At their mercy

A 6-year-old girl suffers without care at an Iraqi hospital after being hurt in a car crash with her mother. Her struggle is typical in a country with poor medical equipment, underpaid staff and corrupt workers.

[Times photo: Kinfay Moroti]

Batool Saleh, 6, and her mother, Atheema, lie hurt in the emergency room of Iraq's Basra General Hospital after a car accident. Batool was given an IV, but none of their wounds were treated until they were taken to another hospital.

BASRA, Iraq - She looked like a fallen angel with a halo of flies.

Six-year-old Batool Saleh lay unconscious in the empty emergency room, flies swarming around bloody cuts on her head. It would have been easy for someone to cover the cuts with a towel.

A simple act, but nobody did it. When Batool and her mother, both hurt in a car crash, arrived at Basra General Hospital that morning, the two nurses on duty all but ignored them. For nearly an hour, they joked and chatted until the hospital's sole gurney was free and mother and daughter could be rolled away and sent someplace else.

It wasn't my responsibility to treat them, one of the nurses later shrugged.

Compared to the horrors inflicted by war and Saddam Hussein's sadistic regime, a car accident in Iraq doesn't rank very high. What happened to Batool is noteworthy only because it is typical.

Typical of hospitals so poorly equipped that patients often have to bring their own sheets.

Typical of doctors and nurses so poorly paid that many have refused to work.

Typical of other doctors and nurses so corrupt that they stole drugs from their hospitals and sold them outside.

Yet Batool and her mother also encountered men and women struggling to give care under the worst of circumstances. People like the doctor who came to work after an allied attack killed 10 members of his family, including four of his five children.

"I am an example," says Dr. Akram Hamodi matter-of-factly. "I lost my family, and I am still working. We are doctors. We are nurses. We are supposed to care for patients. There should be no excuses."

Batool and her family live in Nasiriyah in south-central Iraq. Early that Saturday, they were going to Basra, Iraq's second-largest city, so that Batool's 3-year-old brother could get another course of treatment for his leukemia.

Somehow, Elewes Saleh lost control of the family's Toyota Corona. It rolled several times, seriously injuring Batool and her mother. American soldiers pulled them out, and a passing van took them to Basra General.

Built in 1917 during the British colonial era, the 700-bed public hospital is Iraq's oldest and largest. It is also among the dirtiest and most sparsely equipped.

Hussein's government built 14 waterfront palaces just a few miles away, but it required the hospital to support itself entirely from fees paid by patients. But Basra - on the front line of three wars since 1980 - is one of the poorest cities in Iraq, and almost a third of those treated couldn't pay a single dinar.

"The hospital has been ignored for 25 years," says Dr. Mustafa Al Ali, the director. "Nothing new has happened in this hospital, no maintenance, no medical equipment."

At 8:56 that morning, Batool and her mother, Atheema, were wheeled into the dingy emergency room. The linoleum floors were filthy. The small sink, caked with grime, was full of used syringes, empty ampuls and bloodied tufts of cotton.

The 26-year-old Atheema, gashed from mouth to eye, was soon transferred to another room but received no medical care. Batool was left alone in the emergency room on a bed so old that yellow foam stuffing poked out of the mattress.

She lay half on, half off the bed, flies landing on her open wounds. Even when she began to cry and shake, the nurses paid no attention.

An elderly woman was the next patient to arrive, accompanied by relatives.

Why isn't anyone helping that little girl? they asked a doctor.

"This happens all the time," he replied. "Sometimes patients are even left on the floor."

Before the 1991 Persian Gulf War, Iraq had many well-qualified nurses from the Philippines and other countries. But when the war began, they went home and never returned. As economic sanctions and the regime's greed wrecked Iraq's health care system, the nurses who emerged from Iraqi schools were badly trained and poorly motivated.

Today, nurses are held in the same low regard as police.

Pay is also a problem. Under Hussein's government, hospital staff who were not Baath Party members made only a few dollars a month. Some doctors and most nurses supplemented their incomes by selling prescription drugs on the black market, says Ali, Basra General's director.

When the government collapsed, the supply of drugs dried up, and no one got paid for weeks. The former director, a Baath official, left the hospital. The staff elected Ali, a $5-a-month surgeon, to replace him. Ali persuaded the city's British occupying forces to provide money to pay everyone a few dollars.

"It is enough for one day," he says, "not one month."

So the level of disgruntlement remains high. Doctors have threatened to strike, and nurses do even less work than usual.

That morning, they did nothing for Batool or her mother except hook the little girl to an intravenous machine. Nearly an hour after they came into the emergency room, they were transferred to Basra Teaching Hospital, the only hospital in the city with a neurological department.

Care was not swift to arrive there either. Mother and daughter were put in the same room, but their wounds remained uncleaned for hours.

The head nurse had forgotten to order any antiseptic for the ward, Batool's doctor explained.

Though Batool had apparently suffered a serious head injury - she was still unconscious - the doctor said she couldn't get a brain scan until the following day. In all of Basra, a city of 1.3-million, there is just one CT machine, and its operator had a backlog of patients.

Still, the atmosphere at Basra Teaching Hospital was much better. Smaller and newer than Basra General, it has fewer equipment and maintenance problems. And while its doctors and nurses also felt overworked and underpaid after the war began, they were inspired by their longtime director.

Dr. Akram Hamodi was at the hospital April 5 when he got the news. A British commander had ordered a strike on a home thought to be occupied by Gen. Ali Hassan al-Majid, the notorious "Chemical Ali." Instead, six missiles had hit Hamodi's house, killing everyone inside.

"I went there and took the bodies out with my own hands," he says. "I buried them myself. I lost everything."

Hamodi returned to the hospital a few days later and has remained there almost constantly. Work distracts him from his own grief at a time when thousands of others are suffering, too.

Like Ali, his counterpart at Basra General, Hamodi admits that his own hospital needs help. He faults the British for not providing better security and more humanitarian aid, but he also criticizes his employees for letting their anger override their ethics. He has heard reports of doctors and nurses refusing to work, of patients being neglected.

"I will punish any staff that does not give proper care," he says. "We are professionals. We have promised to give service to this hospital and this city."

Meanwhile, nature seems to be curing what the hospitals could not or would not.

By Sunday afternoon, Batool was sitting up for brief periods and eating yogurt. By Monday morning, she was smiling. Her mother's wounds also were starting to mend.

And Tuesday afternoon they were released from the hospital and headed home. In a taxi.

Susan Taylor Martin can be contacted at susan@sptimes.com

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