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Iraqi hospitals prove unwilling to treat injured soldiers

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7570.673-a (Published 28 September 2006) Cite this as: BMJ 2006;333:673
  1. Roger Dobson
  1. Abergavenny

    Iraq's Ministry of Health has obstructed access to care for injured members of the Iraqi armed services, a new report says.

    Politics, lack of leadership, and a cultural bias against treating soldiers in civilian hospitals have hindered access to care for wounded members of Iraq's armed forces, says the article, which was published online on 19 September in the World Journal of Surgery (http://www.springerlink.com).

    Many of the wounded soldiers, it says, are being treated by American doctors. “US surgeons are providing trauma care for Iraqi soldiers in American field hospitals, with more than 80% of hospital bed days occupied by Iraqis.”

    The authors say it is imperative that the new Iraqi government and the international surgical community strongly endorse the implementation of a single healthcare system for all Iraqis.

    “Medical support for Iraqi security forces is facing major challenges that may limit the effectiveness of military and police units in conducting operations and could impede the ability of Coalition Forces to begin withdrawing personnel in 2006,” write the authors, Jon Bowersox and Shakir Al-Ainachi

    Dr Bowersox, a trauma surgeon, served as the adviser on clinical operations to the Iraqi health ministry during 2003 and 2004 and returned to Baghdad last year as the health attaché and senior adviser on health sector reconstruction at the US embassy. Dr Al-Ainachi, an orthopaedic surgeon, was a brigadier general in the Iraqi army until 2003, when he became director general of clinical operations at the Iraqi Ministry of Health before returning to clinical practice in Baghdad.

    They say that over the years Iraq's armed forces developed an independent health system that was widely regarded as the best in the country but that when the military structure was dissolved in 2003 more than 20 000 uniformed health personnel lost their jobs, and 31 military hospitals were either abandoned or destroyed by looting.

    The report says that the biggest impediments to medical care for Iraqi security forces are the politicisation of healthcare delivery, inexperienced leadership in Iraqi ministries, and ineffective recruiting, training, and use of military medical personnel.

    Of one minister the report says, “He has openly expressed his beliefs that the ministry cannot care for Iraqis serving in the military because the health care system harbours deep-seated resentment of the military that will take a generation to overcome.

    “Consequently, the Ministry of Health has obstructed access to care for ill and injured members of the Iraqi Security Forces, and has delayed filling orders for medical equipment and supplies needed by the Iraqi armed forces.”

    It says the minister has endorsed the creation of a parallel military health system with four tertiary care hospitals. It adds that the military has recruited less than 15% of the doctors needed to support a force of more than 270 000.

    “It is incumbent on all forces in Iraq, political and military alike, to recognise the neutrality of medical facilities and personnel and to accept that care must be rendered regardless of circumstances. Physicians, as the respected leaders in Iraq's health system, must welcome all Iraqis into Ministry of Health hospitals and clinics and set the example for compassionate care and not discrimination. To do otherwise will only prolong the civil strife and suffering that have wreaked havoc in Iraq for more than 35 years,” concludes the report.

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