Iraq - Alternative Networks of Community Care During COVID-19

 

 
Corona Boell

The status of Iraq’s health care system

Shawk Alani

Iraq’s health care system has been plagued with neglect. Since the sanctions of 1990, 90% of the health care budget in Iraq has been cut[1]. Consecutive wars have resulted in severe brain-drain in the medical field. There is a lack of proper management and accountability as corruption is widespread and normalized in Iraq. Moreover, poor sanitation and water quality have had detrimental effects such as spreading infectious disease. The psychological and mental health effects of the US-invasion of 2003, war, violence, contribute significantly to these challenges. All of these factors have had a huge strain on a deteriorating health care system.

With over 548,000 confirmed cases of COVID-19 in the country[2], the added pressure on public-funded hospitals in Iraq is very high. Immediately preceding the outbreak of COVID-19, Iraqis from all over the country, particularly from Baghdad and the southern provinces, had spent four months taking up the streets in central squares, like Tahrir Square in Baghdad and Al-Haboubi Square in Al-Nasiriya. These protests had reached a vigour and popularity in their defiance to the state that the country had not seen in recent years. The protests resulted in the breaking of major taboos and fears of speaking out against the state and the religious institutions that have been leeching Iraq’s resources since 2003. More than 700 people were killed by tear gas canisters and riot police violence during the October uprising. Thousands of others were kidnapped (and many are still missing), attacked and threatened by government authorities and militias. The government continues to deny its role in these crimes and fails to take any real action to protect Iraqi people. Although Iraqis have distrusted their government for many years now, this sense of distrust has reached a new peak after the violence of the October uprising.

 

The irony of government care

With this deep sense of distrust, how could Iraqis trust any COVID-19 measurements instated by the government as one motivated by care for the population? Iraqis have felt uncared about for decades. This sentiment has translated into an attitude of contemptuousness towards government-imposed COVID-19 restrictions. The government initially imposed a total curfew on March 17th, 2020[3], which then turned into a nighttime curfew (7 PM to 6 AM) on April 21st, 2020[4]. The timings of this partial curfew changed a few times over the next few months until the lockdown was lifted in September. Curfews however, are not a neutral measure. Curfews have been used in the recent and distant past as a form of control. During the first ten days of the October uprising, a curfew and total internet blackout was used to cover-up the killing of youth in protest sites and prevent political organizers from communicating with each other. During the October r people of all ages filled the streets every night, driving around the city with loud music and dance parties to defy the curfew, which was understood as a form of control. This is critical to understanding why Iraqis receive preventative measures with a sense of disdain.

Light blue surgical masks, which had become a symbol of the October uprising when protestors used them as a cheap and easy protection method against government tear gas, are now seen worn by some people in public. However, there is no strict policy to enforce this anywhere in the country. One can easily perceive how a government that suffocated thousands of Iraqis in October and November 2019, which then asks the same citizens to wear masks for their protection just a few months later, will be received with anger, mistrust, defiance and a largely careless response to the pandemic. This defiance is so intense that there are stories of people digging up dead bodies from the government allocated COVID-19 cemetery and re-burying them with other family members or in sites accessible for visitations.

Before the New Year celebrations, the Iraqi Ministry of Health recommended an evening lockdown. While there was initially confusion about the binding force of such a recommendation, the crowded restaurants and streets on New Year's Eve showed that it had no assertiveness. At the beginning of 2021, the Minister of Health announced that Iraq would soon start corona vaccinations; an agreement with the Global Vaccine Alliance was only reached at the beginning of December 2020 that would allow the country to secure vaccines for 20% of its population.[5] Then in mid-January the emergency approval of a British and Chinese vaccine followed[6]. Nonetheless, there is a growing belief in Iraqi society that the dangers of a vaccination are greater than its protection. This notion is reinforced by the unclear actual contagion and death numbers from Covid-19, according to which Iraq is not as bad off as many European countries and therefore some believe that Iraqis are more immune. The vaccination doses for eight million Iraqis are to be distributed centrally by the Ministry of Health according to the number of inhabitants in all 18 provinces - including the autonomous region of Kurdistan.

 

Alternative Networks of Community Care in COVID-19 Iraq

A major catastrophe that resulted from shutting down cities has been the loss of daily work for Iraqis who depend on precarious work. With over 60% of Iraqis working in the informal sector[7], the long-term repercussions of this are starvation and impoverishment of an already at-risk population. During the initial period of the Coronavirus outbreak (March to May) there were many campaigns to support communities who financially struggled the most[8]. Some of these groups, such as the “Iraq Hope Team” were founded between 2015 and 2017 when there was a large influx of internally displaced peoples from Mosul and ISIS-occupied areas. These groups were created and run by volunteers from various neighbourhoods who collected donations for displaced people in their areas. As Iraqis have been failed by their government for so many years, many alternative networks of community care have already been established. These networks of community care have existed since the comprehensive UN-imposed economic sanctions of 1990. Community care and solidarity is the main backbone that has been keeping Iraqis alive and coping.

Grand Ayatollah al-Sistani, the major spiritual of Iraqi Shia and social reference, issued a statement calling on people to give aid and help those affected within their communities[9]. Sistani ruled that when it comes to COVID-19 the responsibility is “collective obligation on those members of the community who are capable of contributing”; and in another statement he writes that the good Samaritans amongst us Iraqis who are financially comfortable should provide financial support to their brethren, and that youth should commit their time to volunteer and deliver aid materials to affected families. In his statements Sistani conjured up the recent memory of Iraqi’s collective efforts in the fight against ISIS and asked them to uphold the same effort during the COVID-19 pandemic[10].

Omar, a 24 year old pharmacist living in Baghdad has been taking care of his elderly neighbor who has been infected with COVID for 20 days[11]. “I got a call from my brother Ali, who is also a pharmacist, that our neighbor is very sick. I rushed over from work, and brought antibiotics to treat him against secondary infections. Since then we have been watching over him 24/7. He has gone into a highly critical state three times.” Badry’s children, who live abroad, and the two pharmacist brothers, Omar and Ali, collectively decided after discussion that taking him to the hospital would put him at great risk. Due to high concentration of patients, the viral load, improper care, poor sanitation and lack of enough oxygen, hospitals have become a major source of Coronavirus spread. Many Iraqis who suspect that they might have COVID-19 do not go to hospitals unless their symptoms have severely deteriorated. Even then, those who are financially capable prefer to spend thousands of dollars buying the machinery and medication needed to facilitate recovery rather than being treated at a hospital.

Badry has diabetes, COPD, hypertension and kidney disease, which have created many complications as the two brothers cared for him in the past 20 days. “We are pharmacists and although we have many acquaintances in Baghdad’s pharmaceutical warehouses we still find it very difficult to get a hold of the medicines we need. So imagine what the situation must be for the average person who needs these resources.” Omar explained that they tried over twenty pharmacies and drove around the city for an entire day to find the anticoagulant medication needed to fight against pulmonary embolism, which is the number one reason people are dying from COVID-19. The brothers found an oxygen tank at a local mosque, donated by a generous and anonymous person. “It costs $250 for one oxygen tank; $230 for the Russian antiviral medicine; all the other medications could reach up to $650; blood tests have cost us about $550 in the past 20 days.” Omar explained. These are really significant expenses that the average Iraqi would not be able to afford. “The first time he went into a very critical state, his oxygen levels went down to 79%. I was watching him die, like he was drowning,” Omar said, “After that I went to the bathroom and started vomiting from how stressful the situation was.”

Although these community support systems do fill a vacuum and are responsive to the urgency of the situation, they cannot replace the necessity of having functional medical infrastructure.  In a country whose communities have been ripped apart through years of violence, forced displacement, sectarian rhetoric and state neglect, Iraqis once again build internal solidarity to survive a phase of hardship. With the decision of the Iraqi central bank to devalue the Iraqi Dinar against the US dollar at the end of December 2020[12] and the associated increase in food prices while having constant wages, it is above all the economic aspects that burden Iraqis.

 

 
[1] “Health in Iraq. The Current Situation, Our Vision for the Future and Areas of Work,” Ministry of Health (2004). World Health Organization, Page 9 https://www.who.int/hac/crises/irq/background/Iraq_Health_in_Iraq_second_edition.pdf
[2] According to the World Health Organization, as of November 28th, 2020, Iraq recorded 548,821 positived COVID-19 cases. 58,084 are currently active cases, while 12,200 cases have resulted in death. https://app.powerbi.com/view?r=eyJrIjoiNjljMDhiYmItZTlhMS00MDlhLTg3MjItMDNmM2FhNzE5NmM4IiwidCI6ImY2MTBjMGI3LWJkMjQtNGIzOS04MTBiLTNkYzI4MGFmYjU5MCIsImMiOjh9 (accessed on November 28th, 2020)
[7] “COVID-19 in Iraq: the virus of social inequality”, Maurizio Coppola, Open Democracy https://www.opendemocracy.net/en/north-africa-west-asia/covid-19-iraq-virus-social-inequality/
[11] This interview was conducted on October 12th, 2020. As of November 28th, 2020 Badry has fully recovered from COVID-19 but with some ongoing side effects that continue to be monitored by the family.
[12] From 1200 IQD against 1 USD to 1450 against 1 USD, see https://www.rudaw.net/english/middleeast/iraq/211220202.
 
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