AMMAN, Jordan – Five years of war have disfigured the people of Iraq, hobbling and maiming many thousands of them.
There are no definitive counts. But Health Minister Salih al-Hasnawi said the number of wounded Iraqi civilians is “of course” higher than the estimated 151,000 who died from violence in the first three years of the war, the figure given in a recent survey by the World Health Organization and the Iraqi government.
“For any explosion, it is five to one, or seven to one, wounded to dead,” al-Hasnawi said.
About 50 of those wounded Iraqis have been living at the Amman Palace hotel, while half that number are at the Jordan Red Crescent hospital up the hill. Dozens more, limbless and broken, arrive in Amman each month asking to be remade. They stay an average of 53 days, sometimes more than a year, attended by a team of orthopedic, plastic and maxillofacial surgeons from the Geneva-based Doctors Without Borders organization.
“Fear is legitimate,” a therapist said. “It's all right to be afraid, but we must not let it wear us out.”
The lives these people knew in Iraq changed in a moment, with no time for them to react. The young boy standing at his grandfather's funeral when the suicide car bomb exploded. Neighborhood kids playing soccer when a mortar shell landed among them. A hotel clerk hailing a taxi when a bullet passed through his thigh.
Now they have nothing but time: for the melted gums and charred skin, the hair implants and the plastic legs, septicemia and osteomyelitis, antibiotic resistance and opiate addiction.
Iraq's medical system is all but incapable of caring for such patients. It was already beleaguered by the international sanctions imposed on the government of Saddam Hussein, but the problems have grown legion: Specialists have fled the country; necessities such as bandages, intravenous saline and electricity are in short supply; and hospitals are guarded by gunmen who intimidate and sometimes kill patients of rival sectarian backgrounds.
A report last year by the Iraqi Red Crescent Society recommended leveling Yarmouk Hospital, one of Baghdad's biggest. “It's not fit for animal treatment,” said Said Hakki, the group's director. “There is no medical system in Iraq to speak of. It doesn't exist.”
Many of the Iraqi patients who arrive in Jordan are referred by physicians at home to Doctors Without Borders, one of the few organizations that help Iraqis wounded in the war and pay for their transportation and treatment. Since the group began treating Iraqis in Amman in August 2006, a dozen doctors have provided care to more than 340 wounded civilians in need of reconstructive surgery. An additional 140 people are on the waiting list.
“Sadly, we recognize that this is merely a drop in the sea of what is going on in Iraq,” spokeswoman Valerie Babize said.
An Iraqi physician who now works in Amman with Doctors Without Borders and who asked that his name not be used because he fears for his safety said that of the 100 resident doctors in his 2004 graduating class, only five remained in Iraq after a year.
“If patients are kept in a hospital there, they have a 90 percent chance of having a severe infection,” he said. “There are no blood cultures. No proper swabs. Labs are basically working on the routine biochemistry tests. Microbiology is almost nonexistent there. Elective surgeries did become nonexistent. It's basically all trauma management.”
A surgeon in the northern city of Mosul, who also spoke on condition of anonymity, said hospitals have grown accustomed to handling a high volume of trauma cases, but not complex or lengthy procedures.
“Each patient gets no more than two hours maximum in surgery, because there is a long queue,” he said. “We end up with complications and infections. The patients might die two weeks after their operations.”
The experienced doctors who have left Iraq have been replaced by younger physicians. Concerned about contaminated instruments and unsanitary rooms, they often choose to pump patients full of antibiotics.
“The staff is not well-trained, we don't have the new techniques of sterilization, (and) our operating theaters are dirty,” the Mosul surgeon said. “We can manage the quantity, but not with quality.”
Doctors in Jordan said many Iraqis arrive with bone infections because of inadequate surgical procedures and a resistance to antibiotics.
