One trauma-stricken eyewitness, Ahmed al-Saedi*, described to New Lines what happened inside Ibn al-Khatib hospital, in northeast Baghdad, on the evening of April 24. The old and dilapidated health facility had been transformed to care for COVID-19 patients, but within minutes, the sanctuary turned into a chamber of fire, mercilessly devouring patients and their families as well as some medical staff.
Al-Saedi described a woman screaming with self-abasement for bringing her father to the hospital only for him to be caught in the flames. “Ya waili,” she shouted — an Iraqi expression of grief that translates roughly as “my agony.” “Ya waili, oh father, I brought you to death with my own hands.”
The enormity of the hospital fire was such that you might be forgiven for forgetting this is Iraq, a country accustomed to almost daily instances of horror and tragedy. Why and how did this happen? Iraqis want to know.
Al-Saedi, who lives near the hospital, said the fire started by the very thing meant to save the lives of these COVID-19 patients: oxygen. In a corridor on the second floor, about an hour and a half after iftar, the breaking of the Ramadan fast, an oxygen cylinder exploded. The hospital lacked a fire suppression system, which allowed the flames to tear through the facility, as well as catch the remaining cylinders, which then exploded, too. There weren’t even emergency exits for patients to escape.
Ibn al-Khatib hospital was founded in 1959 and opened in 1962. It has not been developed or renovated since.
People from nearby neighborhoods rushed to aid the patients and their families. Ambulances did not arrive until after fire had taken out most of the floors and facilities of the hospital. “It was very hard helping the patients in recovery,” says al-Saedi. “They were attached to supporting devices, and disconnection would have killed them.” To make matters worse, most patients in the recovery room were senior citizens who could not easily move and lay at the mercy of the oxygen. Some died as rescuers disconnected the breathing aid devices, while others choked to death on smoke. More than 20 Civil Defense units of the government attempted to put out the flames and save whoever they could. By the end of that fateful night, 82 Iraqi civilians were dead and more than 110 were injured, some permanently.
The Iraqi government announced three days of mourning and an investigation into the incident. Dr. Hassan al-Tamimi, Iraq’s health minister, resigned. Yet no one believes Baghdad will hold anyone to account for such gross negligence. The health minister submitted his resignation over the incident amid public pressure, and Iraq’s Prime Minister Mustafa al-Kadhimi approved, but mismanagement and greed will continue to triumph in modern Iraq as long as the current system, entangled in patronage, does not reform.
Al-Tamimi belongs to Shiite cleric Muqtada al-Sadr’s movement — and his boss wasted no time indulging in conspiracy theories about the cause of the Ibn al-Khatib inferno. It was “arson,” al-Sadr said, and the phantom perpetrators simply wanted to undermine the Sadrists who have long held control over Iraq’s Health Ministry, monopolizing its facilities, systems, and even medical equipment since the collapse of Saddam Hussein’s regime. For the past 18 years, all but two ministers of health have been selected, as Iraqis put it, from under Muqtada’s abaya (a robe-like garment worn by Muslim women) while the ministry’s various directories are fully under Sadrist control.
During this time, health services in Iraq have deteriorated to the point that patients fear going to hospitals, every one of which was built during or before Saddam’s era. The bricks are from the ‘50s; the equipment is from the ‘80s. There has been little to no development in the health sector, even amid a pandemic that has severely affected Iraq’s population: There have been over a million confirmed cases and upwards of 15,000 deaths, with around 4,000 new infections being recorded each day for the last two weeks.
Relying on public health care is a risk that Iraqis nevertheless must take because not everyone can afford the soaring cost of private health care
Relying on public health care is a risk that Iraqis nevertheless must take because not everyone can afford the soaring cost of private health care, an industry rife with corruption and payola schemes. The politicians who might have prevented the Ibn al-Khatib tragedy lined their pockets by arranging for private hospitals in Iraq to hire the best foreign doctors and adhere to the most exacting modern medical standards of practice. Most Iraqis can’t afford the bills of such state-of-the-art institutions and so must opt for decrepit public facilities where rats run free, beds are scarce, and medicine beyond painkillers is almost impossible to come by. “Buy it from the pharmacy outside the hospital,” is a common refrain in Iraq’s public hospitals.
The country’s health care system is a forbidding mix of the worst forms of socialist and capitalist models. Insurance does not exist; instead, public hospitals demand a very low copay at registration and, as most patients will attest, they get what they pay for. Drugs and prescription medication are supposed to be provided at the public facilities but rarely are because of low or nonexistent supplies. Private hospitals are allowed to operate without a limit on how much they can charge, and yet the government refuses to help citizens defray the costs because they are — theoretically — entitled to free health care. Iraq’s upper class thus stays healthy while the middle and lower classes die from easily treatable diseases or from avoidable acts of malpractice.
And even those who make it through treatment regimens or surgeries alive are then forced to face Iraq’s recovery rooms, such as the ones in which the Ibn al-Khatib victims burned up.
Suha Ahmed took her late mother to the Yarmouk hospital in Baghdad after her blood pressure suddenly increased. The first shock came when they saw all the beds occupied, sometimes shared by two patients. A third patient would have their back to a wall stained with dry blood and be forced to lift an arm to elevate the IV as a makeshift pole stand. “For over an hour all the beds were occupied,” Suha says.
“I was frantically looking for medicine to control my mother’s high blood pressure, but it was not available. The nurse told me my mother was unlucky and that her blood pressure should have gone up earlier to find a bed and the needed drugs. Then a bed was vacant when a patient died. His family carried his body weeping and crying. The nurse shouted to us: ‘Bring the old lady here.’ Yes, minutes after someone had died, we brought my mother to the same bed.”
Suha’s mother suffered for a few hours and died due to the lack of basic medicine.
Layla says that Al Za’faraniya hospital is more a facility for rodents than people; mice compete with patients for beds. Layla’s daughter broke her arm and had the misfortune of being treated there. “Everything was awful,” Layla says. “I don’t know where to start: from the nurses who only saw us as pockets to pick, to the exhausted doctors who could not operate beyond their capacity, to the mice that would run around comfortably. We were startled when we saw a mouse crawl from under the pillow used by a patient!
“Where is all the money allocated from the budget to the Ministry of Health?” Layla asked. “Where is the money going if the number of mice in hospitals is more than the number of pill bottles?”
Where sick Iraqis don’t have to navigate vermin, they have garbage, used needles, and dirty beds to contend with.
Dr. Saad, a resident at one of Iraq’s public hospitals, says he feels helpless and regrets not emigrating: “The equipment is usually outdated. The operation rooms are old, and the lighting is agitating. Sometimes we delay a simple procedure because the basic tools are not available. We buy surgical gloves and masks with our own money. The ministry justifies its deficiency by shifting the blame to the lack of budget, but how is it our fault when a patient dies because of a lack in basic treatment? We (doctors) are the ones getting physically beaten and threatened.”
Saad says that some families can’t comprehend that their loved ones died because the Health Ministry is incompetent or crooked, and so they find it easier to blame the doctors. “Doctors are only soldiers. Who sends a soldier to the battlefield without weapons?” Saad asks. “How can we save lives with equipment that does not work? There is not one respiratory assist device in the entire hospital I work in. Should we buy that, too?”
In 2018, there were more than 10 incidents of fires in health facilities. (In April alone, two massive hospital fires broke out in Iraq before the Ibn al-Khatib catastrophe: al-Khansa hospital in Mosul and al-Hakeem hospital in Najaf, although no deaths at either were reported.) In 2016, at least 12 newborns died and nine were severely injured in Yarmouk hospital when an electrical malfunction led to a massive fire near the delivery rooms. This disaster occurred during Adeela Hmoud’s tenure as health minister.
The only female health minister in Iraq’s history, Hmoud was nicknamed “the minister of death” by her own people. The corruption during her time may not have been the worst, but it was the most visible and tangible. She and Dr. Jaafar Allawi were the only health ministers who were not members of the Sadrist movement.
Hmoud is affiliated with Nouri al-Maliki’s “State of Law,” but sources inside the ministry confirm that most contracts would be reviewed and approved by Sadrists, whose reach in the health ministry goes beyond assigning the minister. The former deputy minister Hakim al-Zamili is a Sadrist accused of corruption by prominent Iraqi figures. Even at the local level, Sadrists dominate the health industry. Jasb al-Hajjami, the health director of Baghdad’s Karkh district, who is rumored to be the next minister, is also a Sadrist.
Like fire, corruption consumes everything in its path. The health director of Karkh district claimed that Yarmouk hospital was old, and though there were fire extinguishers, there was no sprinkler system. As to why there are no modern systems to maintain the minimal standards of safety, the answer is known, and officials are comfortable enough with the “don’t ask, don’t tell” approach.
Under Hmoud, the health industry was notorious for its graft. It imported 26,000 medical slippers from Portugal, which sell in Iraqi markets at $2 a pair but were purchased at $27. The contract topped $900 million, enough to build more than one new hospital. The money, as everyone knows, lined the pockets of the Sadrists. Another contract for $23 million was for importing bed covers. Had these millions been spent on vital necessities, they might have saved thousands of lives.
Various ministers have assumed the highest role in Iraq’s health services since Saddam’s overthrow in 2003, but none has offered, or merely suggested, any solutions to help medical staff or improve hospitals. “The irony is that all the ministers are followers of the self-proclaimed Patron of Reform, Muqtada al-Sadr,” Saad says. “What reforms when all hospitals are threatened to face a disaster similar to Ibn al-Khatib?”
*All names in this report have been changed for safety reasons.