A kidney specialist who fled Iraq's bombings, kidnappings and sectarian killings 20 months ago has reported back to work at his Baghdad hospital — one of some 800 doctors who have returned over the summer.
Doctors are just a tiny group among Iraq's more than 4 million refugees and displaced, but Iraq's health minister says their homecoming sends a message to other emigres that security has "improved dramatically."
Still, the nephrologist, who came back from Britain in July, remains cautious. He mostly sleeps at his workplace, Baghdad's Surgical Hospital, because he fears being attacked en route to his hometown, an insurgent stronghold north of Baghdad. He refused to give his name for publication because he still fears being targeted.
For every doctor who comes back, nine stay away.
Thousands left after invasion
Some 8,000 physicians, most of them specialists, have abandoned jobs at government health centers since the U.S.-led invasion in 2003, most seeking refuge abroad and a few hundred heading to the relative safety of Iraq's Kurdish region. Many ran from a violent campaign by extremists and crime gangs that targeted Iraq's elite.
Their departure has further crippled a health care system plagued by corruption, mismanagement and a lack of equipment and drugs. Only four of 10 elevators work at the 17-story Surgical Hospital, and patients wait a month for root canal treatment at a Baghdad dental hospital because surgeons lack electricity and anesthetics.
Health Minister Dr. Salih al-Hasnawi said getting doctors back is key to turning the situation around. Al-Hasnawi has floated the idea of turning Baghdad's Medical City, a five-hospital complex near the Tigris River, into a safety zone for visiting emigre specialists.
He's even come up with a catchy name — the "White Zone" — similar to Baghdad's fortress-like "Green Zone" for international staff. Al-Hasnawi promoted the plan in a meeting in Jordan with Iraqi doctors.
"Our proposal is that the military can provide security for this complex, and we bring doctors from outside Iraq because it is a secure area," he said in an interview at the Rashid Hotel in the Green Zone, where he and other Iraqi Cabinet ministers still live for security reasons.
"This is a first step in bringing the doctors home," he said.
Nation needs 100,000 doctors
Iraq needs 100,000 doctors and has only 15,500, said Adel Muhsin, a top Health Ministry official. Egypt and Jordan, paupers compared to oil-rich Iraq, have almost four times as many — 24 per 10,000 residents to Iraq's six per 10,000.
Iraqi rheumatologist Dr. Muneeb al-Huwaish, who has settled in the Jordanian capital of Amman, said he likes the idea of the White Zone, but that it's not enough to lure him back.
"When you leave the hospital and go home, you don't know what will happen to you," said the 61-year-old, who fled Iraq in late 2004 after being seized by a dozen gunmen outside his Baghdad clinic. During a struggle, the abductors broke his right arm with a rifle butt, but released him five days later for $40,000 in ransom.
Al-Huwaish's experience isn't unusual.
In the past five years, Iraq's doctors, professionals and academics have been targeted by militants trying to widen chaos or by extortion gangs going after the wealthy. Since 2003, at least 620 medical professionals, including 134 doctors, have been killed and many more threatened.
"Simply, the goal is to destroy Iraq," Muhsin said.
Physicians being kidnapped
In late August, an anesthesiologist, Dr. Tariq Qattan, was abducted in the northern city of Mosul. When his family couldn't pay $15,000, the kidnappers killed him and dumped his body in a street.
In Basra in southern Iraq, Dr. Khalid al-Mayahi, a neurosurgeon, was grabbed on his way home from work one evening in February, and his body was found in a street the next morning with three shots to the head. A colleague, neurophysiologist Dr. Wathib al-Amoud, said he later received text messages from the kidnappers saying al-Mayahi was killed because of alleged contacts with U.S. and British forces.
Under the previous health minister, militants even infiltrated the health care system.
The minister's deputy at the time was seen as loyal to anti-American Shiite cleric Muqtada al-Sadr, and some hospitals were transformed into bases for militiamen from al-Sadr's Mahdi Army militia. Gunmen would seek out wounded Sunnis or attack Sunnis who claimed bodies of relatives at morgues.
During that time, as much as $1 billion in public medical supplies is believed to have been sold on the black market, according to congressional testimony earlier this year by a U.S. government watchdog.
The new minister, while acknowledging there has been some corruption in most Iraqi ministries, said he believes that figure is far too high. He said he's fighting corruption, including cracking down on counterfeit drugs, and that the supply of medication has improved in the past year.
Yet many hospitals remain underequipped and pharmacies understocked — a state of affairs Iraqis find difficult to accept, at a time when their government could end the year with an oil-fed $79 billion budget surplus.
"We have a lot of money. Why do we have a shortage of drugs?" said Dr. Saleh al-Jany, 35, an oral surgeon at a government-run dental hospital in Baghdad that lacks dental chairs and digital X-ray machines.
In the 16-bed intensive care unit of Baghdad's Surgical Hospital, department chief Dr. Waleed Ibraheem works long hours to make up for his missing colleagues.
"One day, we were actually just four doctors in this building because many doctors ran way because of the violence," said Ibraheem, 42, as he checked on a patient hooked up to a ventilator.
Ibraheem, a top anesthesiologist also threatened by militants, tries to prevent further defections by appealing to team spirit. "Usually, I tell my staff those patients could be one of our family," he said. "So if I run away, you run away, everyone runs away, who will treat them?"
In recent weeks, three doctors came back to the hospital, Ibraheem said. Those include the kidney specialist who returned from Britain.
Salaries increase to attract doctors
In 2005, gunmen abducted the specialist's brother and the ransom almost bankrupted the family. In early 2007, the lanky 40-year-old doctor fled Iraq because violence kept him housebound. He didn't find acceptable work in Jordan or Syria for a while, then tried his luck in Oman and Dubai but failed to get work visas.
After a two-month course in England, he came home in July, happy to be in familiar surroundings but still afraid. He goes to his hometown only once a week to reduce risk. "We live in a small city. Until now, I cannot walk in the city in which I was born because I am a doctor," he said, speaking in an office in the hospital.
As an incentive, the government has sharply increased doctors' salaries. Specialists now make $2,000 to $3,000 a month, while under Saddam Hussein's rule, doctors would earn as little as $30.
But some doctors may be gone for good.
Dr. Zaid al-Sharbaqi, 29, a general practitioner who left Baghdad in 2006, has settled in faraway Stockholm, studying Swedish in preparation for the local medical exams.
"I'm dreaming to go back to Iraq, but I think the situation is still dangerous for all Iraqis," he said. "Every day, I become more and more tired when I listen to the news."