Views & Reviews Personal View

The killing of doctors in Iraq must stop

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4467 (Published 13 July 2011) Cite this as: BMJ 2011;343:d4467
  1. Nisreen A Alwan, clinical research fellow and specialist registrar in public health, University of Leeds and graduate of Baghdad Medical School, 1998
  1. n.alwan{at}leeds.ac.uk

On 29 March 2011 Professor Mohammed Alwan, dean of Al-Mustansiriya Medical School in Baghdad and my uncle, was assassinated. A bomb was planted in his car and exploded as he got in after leaving his medical practice. He was a distinguished academic and surgeon who was respected by his students, and he was a fellow of the Royal College of Surgeons of England. Within a week, another clinical academic from the same institution—Dr Zaid Abdul Munim, head of research at the molecular department—was killed with a similar technique.

These are not isolated incidents. Assassinations and kidnapping of Iraqi doctors, academics, and scientists are now part of everyday life in Iraq, particularly in Baghdad. This phenomenon started after the 2003 US led invasion of the country. One study estimated the combined rate of violent event (death, kidnapping, and threats) among specialist doctors in Iraq in 2004-7 to be 3.7%, and the rate of violent death at 1.6% (Social Science and Medicine 2009;69:172-7, doi:10.1016/j.socscimed.2009.05.021). There seems to be a systematic targeting of the brightest, most distinguished, and most highly regarded doctors and scientists. The Spanish Campaign against the Occupation and for the Sovereignty of Iraq (Iraq Solidaridad) listed the names and affiliations of 314 university academics assassinated in Iraq since 2003. Other sources, such as the Iraqi Medical Association, report a higher figure of about 500. As a consequence, the people whom Iraqis desperately need to help rebuild their country are fleeing in fear for their lives and their families’ safety.

Before 2003 Iraq’s higher educational system, including medical training, was still well regarded despite years of repression on the part of the regime, neglect, and international economic sanctions. Currently, medical training is suffering enormously in Iraq, with students and academics facing daily threats and junior doctors leaving without proper training and leadership. According to the 2008 Medact report on Iraq’s healthcare, about three quarters of doctors, pharmacists, and nurses have left their jobs since 2003, with half of them leaving the country. About 9000 doctors remain to serve a population of 28 million people, a ratio of only six doctors to every 10 000 citizens, compared with 23 to every 10 000 in the United Kingdom (www.medact.org/content/violence/MedactIraq08final.pdf). This has resulted in rapid deterioration of the already strained healthcare services by rendering health facilities, acute and primary care, short of staff. The health situation in Iraq is not showing any improvement. The mortality rate for people aged 15-59 is soaring, at 222 per 1000 adults, compared with the global average of 176 and the regional average of 188, according to the World Health Organization (www.who.int/gho/countries/irq).

Why has this brain drain been happening for the last eight years? And who is responsible? Unfortunately, the Iraqi government has displayed neither authority nor effectiveness in protecting Iraq’s brightest minds. The killers are not being brought to justice and therefore are not deterred from committing more crimes. In the early years after the 2003 invasion, the perpetuators were more or less known as terrorist and extremist groups. However, now the picture is fuzzy, and it is hard to attribute these criminal acts to a particular group or ideological front. Most of those assassinated did not have any political affiliations or activities. The reasons for the killings are unknown; but these actions can only benefit those who want Iraq to continue drowning in a sea of corruption and civil war.

This problem needs collective action from Iraqis inside and outside the country. International and national medical and scientific organisations must join forces to raise awareness and condemn these atrocities. For example, the Brussels Tribunal has started a campaign and a petition aimed at stopping the assassinations of Iraqi academics (www.brussellstribunal.org/Academics.htm). The first step to tackling this problem is to establish a fair, transparent, and effective legal process of enforcing justice.

Doctors such as Professor Alwan are what the medical profession really stands for. While most of us do our jobs in safe and supportive environments, they risk their lives daily in settings in which honesty, integrity, and hard work are sometimes punished with death. I salute the doctors and scientists of Iraq for fighting every day for what they believe.

Notes

Cite this as: BMJ 2011;343:d4467

Footnotes

  • I thank Zaed Z R Hamady, academic specialist registrar in general surgery, Leeds Teaching Hospitals NHS Trust and graduate of Baghdad Medical School, 1996.

  • Competing interests: None declared.

  • Provenance and peer review: Not commissioned; not externally peer reviewed.

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