Iraq's health care system: A long list of expensive failures

Almost four years after the toppling of Saddam Hussein, Iraq's healthcare system is still a shambles. While most hospitals lack basic supplies, dozens of incomplete clinics and warehoused high-technology equipment remain as a testament to the US experiment in Iraq. Meanwhile the hospitals are grappling with an unexpected health crisis–the daily toll of bombs and sectarian clashes, which leaves over a hundred dead each day and more seriously injured. In mid-December, dozens of workers for the Iraqi Red Crescent, one of the few groups still operating in the country, were kidnapped in broad daylight from its Baghdad offices, forcing the group to shut down operations in the capital city. The violence has also been directed at doctors, on the assumption that they were wealthy or a part of the strategy of civil war. Since the invasion, 2,000 Iraqi doctors have been murdered and some 250 kidnapped, the Brookings Institution reported in December 2006. Altogether more than half of Iraq's 34,000 doctors have fled the country, some leaving to drive taxis in Lebanon. Even the repair and expansion of existing health care facilities in safe parts of the country was botched, leaving hospital administrators frustrated by the lack of basic supplies and simple training. In Sulamanya, a relatively peaceful and prosperous town in northern Iraq where violence is practically unknown, the engineer in charge of construction at the Health Ministry said in an interview that the California-based engineering company Parsons Global promised $29 million to build five new primary health care centers, one new pediatric hospital and to repair a maternity hospital. The ministry was allowed to select sites but the contractors and the US Agency for International Development (USAID) determined the design and budget. Not one of the primary health centers in the province has been completed. An engineer who was in charge of construction for the ministry, traveled to Baghdad in 2004 to review plans for the new hospital but that was the last time anybody talked about it. Nobody from the Army Corps or the company even visited the proposed site. The only thing completed was a new elevator that the Al Monel company installed in the pediatric hospital. During a site visit to the hospital in Sulamanya in April 2006, a security guard showed this reporter the new elevator large enough to fit a hospital bed. It hadn't worked for a couple of days, he said, because local mechanics didn't know how to fix it. The head technician promised to hire a new mechanic who could. Elevators appear to be Parsons' Achilles heel. At the Najaf Maternity Hospital, a New York Times reporter found that only one of the hospital's four elevators functioned while the others awaited repairs. The company was paid in full in June 2004 to install a new elevator bank at the Hilla General Hospital. When auditors visited the hospital three months later, the administrator reported that just a couple days before, a renovated elevator crashed and killed three people. Most prominent among the long list of failures is the Basra Children's Hospital, which was intended as crown jewel of US aid to Iraq. Instead, it has become a showcase for everything that went wrong. In August 2004, USAID awarded the $50 million contract to build the hospital to Bechtel, a San Francisco-based engineering company, one of the largest engineering companies in the world, which has become synonymous with the building of nuclear power plants, gold mines and large projects like the new Hong Kong airport. The idea was to create a state-of-the-art facility to treat childhood cancer, a pressing need in a city where cancer rates have skyrocketed following the first Gulf War. (Contested data link the rise in cancer to extensive US use of depleted uranium weaponry in the region.) The facility, championed by the First Lady Laura Bush and Secretary of State Condoleezza Rice, looked suspiciously like a political propaganda effort. And as with much US aid, it was designed with little local consultation: the city lacked clean water and already had a leukemia ward where lack of funding means that each bed is shared by two or three children. The hospital was planned by Project Hope, a charity headed by John P. Howe III, president of the University of Texas, San Antonio, and a family friend of George W. Bush. Project Hope had built similar hospitals in Poland and in China. Howe pushed the project after Rice and Bush invited him to visit Iraq to assess the country's healthcare system. Before construction began in August 2005, the project attracted skeptics, who were concerned that it was a white elephant. Republican Congressman Jim Kolbe wondered: "Why build a hospital for kids, when the kids have no clean water?" But it went ahead: No new technology would be spared in this showcase facility featuring 94 beds, private cancer suites, CAT scans, and a linear particle accelerator for radiation therapy. But like so many US-initiated projects, the money to build this facility would disappear when things went wrong. A year after the August 2005 groundbreaking, the project became a target for attacks, according to the company. The price tag rose from $50 million to an estimated $169.5 million. Cliff Mumm, president of the Bechtel infrastructure division, predicted that the project would fail. "It is not a good use of the government's money to try to finish the project," Mumm told the New York Times. "And we do not think it can be finished." In July 2006, Bechtel was asked to withdraw from the project, which is now on hold. USAID spokesman David Snider's cheerful spin on the stall was that the contract did not actually require the company to complete the hospital. "They are under a 'term contract,' which means their job is over when their money ends... [so] they did complete the contract."