It's another goal for Iraq

Amid the carnage, a little-reported, high-quality mental health service has been established

Health care in Iraq has come to symbolise the country's intractable agony after three decades of dictatorship, war and civil terror: hospitals left to rot while most of the country's casualties die simply because of the lack of basic equipment and a dearth of staff to use it. But at the end of last month, as the Iraqi football team united the country, its doctors organised a "Health in Iraq" conference that signalled a clear light at the end of the tunnel.

For, amid the carnage of the post-Saddam era, a little-reported, high-quality mental health service has been established. The man responsible for the initiative, the former Kent psychiatrist Dr Sabah Sadik, is now the government's "independent technocrat" candidate for the vacant position of minister of health.

In an address to the Iraqi parliament, he outlined his upbeat proposals for turning the ruined health service into a modern, ethical, well-funded system that gives equal access to all. A London meeting, jointly organised by the Iraqi Medical Association (IMA) and the campaigning charity Medact, gave further support for Sadik's message that while it is essential for other countries and organisations to support the programme of change, only Iraq's own clinical expertise, used to the full, can make the system work.

Like thousands of other doctors, Sadik left Iraq for the UK in the early days of the Saddam regime. He was medical director of West Kent NHS and Social Care Trust until he took early retirement in June this year. Since 2003, he has worked part-time as the Iraqi government's mental health adviser, laying the foundations for a comprehensive community-based service, staffed by newly trained specialist nurses and GPs, offering therapeutic choice to initially baffled patients used to being told what to do.

He plans to kick off health care regeneration by negotiating decent salaries for doctors and nurses that will end years of penury, which encouraged the corrupt practices rife in Iraqi hospitals today. As a priority, Sadik will demand proper protection and security for health workers - not least as the only way to stop the brain drain of doctors fleeing the country and to entice back some of those who have already left.

He will also argue for less spending on large hospitals. This will allow more funding to be channelled into specialist nursing and services that can improve care for those with chronic illnesses and promote health prevention. But he believes that just as important is a cultural revolution to overturn one of Saddam's most damaging legacies: what he describes as "the dictatorship mindset where every Iraqi, modelling himself on the former dictator, thinks he knows everything".

Instead, Sadik intends to promote effective and inclusive leadership, both by personal example and by appointing the right people to positions of power. He hopes this will ensure that Iraqi health care practitioners become accustomed to working in teams and respecting others' views.

A second priority is to outlaw the practice of selective treatment according to ethnic background: "Employees can belong to any group outside working hours, but while they are at work, they belong to Iraq."

The message at the London conference was an encouraging one to an audience of exiled Iraqi doctors but, maybe more significantly, it was the first occasion on which Iraqi doctors had met to plan for themselves a future for their mother country. Earlier "solutions" have come from coalition forces, overseas NGOs or reports from the UK Iraq Commission.

There are roughly 2,000 Iraqi doctors working for the National Health Service, and a few dozen attended the meeting. The Iraqi Medical Association believes that once the message gets through that change is taking place, many more will become involved in training and mentoring Iraq-based health care workers, either during secure visits to the country or by video conferencing.

Still awaiting final confirmation of his appointment as health minister from the Iraqi government, Sadik has made it clear that he will press for continuing aid from all quarters: NGOs, western governments, Arab organisations, the World Health Organisation, the private sector and the UK's royal colleges. The Royal College of Psychiatrists already has strong links with Iraq's developing mental health system.

But, in the end, only Iraq's own clinical expertise, now being put to use around the world, can make a decisive change in the health care of the Iraqi people. Sadik's appointment may well provide an opportunity for a second quiet cheer in a suffering country.

Tags:Iraq