Iraq's fragmented healthcare system 'at the heart of the struggle to overcome war'

Pharmacies stock out-of-date medicine, while understaffed hospitals leave patients suffering, researcher says

Patients being treated in a hospital in Baghdad, as questions have been raised over how effective Iraq's healthcare system is. AP

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".