'Every day there are corpses in the street'

Amidst UN reports that 1.6 million Iraqis have fled the country, with a further 1.5 million displaced, the health situation is worse than ever. Few aid organisations work in Iraq, and for one small NGO, rebuilding and re-equipping a Basra hospital gets more difficult every day. By John ReynoldsLaura Schmidt first visited the fragile hospital building in the southern Iraqi city of Basra in 2001. She came face to face with another doctor in tears. "We're losing all our children," she wept. Nine year-old Fatima was the fourth child in her family to die of a relatively simple medical complication. Had the hospital had the necessary machine, a blood transfusion would have saved her.

Although Schmidt's efforts – supported by several larger international aid organisations – have greatly improved conditions for patients, the security situation in Basra, and in the hospital itself, is now worse than ever. Five years ago, she could walk around the city, talk to people and dress as she pleased, all in relative safety. Today, even armed and heavily protected private security contractors refuse to enter Basra.

Schmidt can no longer visit the hospital in case her presence puts the staff and patients there in mortal danger. Armed with machine guns, 30 special policemen now stand guard around the building's decaying exterior walls. Visitors' handbags and belongings are searched. On several occasions, explosives somehow penetrated the tight security, but were fortunately discovered before any harm was done.

Doctors in Basra fear for their lives. Last Tuesday, Dr Youssra Hashem, a well-known gynaecologist in the city was killed on her way to work, shortly after leaving her home. In response to a media request for an interview about the health conditions there, another doctor replied: "To do this would be my own death sentence. The mafia here would kill me the next day."

On another occasion, many doctors in the emergency room of a large Basra hospital were recently murdered, leaving a city of 1.5 million people with no ambulance service.

According to British military sources in the region, the main threat comes from "rogue elements" in Shia militia groups – particularly the Mehdi army, which is loyal to the radical cleric Moqtada al-Sadr. Every morning in Basra, there are corpses in the streets or dumped in the Shatt el Arab river or one of the canals that criss-cross the city. Frequent protests break out against the violence, unemployment, corruption, the catastrophic health conditions and the lack of electricity in the city.Outside an Iraqi police station in Amarah

"Once Basra was called 'the Venice of the Middle East', but now it is like a big slum," says Schmidt. "On the outskirts of the city, meanwhile, where trees and other natural life grow on lush green riverbanks, there is much potential for development and improvement," she adds.

'Normal' everyday existence in Basra is, in reality, a nightmare. Young female university graduates are confined to their homes for weeks or months on end because they are afraid to go out. If they do, they risk being stoned, having their heads shaved or being kidnapped or murdered.

In contrast, increasing numbers of poorer women – and children – have been driven by hunger and desperation to beg on the streets. Those who cannot afford to purchase safe drinking water must take it from the contaminated river, with ghastly consequences for their health.

On some days, Basra only gets half an hour of electricity. Diesel and petrol are scarce; their price has increased five-fold since before the war. Dozens of vehicles form long queues at petrol stations, despite the fact that the region accounts for the majority of Iraq's oil revenues. The Baghdad government is particularly concerned about the impact of violence, especially since these revenues are already depleted by widespread corruption.

When Saddam Hussein was still in power, the feeling in the city was that people were all 'in it together', as they did their best to survive. Women played little part in political life but businesswomen and academics travelled the country unchallenged, while their daughters mixed freely with male students at university. After coalition forces took control of the city, everything changed. Women cannot drive or venture out alone. People used to worry about whether Saddam's spies were within earshot or watching from the distance. Now mistrust and fear abound as to whether a neighbour, friend or colleague is Christian, Sunni or Shia.

In the capital city of Baghdad the situation is far worse. In a city with few refuges from sectarian violence, even hospitals are no longer a safe haven. Health Ministry officials, speaking on the condition of anonymity, have confirmed reports of Sunni patients being dragged from their beds or tortured and murdered by Shia supporters of al-Sadr. In other cases, hospital staff that refused to side with one faction or another left their jobs and were replaced by Shia sympathisers. Control and accountability were no longer possible, leaving the core function of the hospitals to break down completely.

At the same time, wider US- and British-funded reconstruction efforts achieved poor results. In the first 14 months after the 2003 invasion, for example, hundreds of millions of pounds were allocated to rebuilding and re-equipping Iraq's 180 hospitals and clinics. Billions went missing from the initial sum of almost $20bn (‹25bn) due to corruption, criminal activity and incompetence. The World Health Organisation called the outcome "shocking".

Today, many hospitals in Iraq lack the essentials for even basic medical care. Children such as Fatima continue to die from easily treatable conditions such as diarrhoea and respiratory illness.

"Many supplies are only available on the black market," says Schmidt. "Colostomy bags, for example, which should be changed daily, have to last children a month. Parents have had to resort to selling their fridges and other household appliances to buy such items for their children."

The escalation of violence has meant that one project to build 142 primary care centres ran out of cash this year, leaving just 20 on course for completion. In March, the campaign group Medact said that 18,000 physicians had left Iraq since 2003. An estimated 250 of those that remained had been kidnapped and, in 2005 alone, 65 killed.

In the midst of the declining security situation, and the failure of much larger reconstruction projects, Schmidt has achieved remarkable results. Essential new machines have been delivered, along with new beds and mattresses. A water treatment plant has also been built to guarantee staff and patients have access to clean water. The mortality rate for one serious illness is now 25 per cent, reduced from 100 per cent.

However, the battle for this Basra hospital is an ongoing one. According to Unicef, the number of children under five suffering from malnutrition in Iraq is double what it was in 2003. Other refurbishment work is still badly needed.p

John Reynolds is a freelance journalist based in Dublin

More: Names have been changed and details omitted to protect the hospital and its staff. If you would like to make a donation to the hospital, please contact John Reynolds at john@johnreynolds.ie for further details