BAGHDAD – Already a troubled system, Iraqi medical care has fallen to the brink of collapse since the U.S.-led invasion five years ago.
Scores of doctors have been slain, cancer patients have to hunt down their own drugs — even IV fluid is in short supply. On Tuesday, a former deputy health minister and the head of the ministry's security force will stand trial, a year after they were accused of letting Shiite death squads use ambulances and government hospitals to carry out kidnappings and killings.
Specialists are hard to find. At one point, Baghdad — a city of more than 5 million — had no neurosurgeon, said Dr. Hussein al-Hilli, director of the Ibn Albitar Hospital in Baghdad.
"This was something that was horrible because we had many head injuries, many spinal injuries," al-Hilli said. He described "big shortages of drugs, big shortages of everything" — including IV fluid. "This simple thing, we don't have."
Like so many areas of life in Iraq, the health care crisis is vast and complex, and there is no quick solution to improve conditions for doctors and patients.
According to figures from the Iraqi Health Ministry released earlier this year, 618 medical employees, including 132 doctors, as well as medics and other health care workers, have been killed nationwide since 2003, among the professionals from many fields caught up in Iraq's sectarian violence.
Hundreds, possibly thousands, of other medical personnel are believed to have fled to Iraq's northern semiautonomous Kurdistan region and neighboring countries.
Even with the security gains of the past several months across Iraq, it is still dangerous for doctors and their families if they dare step out of heavily guarded hospital compounds.
Drugs supplies are so low that Iraqis hospitalized for illnesses as serious as cancer are asked to track down their own medicine.
"When we need medicine, we go directly to private pharmacies," said Ahmed Khalil, the 38-year-old owner of an auto repair shop in Fallujah. "We know we're not going to get any from Fallujah hospital."
And when pharmacy shelves are bare, Iraqis turn to the black market.
"Before the invasion, we got our share of medicine through government-owned medicine depots," said a Baghdad pharmacist, who spoke about on condition of anonymity because he feared reprisal. He said hospitals and clinics get some drugs from the medical depots, but it's rarely enough for the number of people in need.
"Sometimes we get medicine stolen by employees who work at the depots or at hospitals," he said.
At worst, the black-market drugs are dubious knockoffs, according to patients, doctors and pharmacists alike.
The war has taken a special toll on hospitals.
Fallujah, site of one of the deadliest battles between U.S. troops and militants west of Baghdad, is slowly rebuilding as violence ebbs, but memories of the danger are acute at the city's main hospital.
"Doctors would concentrate most of the time on treating people wounded in U.S. bombings or clashes between insurgents and U.S. forces. Other patients got little attention," said one doctor at the hospital, who also declined to be identified because he also feared for his safety. "We were beaten by gunmen if we failed to save their wounded fellows."
Jassim Naseef, 52, took his pregnant wife to a private clinic three months ago, paying 20 times what the public hospital would have charged for the birth of their son: $247 compared with $12. The hospital wards, he complained, were dirty and lacked electricity.
"I chose the expensive private clinic in order to ensure that my wife and my son got the best medical care," he said.
The American military and non-governmental organizations such as the Iraqi Red Crescent do a great deal to help, al-Hilli and others said, by bringing in supplies and advisers and helping train medical staff still versed in 1970s-style medicine.
Al-Hilli also has been buoyed by the Iraqi government announcing a plan to build more hospitals. He said no new hospitals had been built since 1986, at the height of the Iran-Iraq war, more than two decades ago.
Yet there are still major problems. Iraq's Health Ministry has been in almost constant flux since the war started. Each minister has stayed "eight months or seven months or 11 months," al-Hilli said.
Then, there are the arrests of former Deputy Health Minister Hakim al-Zamili and Brig. Gen. Hameed al-Shimmari, who was in charge of the ministry's security force. Soldiers stormed their offices last February in separate raids.
U.S. officials had been complaining that radical Shiite cleric Muqtada al-Sadr's followers were transforming hospitals into bases for his Mahdi militia and — were diverting medicine from state clinics to health care facilities run by the cleric's movement.
The clinics helped al-Sadr build a powerful nationwide political movement modeled in part on the Shiite Hezbollah militia in Lebanon.
There was another ominous development earlier this month, when the acting head of al-Rashad psychiatric hospital was arrested by the U.S. military in connection with the possible exploitation of mentally impaired women by al-Qaida in Iraq, presumably the suicide bombers who destroyed two pet markets in Baghdad and killed nearly 100 people.
The U.S. military wouldn't speculate on a motive but noted at the time of the arrest that al-Qaida often uses threats or extortion to get what it wants, which could possibly put the death of the former director, Dr. Ibrahim Mohammed Ajil, in a slightly different light.
He was gunned down on his way home from work in December.