Iraq’s corrupt healthcare system lies at the centre of the country’s failure to overcome conflict, an expert has said.
Citizens of the fifth oil-richest nation in the world struggle to access basic medicine and treatment for conditions and injuries under a network blighted by inadequacy and upheaval.
Medicine destined for public use too often ends up being sold for private profit in under-the-table deals in which the Iraqi upper-class benefits at the expense of the poor. What is left for the public health system is often unusable because it has expired or is not genuine.
War, UN sanctions, sectarian battles and the rise of ISIS have made for a lethal concoction of problems that have led to a years-long crisis in Iraq’s healthcare system.
Damage to infrastructure, a shortage of medicine, corruption in supply chains and doctors fleeing have piled immense pressure on the nationwide institution.
In a new report, Renad Mansour, Iraq researcher at Chatham House in London, said this type of privatisation had "led to the proliferation of fake and expired medicine, which offer greater profit margins for this elite”.
He cited examples of Iraqis searching to find the necessary health care for themselves and their loved ones, such as a mother unable to source treatment for her son’s haemophilia.
“In a country which has struggled to stabilise after decades of wars — the most recent being the capture of one third of Iraqi territory by Islamic State (ISIS) — it is understandable that medicines may not be seen as a priority issue,” he said in a report published on Chatham House’s website. “But these stories show medicine lies at the heart of Iraq’s failure to overcome conflict.”
Since the 1970s Iraq has been home to a free government-run public healthcare system, upon which the majority of citizens rely.
Fewer than 5 per cent of Iraqis have health insurance and hose who do have the means often choose to travel abroad for treatment.
There are about 230 hospitals to serve a population of 41 million, according to data from the World Health Organisation (WHO).
The US-led invasion of Iraq in 2003 and years of fighting thereafter led to more than one in 10 hospitals being destroyed.
Over the past decade, as Iraq has tried to rebuild, the government pumped more money into the healthcare system. Between 2003 and 2010 spending on health jumped from 2.7 per cent of GDP to 8.4 per cent, the World Bank said.
But the system is failing millions of Iraqis in dire need of medical care and the country spends far less on health than other Middle Eastern nations.
Mr Mansour said “even fake drugs are desirable to desperate Iraqi patients”, who lack the financial means to afford trustworthy alternatives.
The lack of equality, he said, means “poor Iraqis are forced to turn to the lowest-cost option for health care despite knowing it is poor quality”.
Foreign companies looking to ship medicine to Iraq face a long, drawn-out process. It entails gaining approval from local health representatives on Iraq’s border, which sometimes involves favouritism and political bias.
If the firm manages to gain approval, the process of getting the equipment into Iraq is not easy. Many end up paying bribes to border officials to have cargo pass through sea, land and air borders at a faster pace.
At checkpoints staffed by Iraqi officials, the medicine is divided into smaller batches for domestic transportation. This leg of the journey is not simple as the “formal” part of the trade is “largely controlled by those with links to ruling parties”.
Mr Mansour said the “informal” part of the deals can involve armed groups using their political and economic links in Baghdad and military weight to distribute medicine across networks of pharmacies.
“Those which refuse to pay fees or which take product from other wholesalers risk the threat of violent intimidation,” he said.
The reality is far from that experienced by Iraqis in the 1970s, when neighbouring nations looked upon the country as an example when it came to healthcare.
Iraq was the region’s second country, after Egypt, to enter the pharmaceutical industry. One of its state-owned medicine factories was destroyed after the rise of ISIS while the other continues to operate but with outdated equipment.
Two years after the 2003 invasion, a government probe found “bribery, nepotism and theft” were rife within the healthcare system.
Amir Batrus, who led the inquiry, said corruption in the system had been a problem under dictator Saddam Hussein, "but the deteriorating security situation and an absence of regulation has seen it increase".
Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
GRAN%20TURISMO
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TO ALL THE BOYS: ALWAYS AND FOREVER
Directed by: Michael Fimognari
Starring: Lana Condor and Noah Centineo
Two stars
The%20BaaS%20ecosystem
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Avatar: Fire and Ash
Director: James Cameron
Starring: Sam Worthington, Sigourney Weaver, Zoe Saldana
Rating: 4.5/5
The%C2%A0specs%20
%3Cp%3E%3Cstrong%3EEngine%3A%20%3C%2Fstrong%3Etwo%20permanent%20magnet%20synchronous%20motors%3Cbr%3E%3Cstrong%3ETransmission%3A%20%3C%2Fstrong%3Etwo-speed%3Cbr%3E%3Cstrong%3EPower%3A%20%3C%2Fstrong%3E625hp%3Cbr%3E%3Cstrong%3ETorque%3A%20%3C%2Fstrong%3E850Nm%3Cbr%3E%3Cstrong%3ERange%3A%20%3C%2Fstrong%3E456km%3Cbr%3E%3Cstrong%3EPrice%3A%20%3C%2Fstrong%3Efrom%20Dh737%2C480%3Cbr%3E%3Cstrong%3EOn%20sale%3A%20%3C%2Fstrong%3Enow%3C%2Fp%3E%0A
THE 12 BREAKAWAY CLUBS
England
Arsenal, Chelsea, Liverpool, Manchester City, Manchester United, Tottenham Hotspur
Italy
AC Milan, Inter Milan, Juventus
Spain
Atletico Madrid, Barcelona, Real Madrid
Tree of Hell
Starring: Raed Zeno, Hadi Awada, Dr Mohammad Abdalla
Director: Raed Zeno
Rating: 4/5
BAD%20BOYS%3A%20RIDE%20OR%20DIE
%3Cp%3E%3Cstrong%3EDirector%3A%3C%2Fstrong%3E%20Adil%20El%20Arbi%20and%20Bilall%20Fallah%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EStarring%3A%20%3C%2Fstrong%3EWill%20Smith%2C%20Martin%20Lawrence%2C%20Joe%20Pantoliano%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3ERating%3A%3C%2Fstrong%3E%203.5%2F5%3C%2Fp%3E%0A
Islamophobia definition
A widely accepted definition was made by the All Party Parliamentary Group on British Muslims in 2019: “Islamophobia is rooted in racism and is a type of racism that targets expressions of Muslimness or perceived Muslimness.” It further defines it as “inciting hatred or violence against Muslims”.
COMPANY%20PROFILE
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Quick pearls of wisdom
Focus on gratitude: And do so deeply, he says. “Think of one to three things a day that you’re grateful for. It needs to be specific, too, don’t just say ‘air.’ Really think about it. If you’re grateful for, say, what your parents have done for you, that will motivate you to do more for the world.”
Know how to fight: Shetty married his wife, Radhi, three years ago (he met her in a meditation class before he went off and became a monk). He says they’ve had to learn to respect each other’s “fighting styles” – he’s a talk it-out-immediately person, while she needs space to think. “When you’re having an argument, remember, it’s not you against each other. It’s both of you against the problem. When you win, they lose. If you’re on a team you have to win together.”
THE BIO
Favourite car: Koenigsegg Agera RS or Renault Trezor concept car.
Favourite book: I Am Pilgrim by Terry Hayes or Red Notice by Bill Browder.
Biggest inspiration: My husband Nik. He really got me through a lot with his positivity.
Favourite holiday destination: Being at home in Australia, as I travel all over the world for work. It’s great to just hang out with my husband and family.
COMPANY%20PROFILE%20
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Jetour T1 specs
Engine: 2-litre turbocharged
Power: 254hp
Torque: 390Nm
Price: From Dh126,000
Available: Now
Our legal columnist
Name: Yousef Al Bahar
Advocate at Al Bahar & Associate Advocates and Legal Consultants, established in 1994
Education: Mr Al Bahar was born in 1979 and graduated in 2008 from the Judicial Institute. He took after his father, who was one of the first Emirati lawyers
Nayanthara: Beyond The Fairy Tale
Starring: Nayanthara, Vignesh Shivan, Radhika Sarathkumar, Nagarjuna Akkineni
Director: Amith Krishnan
Rating: 3.5/5
COMPANY%20PROFILE
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KILLING OF QASSEM SULEIMANI
SERIES INFO
Afghanistan v Zimbabwe, Abu Dhabi Sunshine Series
All matches at the Zayed Cricket Stadium, Abu Dhabi
Test series
1st Test: Zimbabwe beat Afghanistan by 10 wickets
2nd Test: Wednesday, 10 March – Sunday, 14 March
Play starts at 9.30am
T20 series
1st T20I: Wednesday, 17 March
2nd T20I: Friday, 19 March
3rd T20I: Saturday, 20 March
TV
Supporters in the UAE can watch the matches on the Rabbithole channel on YouTube
Groom and Two Brides
Director: Elie Semaan
Starring: Abdullah Boushehri, Laila Abdallah, Lulwa Almulla
Rating: 3/5
SQUADS
Bangladesh (from): Shadman Islam, Mominul Haque, Soumya Sarkar, Shakib Al Hasan (capt), Mahmudullah Riyad, Mohammad Mithun, Mushfiqur Rahim, Liton Das, Taijul Islam, Mosaddek Hossain, Nayeem Hasan, Mehedi Hasan, Taskin Ahmed, Ebadat Hossain, Abu Jayed
Afghanistan (from): Rashid Khan (capt), Ihsanullah Janat, Javid Ahmadi, Ibrahim Zadran, Rahmat Shah, Hashmatullah Shahidi, Asghar Afghan, Ikram Alikhil, Mohammad Nabi, Qais Ahmad, Sayed Ahmad Shirzad, Yamin Ahmadzai, Zahir Khan Pakteen, Afsar Zazai, Shapoor Zadran