‘We’re treating patients in caravans’: corruption and neglect intensify Mosul’s coronavirus crisis

Special report: Frontline health workers in Iraq’s second city are falling sick and coming under attack as a battered health system verges on collapse

Al Batool Hospital in Mosul, where many war-damaged medical facilities are operating out of caravans. Courtesy: Facebook

The doctor stood in his green scrubs and watched as a civilian frantically pumped at the lifeless man’s chest in the hospital forecourt. As bystanders gesticulated at the medic, he walked away from the stretcher. They gave chase, and the first to reach him lunged with a kick, a punch and a push.

The assault at eastern Mosul’s Shifaa Hospital in July, captured on CCTV, is just one of a series of attacks on medics in the northern Iraqi city since the Covid-19 outbreak began.

At the Ibn Sina hospital in the city’s west, the coronavirus attacks the patients and, when they succumb to it, their relatives attack the medics who tried to save them with minimal resources.

“We are used to the fights and people shouting,” said Fayez Ibrahim, the hospital’s general manager. “This is done to show their families that they’ve done something to help save their lives.”

Ibn Sina’s emergency department has just 30 beds but has been receiving up to 300 patients a day, Mr Ibrahim said. Those admitted are usually at the most critical stage of the disease, leaving the medics helpless to save them and facing the wrath of patients' families.

At least 12 doctors and activists from Iraq's second city interviewed by The National, many who asked not to be identified for fear of government or militia reprisals, say this anger is misplaced.

They speak of an underreported crisis of great proportions, one spiralling out of control because of a shortfall of equipment, support and services. They say the lack of medical facilities has been exacerbated by a four-year occupation by ISIS militants, state corruption and neglect by local and national authorities.

Heavy bombardment during the battle to wrest Mosul from ISIS, which ended in December 2017, left the city’s medical facilities in tatters. Medical workers faced up to the threat of attacks at hospitals throughout the campaign, especially women, and Red Crescent ambulances were routinely looted.

Now the city’s medics are having to use ill-equipped, makeshift facilities to cope with the demand for treatment of Covid-19 patients. The national art gallery of Nineveh, the province in which Mosul lies, has been converted into a quarantine site and at least two medical facilities are now operating out of caravans.

Health workers have the capacity to conduct only 200 tests a day, according to activists and medics, meaning Mosul’s coronavirus crisis could be much worse than reported. Mr Ibrahim said bed space has fallen from 1,800 before the ISIS occupation in 2014 to less than 1,000 at present.

“The main problem we are facing is working in a hospital that has the right facilities to cater to a patient's needs: in Mosul, we don’t have that option,” said Okba Al Obeidi, a cardiovascular surgeon.

“We are now in 2020 and we don’t have proper hospitals, we are treating patients in caravans.”

The flood of Covid-19 cases has led to patients lying in hospital corridors or outside, activists say. Medics say they are unable to treat illnesses such as cancer, diabetes or leukaemia.

Iraq has recorded at least 467,000 cases of Covid-19, including 10,815 deaths. Precise numbers in Mosul are harder to come by but those interviewed said hundreds of cases were being reported daily.

NGOs warn the situation will only get worsen unless the Iraqi government acts.

“The health sector in Mosul is affected by years of conflicts and violence, it is hard to cope with the increasing numbers of Covid-19 cases in the city, especially since most health facilities are still damaged,” said Sahar Tawfeeq, spokesperson for the International Committee of the Red Cross, which has helped to repair some health facilities and is providing protective equipment to medics in the city.

But the medics and activists say another obstacle stands in the way of Mosul reaching the capacity required: rampant corruption.

Muslawis point the finger at the highest levels of government as well as local officials, accusing them of striking deals that line their pockets and risk the health of the residents. The former governor of Nineveh, Nawfal Akoub, was arrested last month along with officials close to him for allegedly embezzling $64 million of public funds.

The money had been designated for the reconstruction of Mosul, including the rebuilding of two hospitals and support for those who lost their homes in the war against ISIS. Mosul mayor Zuhair Al Araji has had several charges of corruption levelled against him by various Iraqi officials, but remains in power. The National was not able to reach Mr Al Araji for comment on the matter.

“Corruption is rife in the health sector, we don’t know where the money is going. We are not aware of what humanitarian organisations are doing in the city and there is no co-ordination between the local health sector and medical organisations,” said Abdul Wahid Al Jubouri, resident doctor at Ibn Sina hospital.

“Most of the projects are filled with corrupt deals that are being done at the expense of poor and innocent people.”

Another doctor, a woman, said: “The government has allocated money to us but we don’t know where it's going or how it’s been spent, we’ve not seen any development since the fall of ISIS.”

Others suggested that the international community provide aid by circumventing local and national authorities to ensure that Mosul’s health system receives the funds it needs. “Money is being given but we are not seeing the results on the ground,” a male medic said.

A common feeling among Mosul’s majority-Sunni population, which stood at two million before the ISIS occupation in June 2014, accuse the Shiite-dominated government of neglecting the city after its liberation, sanctioning financial and health resources to Baghdad and other southern cities instead.

Responding to claims that the Iraqi government is not doing enough for Mosul in the pandemic, Dr Jassim Al Falhy, Iraq’s deputy health and environment minister, said the city’s health infrastructure was not functioning properly because of the “destruction in the city caused by ISIS”.

The militant group used at least one major Mosul hospital as a base for two years, and occupied several other medical facilities in the city, according to Human Rights Watch, putting staff and patients at risk.

“The health ministry in Baghdad has increased its efforts since the liberation of Mosul to help rehabilitate the city’s health care system and infrastructure, despite the lack of funding it currently faces,” Dr Al Falhy said, pointing to makeshift facilities, or caravans, built by the government in the city to increase medical capacity.

“Of course, Covid-19 has played a heavy toll on the city’s healthcare system following years of wars and conflict, lack of security and stability and the great challenges it faces from terrorism,” he said. “The ministry has done everything it can to rehabilitate a number of health and medical centres as well as hospitals that existed in the city.”

Dr Al Falhy did not respond to a request for comment about the claims of rampant corruption in Mosul’s health system and the effect it may have had in exacerbating the city’s coronavirus crisis.

Coupled with the city’s dilapidated facilities, a deeper societal issue has promoted exposure to the coronavirus, medics say. Because of the stigma attached to becoming infected, people including doctors and nurses refuse to reveal it when they test positive for the virus.

“No one will ever say that they are sick, that’s the primary problem. Even the doctors won’t say they have the virus,” said one Muslawi doctor.

At least 20 per cent of the city’s medics have tested positive for coronavirus, according to Dr Al Obeidi, who said that figure would rise to 30 per cent if testing increased.

“Doctors are being infected because their clinics are not prepared to tackle the virus, they don’t know what to do to avoid getting the disease,” said another Muslawi doctor.

“If you had animals or pets in these clinics, they could not stand being there.”

Despite the array of problems facing the city, it is Mosul's own communities that are leading the way in helping health officials to cope with the pandemic.

A mosque in the centre of the city, Al Rahma, has been collecting donations to buy medicine and oxygen tanks. Those who have no income are told to go to the mosque to receive the right treatment so they can self-isolate at home, according to one Muslawi activist.

Families who can afford an oxygen tank are buying their own and staying at home, preparing for the worst in the knowledge they will not be able to receive adequate treatment from a hospital. The price of an oxygen tank has risen from 60,000 Iraqi dinars ($50) to 250,000 Iraqi dinars since the pandemic began, according to Omar Mohammed, the founder of Mosul Eye, a blog focused on the city. It is a sum that many in the war-wracked city do not have. To refill a tank costs 6,000 Iraqi dinars.

Although some doctors have returned to Mosul to help, the city is still suffering from a brain drain, with many of top professionals fleeing to better conditions elsewhere, including in Iraqi Kurdistan.

It is a hard choice for doctors: leave your hometown, or stay and risk death? Several years ago, it was the prospect of being killed by ISIS, now it is the threat of the coronavirus.

Dr Al Obeidi and his colleagues are calling on the government to prioritise Mosul once again.

“We have suffered in unimaginable ways. We hope that the central government and the international community will help us. We need action to offer the right treatment to the public and to do our jobs,” he said.

“Our message, as doctors and residents, is that the process of rebuilding the city and its medical facilities, clinics and hospitals must be implemented as soon as possible.”

For Mr Ibrahim, the head of one of Mosul’s only functioning facilities, the city can no longer rely on hope and prayer alone.

“God has protected and guided us through this pandemic,” he said, “but we need more support.”