Two invasions, a decade of sanctions, and the occupation largely caused the ruin of Iraq’s medical and public health systems
US Army Soldiers transport a trauma victim to a U.S. Army medical helicopter in Tarmiyah, Iraq, Sept. 30, 2007
Many US union activists remember Falah Alwan. As the occupation of Iraq unfolded in the summer of 2005, he and several Iraqi union leaders traveled here to make clear the impact of sanctions and invasion on his country’s workers. From one union hall to another, on both coasts and through the Midwest, Alwan and his colleagues appealed for solidarity.
In the end, the war’s damage went virtually unhealed, but the ties forged between workers and unions of the two countries have remained undiminished. Last week, as both face the coronavirus pandemic, Alwan wrote to the friends he made in those years. “The news from New York is horrible,” he commiserated. “I believe the days to come will be much worse than they are now, not only in Iraq but for you also.”
In 2005, the Iraqis effectively dramatized the human cost of US policy. Today, as both countries face the coronavirus, the devastating situation of Iraq’s people calls for revisiting that question of responsibility.
On paper, the virus’s toll in Iraq today stands at 1,031 officially confirmed cases, with 64 deaths. While these numbers are still much smaller than the United States’, these cases don’t tell the full story. In Iraq, very few people can access medical treatment, and the number of infections and deaths is almost certainly much higher than that given in official statements.
This past week, Reuters reported that confirmed cases numbered instead between 3,000 and 9,000, quoting doctors and a health official—a report that led the Iraqi government to fine the agency and revoke its reporting license for three months. The higher figure would give Iraq a per capita infection rate higher than that of South Korea, one of the virus’s early epicenters.
Unions and civil society organizations must now try to make up for Iraq’s political paralysis and the partial dysfunction of its government. “Because of our ruined health care institutions,” Alwan explains, “the government hurried to impose a general curfew [a stay-at-home order] to stop the outbreak and a rapid collapse in the whole situation.”
That had an enormous impact, especially on workers. Public employees encompass 40 percent of the workforce, and in theory should still be receiving salaries. But Hashmeya Alsaadawe, head of the country’s union for electricity workers and Iraq’s highest-ranking woman union leader, points out that 80,000 of her members have already gone without wages for months because of the country’s economic crisis. Yet they are expected, and do, show up for work to provide essential services. In oil refineries and state-owned factories, it’s the same situation—essential and unpaid—one of the reasons for the huge demonstrations that have challenged the government since last October.
In the meantime, to stop people from moving within the country, “the main roads were barricaded by concrete blocks,” she says. “While this is necessary, the government did not provide anything for those who earn their living on a daily basis. Shops and markets simply closed.”
“There’s not even a promise of pay for workers losing jobs in the private sector,” Alwan adds. “And more than 7 million Iraqis only have informal work. To survive, they’re obliged to violate the curfew, especially in the slums where 3 million live in Baghdad alone. Authorities have detained more than 7,000 people there, and fined more than 3,000 in Najaf.” Iraq’s population is about 40 million.
War, Sanctions and Iraq’s Health Care System
Economic desperation contributes to the impact of the virus in Iraq, but another factor makes it much more lethal. The spread of Covid-19 is taking place in a country with a devastated health care system. The United States owns a great part of the responsibility for this. Two invasions, a decade of sanctions, and the occupation largely caused the ruin of Iraq’s medical and public health systems.
According to an analysis by the Enabling Peace in Iraq Center, “Before the imposition of international sanctions in 1991, Baghdad operated some of the most professional and technologically advanced health care and public health institutions in the Arab world.” The Ministry of Health operated 172 modern hospitals, 1,200 primary care centers and 850 community clinics, providing free health care with an annual budget of $450 million. While the Iran-Iraq War of the 1980s produced enormous casualties, the infrastructure itself was not attacked.
Public health depends on well-functioning water and sanitation systems, which served 90 percent of the population in the 1970s. This infrastructure was largely destroyed by US bombing in the first Gulf War in 1991. The EPIC report noted, “By March the Tigris River was ‘running thickly and slowly with human waste,’ according to a Baghdad University law professor. An 87-member international monitoring committee reported that in Iraq’s 30 largest cities, electricity, water, and sewage services were close to total collapse.… Deliberate targeting of civil infrastructure by US air strikes, and enduring UN sanctions…dissolved the foundations on which Iraq’s medical infrastructure was built.” In the 2003 invasion, 7 percent of Iraq’s remaining hospitals were destroyed and 12 percent looted in the subsequent chaos.
Over a third of the country’s 52,000 licensed physicians fled during the sanctions period of the 1990s. Then another 18,000, over half of those who had remained, left during the extreme violence that followed the US occupation. That violence especially affected health care workers. Omar Dewachi, a professor of medical anthropology at Rutgers University, says Baghdad’s hospitals were “transformed into ‘killing fields.’” By 2012, Iraq had a third of the doctors, per capita, of Jordan, Syria or even the Israeli-occupied territories.