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26 July 1999

Kidneys for sale at $500 each

In Iraq, people walk barefoot, and doctors have lost interest in ethics. ByPeter Kandela

By Peter Kandela

Baghdad today is a very different place from the modern, affluent city I knew in the 1980s. After nine years of war and sanctions, everyone’s daily life is dominated by the need to survive the shortages, the unfamiliar rigours of poverty, the collapse of services. Cracks are appearing in the social fabric that may, in the long term, prove more difficult to repair than bombed power stations and cracked sewers.

Walking down the street, one sees the evidence of poverty everywhere. Once- fashionable clothes are now shabby and patched, and it is common to see people walking barefoot in the city centre. Old and noisy cars emit stinking exhaust, and their rusty holes are covered with an ingenious patchwork of materials.

Anything is available on the black market – but at a price. A junior hospital doctor is paid about 3,500 Iraqi dinars (ID) a month (£1 = ID3000), and an experienced teacher earns a maximum of ID7,000, but a kilo of meat costs ID2,400, and a 450g tin of milk is ID1,500.

Under these circumstances, most ordinary people have to sell possessions regularly in order to eat. Houses are becoming bare. Ornaments went, then rugs, cushions, utensils and now furniture. In some school playgrounds, teachers have set up stalls to sell their surplus household items. Parents feel a pressure to buy and they claim there is a connection between their spending and the examination marks that their children can expect to achieve.

The whole education system is in decline. Materials and equipment are not replaced, buildings are decaying and students are leaving school early and not going on to higher education, because they need to work if they are to eat. All this in a country that once had one of the highest percentages of graduates in the Arab world.

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Anyone who can supplement their income with a second job will do so. A university engineering lecturer will come home as soon as he can to mend other people’s radios. The city’s main teaching hospital has a short operating list – because surgeons leave at lunchtime to drive taxis or cut hair.

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The electricity supply to every household is now cut for 12 hours every day. The old houses of Baghdad were built to withstand the summer heat and keep food cold, but perishable food is often seen on open lorries in the searing heat, because there are no spare parts for refrigerated transport. The domestic water supply is often so brown that it stains the clothes washed in it, nobody collects the rubbish and burst pipes in the street are as likely to discharge sewage as water.

With all of this, the incidence of infection and food poisoning is high and increasing, but the shortage of drugs remains a critical problem, except on the black market.

The government has recently issued health ration books, which entitle everyone to six free visits to a doctor each year, during which drugs may be dispensed at nominal prices.

But people complain that, because of the shortages, they rarely get their full complement of drugs. Similarly in hospitals the lack of medicine and equipment means that there is a grave deterioration in healthcare and that malnutrition and infection are endemic. Resources are now so depleted that patients’ notes are written on the back of torn-up packaging.

Perversely the private health sector is still flourishing, but it provides mainly cut-price services for patients from neighbouring countries. A kidney transplant package will cost about $4,000, with patients required to bring all the necessary medicine, including anaesthetic, with them. The organs are supplied locally, because people are only too willing to sell their kidneys for ID1 million (about £320).

At least ten such transplants take place every week in Baghdad alone, and doctors say that they are no longer interested in the ethical aspects of their behaviour in a world that has abandoned them.

In this desperate struggle for survival, moral issues are dismissed as luxuries, and crime and corruption are increasing exponentially. Homes are robbed so routinely that few people will ever leave a house unoccupied even for a short time. Many adults carry guns, and almost every family has a story of an accidental shooting, often involving children. After a funeral, where rites involve burial in a coffin, people have to guard graves for a few days or they will be dug up and the coffin removed for resale.

Iraq has never been free of corruption but it has now reached extraordinary levels, as officials invite bribes for almost any service in order to supplement their income. One Iraqi traveller reported recently that it cost him $40 to bribe his way back into the country. This amounts to ID80,000; the average monthly pay of border officials is around ID4,000.

Even without the cataclysms of wars and internecine strife, the people of Baghdad are becoming accustomed to levels of crime and corruption that were unimaginable just a few years ago.

The result is a climate of fear – and of mutual suspicion. Individuals fear for their lives, and minority groups are increasingly uneasy, because the scarcity of resources brings their very existence in the country into question. Baghdad is a city in rapid and dangerous decline, and action is urgently needed if we are not to see another humanitarian disaster.

The author is a medical practitioner and foreign correspondent for the “Lancet”