Iraq's Medical Breakdown

BAGHDAD, March 4, 2008 — -- Sitting on a worn carpet in the living room of her small house in central Baghdad, Samah Ibraheem sifts through a stack of medical files and tries to explain how difficult it is living with the constant fear of slowly bleeding to death.

Ibraheem, 20, and her 16-year-old brother Omar both suffer from a potentially lethal form of hemophilia in a country where the medical health-care system is teetering on the brink of collapse.

"My disease affects everything I do," Ibraheem said to ABC News. "I love cooking but I have to be very careful not to cut myself with a knife or burn myself on the stove. It's a very difficult life."

Omar has to be careful too, sitting quietly indoors ruminating on his condition while other boys play outside in the sunshine: "I can't play soccer because my joints hurt when I run. Sometimes the other kids tease me by punching me lightly, but what is just a normal hit to anyone else will cause internal bleeding to me."

What Ibraheem and Omar are desperate for is a steady supply of a lifesaving drug that induces blood clotting, but they find it impossible to get sufficient doses of the drug in Iraq where scores of doctors have been slain, medical supplies are in critically short supply and requests for help from hospitals get mired in red tape.

"There is a big, big breakdown in Iraq's medical health-care system," said Jamal Taha, a surgeon in al-Yarmouk Hospital, one of Baghdad's busiest emergency rooms. "It's worse than ever before, even worse than during the days of sanctions in the 1990s after the first Gulf War."

The shortages are not just confined to drugs. According to Taha, there is also a dire need for basic medical supplies like blood, anaesthesia and even bandages and sutures for stitching up wounds.

"Between 2005 and early 2007, when security was very bad in Baghdad and the violence very high, we lost many patients who could have been saved by simple procedures," he said. "But now, even though the security situation has improved and we have many fewer patients than before, we still can't treat them all."

Ironically, Taha says lack of funding isn't the problem.

New hospitals are being built all over the country and even at his hospital buildings are going up for staff living quarters and offices.

He says graft and corruption are among the chief reasons for Iraq's health-care chaos, but his No. 1 complaint is bureaucracy, which forces him to postpone many operations, even routine procedures, because of a lack of basic supplies.

Citing an example of this bureaucracy, Taha explains that at the end of every year he submits to the hospital's administrators a detailed list of medications and supplies that he predicts will be needed in the coming year.

That list then has to go through a 25-step approval process in which committees from the health ministry discuss needs, debate requirements, tender bids, review offers from contractors and make their own additions and subtractions.

"That process can take up to several years," Taha said. "Thus, when I submitted my list of needs for 2008 I knew full well that I probably wouldn't see it approved until at least 2010."

Another major blow to the country's ability to treat its sick and injured is a lack of qualified caregivers.

Recent figures from Iraq's Health Ministry show that 132 doctors and 486 other medical and health care workers have been killed in the last five years.

Hundreds, perhaps even thousands more, have fled the violence to neighboring countries or the relative stability of Iraq's semiautonomous Kurdistan region in the north.

With medical drugs and treatments in such high demand, unscrupulous people looking to make a quick profit have stepped in.

Baghdad's police force recently broke up what they called an "expired medications" ring, in which criminals were collecting bottles of old drugs, altering the expiration dates on the labels and then selling them to pharmacies and medical centers.

Meanwhile, Iraqis desperate for medication are turning to whatever source they can find, even counterfeit drugs on the black market.

Muthana Saeed Ahmed, a Baghdad drugstore owner, tells ABC News that he never sells counterfeit drugs, but says they're readily available and virtually indistinguishable from the real thing.

"Counterfeit medicine looks like the original medicine in form and package, while the chemical makeup of the drugs inside can be totally different from the original," he said. "Taking them could lead to an intensity of the sickness, or side effects, or, God knows, the drugs could even contain something dangerous."

At their home in Baghdad, Ibraheem and Omar's mother tries to shake off feelings of helplessness and care for her children the best she can.

"The last time my daughter was badly stricken with internal bleeding she came so very close to dying because they couldn't supply medication for three months," she said.

Even Ibraheem admits that at times she has tempted fate by using black market drugs: "Of course there's a risk, but what else can you do if you are dying? I take the risk of destroying something inside me for the sake of keeping myself alive."