more than 15 years and says finding insulin has been difficult for the last seven months.

"I frequently spend the whole day going from one pharmacy to another," he said. The shortage "has become life-threatening for me daily. It drives me crazy".

Karbala's shortages of drugs and qualified medical professionals are undermining the provision of healthcare in the province.

The problems in Karbala, the Shia holy city located 100 kilometres southwest of Baghdad, reflect the catastrophic effects of the war and corruption on Iraq's healthcare system as a whole.

The country has a centralised system in which drugs and other medical supplies are distributed to the provinces from warehouses in Baghdad, but distribution is often sabotaged by graft and violence.

Many times, Hussein ends up buying his insulin on the black market. That is where much of the drugs and other medical supplies sent to state clinics and hospitals end up, while public facilities suffer shortages of medicines to treat heart disease, high blood pressure, asthma and sedatives, according to Dr Mohammed al-Fartusi, who works in Karbala.

He attributed some of the shortages to corruption in government warehouses in Baghdad, where some employees allegedly steal medicine and sell it on the black market. Another problem is that drugs have sometimes expired by the time they reach the hospitals from the warehouses, he said.

Violence in Baghdad has exacerbated the situation. The ministry's central warehouses in Baghdad are located in Dabbash, and employees of the Shia-run ministry have to cross through the Sunni insurgent stronghold neighbourhoods of Adil and Jamia. Many of them fear going to the warehouses, particularly after two were killed.

Employees "are afraid of being kidnapped or killed by extremist groups", said Salim Kadhim, a ministry of health civil servant.

In a report issued in July, the international medical organisation Oxfam and the NGO Coordination Committee in Iraq called health services across the country "catastrophic". Oxfam stopped working in Iraq in 2003 but supports healthcare organisations inside the country.

The two groups noted that Iraq's state-owned medical supply company, Kemadia, is not providing sufficient supplies for 90 per cent of the 180 public hospitals in Iraq. They maintained that "Kemadia has been crippled by bureaucratic, centralised management and a lack of distribution capacity, while accusations of corruption and sectarian influence have eroded people's confidence in its ability to deliver".

Oxfam and the Coordination Committee in Iraq recommended that Iraq decentralise many of its services, including distribution of medical supplies, particularly because much of the violence is in Baghdad where the central warehouses are located. They argued that to provide better services, local authorities should have power - and larger budgets - to warehouse and distribute medical and emergency supplies.

The current supply of drugs and medical equipment to Karbala is so dire that a report earlier this year by Paul Foreman, former head of the Doctors Without Borders’ mission in Iraq, noted that medics at state hospitals frequently "ask the relative of injured patients to search local pharmacies for blood bags, sutures and infusions before they could start emergency surgery".

Baqir Ali, a 35-year-old teacher, saw cats wandering around the corridors when he took his wife to give birth at one of Karbala's public hospitals. He was equally shocked when the doctor delivering their child asked him to go out to the market to purchase gauze and stitches to prepare for the birth.

"Should I buy a doctor as well?" he asked.

Shortages of doctors are also a major problem. IRIN, the United Nations' humanitarian news agency, has reported that 50 per cent of Iraqi doctors have fled to neighbouring countries.

The province has not tracked how many healthcare professionals have left Karbala, but medical personnel here say that shortages are acute - stemming from not enough doctors being trained locally and the loss of many Sunni Arab doctors who have left the majority Shia province as the sectarian conflict has escalated.

IWPR Middle East Editor Tiare Rath contributed to this report.

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