Healthcare system gasping for breath

Four months into the U.S. occupation of Iraq, this city's hospitals are in disarray, operating mostly through catch-as-catch-can improvisation as patients and their families must so-metimes literally fight for attention in emergency rooms.

Though wartime memories of injured and wounded civilians laid out in hospital corridors are fading, the health care situation remains bleak.

Persistent problems with electrical and water supplies, as well as irregular deliveries of such essentials as anaesthetics and oxygen, continue to plague hospitals, health officials say. Fear of robbery deters some doctors from going to work, and female nurses have virtually disappeared from wards for fear of travelling, especially in the evening.

The hospitals' troubles mirror those in many other areas of the post-war reconstruction programme. While they concede that pre-war Iraqi health care was inadequate, many find it hard to accept that the United States, with its vast wealth and military might, is unable to ensure rapid provision of basic services.

"Certainly, people had it in their minds that things would get better. It is when they need real help that they see the problems and get desperate," said Mohammed Salah, who was injured in the August 7 car bombing at the Jordanian Embassy here.

The three people with Salah, in a passing car as the blast occurred - two Iraqis and a Jordanian driver - were killed. Since the blast tore flesh, nerves and blood vessels away from both his arms, fracturing one of them, Salah has endured a dispiriting odyssey in his search for treatment. A passing motorist took him to Yarmouk Hospital, Bag-hdad's largest.

The day after the blast, when doctors postponed an operation because of a lack of oxygen canisters, Salah became fearful. Three days and two hospitals later, an Italian Red Cross tent hospital agreed to admit him, care for his wounds and fight the infection that threatened his arms and perhaps his life.

"It is like a paradise here," he said from his bed at the field hospital. "This is a confusing period," said Nada Doumani, a spokeswoman for the International Committee of the Red Cross. "It is hard to figure out who is responsible for what. Most hospitals are open, but how they are running is the question."

Doumani said the problems stem partly from occupation authorities' removal of directors who belonged to deposed president Saddam Hussain's Baath Party. Their absence has created administrative confusion in many hospitals. "Iraqis are having pro-blem taking decisions, taking the initiative," she said.

Security is also a crippling problem. Since gunmen ambushed and killed a Red Cross worker driving through central Iraq last month, the Red Cross has curtailed travel, especially late in the day.

American officials seem resigned to maintaining a sort of status quo for the time being and fully restructuring the system later. Jim Haveman, the senior U.S. adviser to the provisional Iraqi Health Ministry, said, "The system is running and basic services are being provided."

The main goal currently is to prevent epidemics, Haveman said. As for the long term, he said, "we're starting from zero."

The American civil administration in Iraq has budgeted $210 million to support hospitals, clinics and forensic laboratories for the final six months of this year. The budget includes funds for drug purchases, repair and maintenance of equipment, child nutritional programs and specialised programmes such a post-trauma stress care.

It has become clear that the United States alone will be unable to rebuild the Iraqi health system and that Iraqi resources will be insufficient for the time being, Haveman indicated. An international donors conference is scheduled for October in Madrid, and organisers hope to attract hundreds of millions of dollars in pledges.

Jalal Massa, a cardiologist who runs the private Samaritan Hospital, one of 40 such small institutions in the city, said that the Hussein-era legacy of corruption hobbles progress.

"There is no need to romanticise the past," he said. "People could get care if they were willing to pay bribes - to ambulance drivers, the doctors, everyone. It might be tempting to go over to an entirely private system... but how many Iraqis can pay?"

Among Baghdad's public hospitals, Yarmouk's shortcomings are typical. It holds 600 beds and is one of the few 24-hour hospitals operating in the city. A visit to its emergency room provides an instant panorama of its burdens.

A bed held a man with a slashed abdomen. A thief who tried to steal his car stabbed him. His wife begged anyone she saw in a white smock to attend to him. No one did.

In another corner, a mustachioed man dabbed with a handkerchief at a gash on his forehead, inflicted wh-en a Yarmouk security guard whacked him with a metal detector because he had resisted being sear-ched.

"We work under all kinds of strange pressures," said Feraz Mohammed Majid, chief of resident physicians.

"Just yesterday, robbers with rifles stole our employee bus as it crossed Jadriya Bridge. Our generator keeps breaking down. For three days, we have had no electricity or water in the doctors' dormitories. We try to find oxygen wherever we can. Sometimes we borrow from other hospitals; sometimes, people bring it in off the streets to sell. They probably buy it from the factory from some corrupt worker.

"Patients and their relatives get angry. They attack the doctors! Still, we do about ten operations a day. Stabbing and gunshots wo-unds are the main things."

A day after the Jordanian Embassy blast, a reporter mentioned Salah's case to doctors at the Italian Red Cross field hospital. The following day, they went to Yarmouk to find him, but he was gone.

Omar Jiggar, a physician on duty, explained: "We told the patient that we were short of oxygen and anaesthetic and could not operate right away. We suggested he go to Al Wasati Hospital."

Salah and his relatives had persuaded hospital officials to use their lone ambulance to ferry him out that morning. But a friend who went ahead by car discovered that Al Wasati would not accept him and directed the ambulance to yet another hospital, Sha-hid Adnan Hayrula.

In the emergency room, a series of doctors inspected him. "First, a plastic surgeon came and said, 'Nothing I can do.' Then another said, 'I don't do broken bones.' Then one came and asked me for documents," Salah recalled.

"So I raised myself up and said, 'I'm dying and no one is doing anything!' "They put me on the seventh floor. Later that day, a doctor said they were going to operate, but that they had to wait for oxygen, like at Yarmouk."

At about the same time, the Italians had located a cousin of Salah's, Ali Adnan. Adnan brought the victim's X-rays to their hospital, and the Italians agreed to visit Salah last Sunday morning.

The Italians operated on Salah's arms on Sunday afternoon, cleaning out deep wounds and sewing up veins. "They saved my life," Salah said.

Suddenly, relatives of Hassan Hussein, the driver of the car in which Salah was riding at the time of the embassy blast, arrived from Jorda