Peter Kandela

When someone seems to have more than their fair share of problems, there is
an Iraqi saying that on top of blindness, their eyes are now infected. I
thought of this frequently during my recent visit, when it seemed that
nature was hurling additional hardships at a people already worn down by the
effects of the UN sanctions.

April should have been a month of pleasant spring weather but this year
summer arrived early and the daytime temperature soared to 400C. The
electricity supply remains poor and power is cut off for hours on end every
day, so that even those people who still have fridges and freezers have
problems in keeping food fresh. The heat was accompanied by fierce
sandstorms every couple of days, brought about by the abnormally low
rainfall.

The effect was that of a dense fog and anyone venturing out came home coated
with sand. For people with asthma and other chronic lung problems this
situation was intolerable, and the demand for oxygen was so great that one
day during my visit, government hospitals ran out completely. Patients were
forced to contact private clinics in search of oxygen, and in one such
hospital I saw staff prioritising children in their allocation of the
increasingly scarce supplies.

While I was there, one mother returned to the hospital with her new baby,
asking whether the date of birth could be changed from April 27 to April 28
on the birth certificate. The latter is the birthday of Saddam Hussein and
the government had announced that all babies born on this "auspicious birth
date" were entitled to a presidential "hiba"--a cash gift worth about US$50.
When the medical officer explained that the birth certificate could not be
altered she left in tears cursing her luck and that of her new born child.

Statistical evidence of the effects of sanctions on the Iraqi people and
particularly on children, are at last being published and reaching a wider
audience (see p 1851 ) but nothing can prepare you for the lives that
children now lead. In the terrible afternoon heat, I saw children playing in
what looked like a crater filled with water from a burst water main. In
fact, it was one of the many broken sewage pipes in the city and these
children were cooling themselves in a stinking cesspit. This was in a
residential area, just a mile or so from the presidential palace.

Children are also seen all over the city scavenging on rubbish heaps. In the
past, I was concerned about the environmental hazard of rubbish being
collected and burned on street corners but now things are even worse as
children are exposed to dirt and disease looking for any items of value in
other people's rubbish. They search in particular for empty containers of
proprietary goods such as soft drinks, shampoo, and tomato puree, which can
be reused by manufacturers of counterfeit goods. This production of
adulterated goods is now such big business, that the government is offering
rewards to anyone who informs on those involved.

Child labour has increased dramatically to supplement the family income, and
to cut the cost of schooling. At Al-Najjat school, one teacher told me about
two brothers who attended school on alternate days, because they only had
one pair of shoes between them. At the other end of the education ladder, I
was surprised to see two university lecturers incongruously dressed in
obviously new suits. Apparently the government had become concerned at the
shabby appearance of lecturers--most of whom are doing two jobs just to
survive--and decreed that they should be given two new suits each summer and
winter. This will not be sufficient to stop the drastic decline in staffing
levels.

About 80% of the staff of the College of Agriculture at Baghdad University
have left the country. Those professional workers who choose to leave the
country cannot take their money with them and become in effect economic
refugees, but several Arab countries are warmly welcoming them because of
the expertise they bring. Their loss will be keenly felt when Iraq is
finally rebuilt (see Lancet 1999; 353: 1861).

Doctors too are leaving, although when I visited the Kadhimiya hospital I
was surprised to find some improvement in the fabric of the building and the
facilities. The reason is that hospitals are now required to be "self
financing", with patients charged for attendance at outpatients clinics, and
for surgery and other treatment. The income received has helped to improve
facilities, but what of those who cannot afford to pay? Only some teaching
hospitals are permitted to offer free care, so these are the only option for
the poor. In the end, waiting lists will be so long that those who cannot
pay will have little realistic hope or expectation of receiving treatment.

The requirement to pay does not stop with hospital fees. I was horrified to
see a patient "tipping" a nurse to bring a bedpan. This practice may have
been originally intended to buy preferential care on the wards but in some
hospitals it has developed to the extent that staff withhold services unless
paid by the patient. Health workers, like other workers, barely earn enough
to feed their families, and cannot be blamed for the falling standards and
corruption which are found as much in hospitals as in the rest of society.

This is the tragedy of Iraq. A once-prosperous country, its doctors,
engineers, and teachers are leaving. Children who should be at school are
scouring rubbish heaps and keeping cool in cesspits, and when they get ill
there will be no treatment for them. These are the next generation, and who
will blame those who survive to adulthood if they react with bitterness and
fury against those they deem responsible.