A self-rule test at Iraq ministry
Cash and expertise boost Health Ministry even as doctors face kidnapping and threats.
From the look of its freshly renovated offices, and on paper, Iraq's Ministry of Health appears to be the successful poster child for US plans to hand back control of Iraq to Iraqis.
Salaries for health workers have increased and hospitals are being refurbished. A sign inside the ministry prohibits weapons on the "ministerial level" where the top brass have their offices; it's backed up by squads of Rambo-like Western security guards.
The question facing Iraq's freshly reformed ministries is whether the upward trend of improvements - spurred by huge infusions of cash, expertise, and US-driven reorganization - can outpace continued insecurity and a culture of corruption.
"There are a lot of obstacles," says Saad al-Amily, director of the health minister's office, where five phones sit on the desk, CNN plays on a large screen, and an air conditioner yields a deep freeze.
"The ministry was in a miserable situation before the war, then it was looted," he adds. "That was the real struggle till now."
On March 28, this Iraqi ministry became the first to be granted full control by US authorities, who celebrated its turnaround after "more than 30 years of neglect and isolation." Ministers now have control of eight of Iraq's 25 ministries, with more being transferred each week as officials gear up for the June 30 handover of sovereignty.
Health officials like to weigh their spending today against that of Saddam Hussein, whose 2002 health budget of $16 million for 25 million Iraqis amounted to just 64 cents per person. The 2004 budget is $948 million, with an additional $793 million coming directly from the US - all told, a 100-fold increase.
The influx is making a difference at the Al Kadhimiya Teaching Hospital in northwest Baghdad, where large projects are focused on revamping a steam-pipe system critical to sterilization, improving sewer networks, and installing new boilers.
Some $3.5 million has been set aside for the projects, due to begin in a couple of months. The health ministry is spending more than $30,000 per month for maintenance at this facility alone. Monthly salaries have shot from $5 to between $200 and $500.
"We have hope, but slowly," says hospital director Qais Abdulwahab. "Money is key."
Jalal Abed Ali, a doctor at Al Kadhimiya, says he is optimistic, though he has yet to see much improvement. "I have a feeling inside that things are in the right hands, but it needs time," he says. "Germany took two years to reunify. Iraq needs more than that, because of physical and psychological damage."
During the Hussein era, he says, guards used to burn medical supplies, deliberately keeping national stocks low to highlight the negative aspects of UN sanctions. Storekeepers kept drugs until well past their expiry date.
"Rome wasn't built in a day, and you can't take a Baath system with a lot of corruption and fix it in a day," says David Tarantino, a US medical adviser to the ministry. "[Iraqis] have become more optimistic, and are increasingly energized."
At the March handover, CPA and ministry officials said they had delivered 30,000 tons of drugs and medical supplies, 30 million doses of children's vaccines, and achieved "at least prewar" levels at 240 hospitals and 1,200 primary health centers. Officials also say they are on track with plans to halve high infant mortality rates by 2005.
But cash alone can't overcome another problem: rampant insecurity. "Huge amounts" of pharmacy goods loaded onto trucks at Baghdad warehouses several weeks ago never made it to hospitals, says the health ministry's Amily. Unconfirmed estimates stretch as high as 50 percent of the stockpile, though most say the figure is far less.
"We are taking precautions, but with all that, some things happen," says Amily. "We can't forget that this security situation isn't good enough, not just for this ministry but for all the country."
"There are reforms and safeguards being put in place, to make sure that doesn't happen anymore," says Tarantino.
More challenging has been a surge in the past month in kidnappings of doctors and surgeons for ransom that is fueling fear about the future, and pressuring some simply to leave Iraq.
"All of us share the same experience of hating to be kidnapped," says one doctor who asked not to be named, speaking in his Baghdad clinic. Several colleagues have been kidnapped, terrorized, and squeezed for upward of $20,000. All paid; most have left - an option this doctor never considered till now. "We are very soft targets," he says. "A patient enters your exam room, and while you examine them, their partner puts a gun to your head."
Attackers have become increasingly sophisticated. One neurosurgeon - the doctor's close friend - was driving with three other professionals when a black BMW blocked their way. Gunmen asked by name for the surgeon, who was driven off. Four days of negotiations were full of threats before he was released.
"There is no remedy," says the doctor. "The police are weak; the Americans are not stopping it - they only protect themselves."
Three weeks ago, the young son of a surgeon was kidnapped from the car that had picked him up from school. The father was shocked when the head of the gang met him openly to count ransom money. Satisfied, the man promised he and his sons would not be kidnapped again.
"The obvious thing is money," says the anonymous doctor, who adds that his surgeon friend took his terrified son abroad.
"In the past 40 years, I have never been this concerned," he says. "Probably things will improve, but in the next year they will go from bad to worse. People think: If the Americans are here, and things are so weak, what will happen when they leave?"
That is a question that will dog Iraqis until July 1. "It's true there is occupation, but ... we feel that better is coming," says Hamid al-Amiri, deputy director at Al Kadhimiya hospital. "It's the term 'occupation' we want to disappear. But we prefer occupation to Saddam Hussein."