Samia Mahmoud, a 66-year-old woman nicknamed Umm Ali from the Um al-Batout area in the Iraqi city of Amarah, transferred her 15-year-old daughter-in-law to Yarmouk Hospital in the capital Baghdad, after she suffered from severe bleeding eight months into her pregnancy. Doctors were unable to save her, and the young girl died 3 hours after arriving at the hospital. But Umm Ali is certain that the doctor who treated her was directly responsible for her death.
The sixty-something woman tells Raseef22, "The doctor was the one who caused her death. She treated us in a condescending way. Her words were stiff and she barely spoke to us". In her opinion, the patient's death was sufficient enough reason for her, and her five female companions, to stalk the doctor to take revenge on her, but they were unable to find her. In efforts to do so, she requested the doctor's full name and the address of her clinic from the information desk, under the pretext of visiting her for a medical consultation.
Umm Ali recounts that the next day she attacked the doctor's clinic located in al-Mansour district, accompanied by some women from the clan, adding, "After that, my husband called her in agreement with the sheikh of our clan to tell her to prepare herself for the "o'twa" (a period of time granted by clans in order to prepare for an agreement between the two parties on the required amount of money), and then we inform her of the tribal ransom period". She goes on to note that "the doctor was very scared and told us that in return for leaving her alone, she would pay the agreed amount." Speaking in an Iraqi dialect, Umm Ali continues, "We took 30 million Iraqi dinars from her, a hefty amount of money to weigh on her heart."
On February 26, 2019, the World Health Organization (WHO) condemned violence against health workers in Iraq
Zainab al-Asadi, a 35-year-old doctor from Baghdad, says that, "The attacks are completely unjustified. It's normal for a doctor to argue with the patient's family in every part of the world, except in Iraq, where the patient is accompanied by at least 5 escorts, brought to insult and assault the doctor, not to mention the amount of hatred and grudge that those who visit us carry," noting that "there are certain sensitivities towards doctors because of central appointments, with people thinking we make a lot of money without working much."
Al-Asadi asserts that "the large number of patients and the deterioration of services in hospitals make patients and their companions resentful of the doctor alone, not to mention the tribal greed that continuously pursues us."
On February 26, 2019, the World Health Organization (WHO) condemned violence against health workers in Iraq. In this regard, Dr. Adham Rashad Ismail, acting WHO Representative in Iraq, said, "WHO calls on the authorities in Iraq to ensure the safety of health workers, health facilities, and the sanctity of health care. Such attacks constitute a serious violation of international humanitarian law and deprive the most vulnerable population of children, women and the elderly of their right to essential health services."
The organization reported that health care workers and health facilities in Iraq have been subjected to many attacks. In 2018 alone, WHO recorded 42 cases of abuse in the healthcare sector in Iraq, 40% of which were directed against health workers.
In a report by the British newspaper The Guardian in August 2022, a recent survey of Baghdad doctors found that 87% of doctors had been subjected to violence in the preceding six months, and that 77% of them were thinking of emigrating. The official spokesman of the Ministry of Health, Sayf Bader, stated in a televised interview back in 2019 that 20,000 doctors had already done so since 2003, violence being a major cause. Unofficial information says that this number has doubled today.
Violence among doctors
Attacks against doctors are not just limited to patients and their companions, as this hostile behavior has spread among doctors themselves. On October 21st, the head of the Iraqi Doctors Syndicate, Dr. Jassim al-Azzawi, was physically assaulted by his colleagues in Baghdad following a dispute that broke out between them in the Doctors Syndicate.
Al-Azzawi said in a statement following the attack, that three fellow doctors “the age of his children” and members of the syndicate's general council that belong to political parties, surrounded him at the syndicate's headquarters. He says, "Upon entering, they asked me to leave the place, saying: 'What business do you have here? Get out. You're not a syndicate member'." Al-Azzawi has actually recently won a court ruling to take over the syndicate after a dispute over the position was settled by the judiciary.
"The doctor caused my daughter-in-law’s death. She treated us in a condescending way. Her words were stiff and she barely talked to us. The patient's death was reason enough for me and my five female companions to stalk the doctor and take revenge on her"
The syndicate member recounts that during his discussion with them, one of them verbally assaulted him, and then another physically attacked him and his 70-year-old brother who had been there with him. He rushed to his brother’s rescue but they all began beating him until he lost consciousness. He was then transferred to the hospital for treatment, noting that the assault took place because he refused the three doctors' request to submit his resignation.
Doctors in exile
Yahya Ali al-Sudani, 78, is a surgeon from Samarra who fled Iraq in August 2011 to Sweden, where he currently lives with his family. They left their country after he and some of his family members were subjected to a clan attack as a result of his patient dying from a heart attack, according to what he tells Raseef22.
Al-Sudani recounts the details of how a group of people attacked him in Samarra General Hospital, where he was working at the time, as a result of the death of a patient. So he went to the judiciary and filed a lawsuit against them, and two of the attackers were arrested. "Two days later they attacked my house with weapons and passed on the message of their tribal chief in a crude manner, basically saying that if I do not withdraw my complaint, 'you will see something you will not like,' and that I should watch out for my son. They also asked me to pay a sum of money as compensation for the damages," he says.
Al-Sudani quickly dropped the complaint, fearing for his life and that of his family. He then quit his job, collected his belongings, and emigrated from Iraq to where he now resides in Sweden. He is convinced that some unruly tribes and clans have adopted a new method of making money, by extorting doctors, and by making false claims that affect an important segment of the country's infrastructure.
Dr. Shadan Bassem, from Baghdad, is a fresh graduate who works in a hospital near Karkh. She says that she is thinking about emigrating and that most of her co-workers have already prepared their documents for living abroad, and are looking for an opportunity outside the country, mainly due to the violence they are exposed to from patients and their families, in addition to the lack of medical services and supplies.
In light of this deteriorating reality, doctors fleeing outside the country , and their exposure to repeated attacks, the Iraqi government, which was headed at the time by Nouri al-Maliki, tried in 2010 to combat the problem by introducing a protection law for doctors, and allowed doctors to carry handguns while working.
In 2010, the Iraqi government tried to combat the problem by introducing a law allowing doctors to carry handguns while working
Dr. Bushra al-Obaidi, a professor at the University Of Baghdad, College Of Law, says, "All successive Iraqi governments, through these decisions, have abandoned the protection of citizens and charged them with protecting themselves. Since 2003, most professions, not just doctors, have been allowed to carry weapons. Therefore, we cannot keep expecting the government to move now to disarm the clans, factions, and militias."
While speaking to Raseef22, al-Obaidi asserts that she believes there is "a weakness in the application of the law, so we are not surprised by this lack of action, especially when we read about the announcement of a vacation in most schools in Nasiriyah Governorate, due to an armed dispute between clans, or when we hear about a judge being unable to implement the law due to tribal attacks and armed parties, not to mention the majority of citizens seeking the approval of clans in order to protect them from the attacks of other clans. In this sort of reality, Iraq has lost both its competency and intellectuals, and here we are in a state of no state", she tells Raseef22.
She adds, "The rulers in control of Iraq know nothing but theft and do not care about anything else. The protection law for doctors and other measures are, to say the least, a sad ironic farce." She finally asserts that she also intends to emigrate.
For her part, Bassem describes this solution as "a band-aid solution, and it is useless because we need intensive security elements, especially since some halls are devoid of security". She adds, "Most doctors are peaceful and hate to carry weapons."
The young doctor also recounts an incident that she experienced in one of the corridors of Karkh Hospital in the emergency department, "A person who had been stabbed by a knife came in accompanied by a number of people. One of them approached me, and told me in a sharp and loud tone: 'Come and take a look at this guy’s injury'. Another said: 'No, we don’t want her, she’s useless'. I did nothing other than give them a sharp look. But then one of them said to me harshly: 'Leave, trash'."
She goes on to say, "Then a woman accompanying them pushed me hard, which prompted a fellow doctor to intervene to protect me." She wonders out loud, "I was exposed to this situation just because I gave them a sharp look, so what would they have done if I was carrying a gun and pointed it at them?" She points out that most of the people of popular areas "carry heavy weapons, so I do not rule out any potential attack on the hospital or on our homes".
"If a patient is declared dead, we have to call the security guards, or else we are forced to give the deceased electric shocks, two or even ten times depending on the understanding of the companions, who usually come in big numbers," Bassem says, hoping that "our voice will reach the patients' families and that they will be sufficiently understanding, as most of them believe that we only give out medicines to our relatives". She also appealed to the concerned authorities to "facilitate the procedures for complaints filed by doctors, and to put an end to clan interference."
Not a vegetable vendor
Attacks on doctors are recorded on a daily basis, starting with insults, tribal threats, and may even end with murder. This reality has caused a significant shortage of medical and nursing staff, at a time when the Ministry of Health is trying to attract experienced immigrant doctors.
In this regard, Dr. Maha al-Sakban, 60, a gynecologist and pediatrician who works at Diwaniyah General Hospital, says that "patients and their companions visit doctors and impose their opinions on us. For example, they ask us to decide on a treatment without knowing or allowing us to examine the patient. And signs of anger become apparent on their face and behavior if the doctor requests a specific test. The immediate response is: ‘No, the patient does not need a test or anything of the sort’."
"A stab patient came in accompanied by a number of people. One of them approached me and said in a loud, sharp tone: 'Come look at this guy'. Another said: 'No, we don’t want her, she’s useless'. Then a third person harshly said to me: 'Leave, trash'"
Al-Sakban recalls that in some cases, those who visit her are the patient's relatives and not the patient himself. For example, a man comes to ask for medicine for his mother, who is suffering from stomach aches, and when the doctor asks that the patient must be present, the man goes into a rage, cursing and screaming. "I always tell patients that we are doctors, not vegetable vendors, and that we must examine the patient or ask for some tests in order to diagnose the disease," she says.
She believes that the rise in attacks and cases mentioned earlier is the result of the lack of awareness resulting from the prevailing Iraqi character today, which has become aggressive, emotional, anxious, and characterized by 'learned helplessness', due to the effects of PTSD, wars, terrorism, and the failure of the new state to achieve the dreams of social and economic welfare as had been expected."
The Iraqi Medical Association organized several protests to condemn the repeated attacks on doctors and the media mobilization against them, and called for the activation of strict laws against those who attack an employee in the health sector, especially limiting the interference of tribes and those who carry weapons.
On February 23, 2019, doctors in Baghdad and a number of governorates organized a unified protest in which their demands centered around "supporting the health sector, controlling the spread of weapons, banning weapons in hospitals, and providing hospitals with security personnel to protect them". The demonstration was followed by another protest in 2021 at the door of the emergency department at Al-Kindi Hospital, in which the head of the Iraqi Medical Syndicate and the director of the hospital, Salem Al-Bahadli, participated.
The Iraqi Penal Code, in Articles 229, 230 and 231, as well as Article 6 of the Doctors Protection Law, punishes anyone who assaults doctors with a 3-year imprisonment period or a fine of 200 thousand to one million Iraqi dinars. The penalty is increased even more in the event of a wound or disability, in the event of carrying a weapon, or if the assault was committed by more than one person, but the relevant authorities are struggling to implement this and in most cases do not do so.
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