Iraqi doctors have started abandoning a healthcare system that was the envy of the Middle East in the s and the s. As many as 20, of the over 52, registered physicians have reportedly left the country of 40 million people since the s. Poor health care has been among the core grievances of the mass protests that broke out in late Iraqis demand an overhaul of a political system that, they say, is corrupt, has plundered state resources and pushed ordinary people into poverty.
In , health minister Alaa Alwan resigned, citing insurmountable corruption and threats from people opposed to his reform efforts. The lack of hygiene among doctors and nurses, the lack of basic supplies or the lack of oxygen canisters or the lack of beds or the fires that gut sick patients? Every house in Baghdad has a tragic story to tell about the loss of a family member to Covid, said Mr Jasim, who lost his uncle to the virus in April.
In recent months, doctors across the country have staged sit-ins, demanding new laws to protect them. The current law, which stipulates six to 12 months in prison and a fine for assaulting a government employee, is hardly a deterrent.
There have also been mounting calls from medical staff to carry weapons. But that cannot be a solution, Prof Al Anbouri said. The Health Ministry could not be reached for comment despite numerous attempts.
Iraq halts working permit of Belarus Consulate in Baghdad. We use cookies in a limited and restricted manner for specific purposes. For more details, you can see "our data policy". On Wednesday, the number of COVID cases surpassed 1 million in Iraq , with the health ministry recording a total of 1,, cases of the disease and 15, deaths since the first infections were reported in the country in February Iraq's hospitals have been worn down by decades of conflict and poor investment, with shortages in medicines and hospital beds.
Those patients who can often prefer to source oxygen tanks for treatment at home, rather than go to overcrowded and run-down hospitals. Search Search. Home United States U. Physical exhaustion, psychological stress, increased absenteeism, and fear of personal safety all can contribute to the diminished quality of care. It was also the younger doctors who were more likely to feel unsafe in the hospital setting.
The frequent reporting of violent events occurring to the colleagues of the doctors participating suggests that violence was pervasive in Iraqi hospitals.
Commonly these events were not reported to hospital authorities or hospital security, suggesting that doctors felt reporting would not lead to any change in hospital violence or feared repercussions from reporting. The impact of violence on the mental health of health care workers only adds to the stress of providing pandemic care in difficult and under-resourced circumstances [ 8 ].
Many Baghdad doctors dreaded reporting for duty each day. In the context of civil unrest, these stresses are likely to be increased, as noted by the Iraqi doctors.
Internal displacement was noted as a factor in Libya, and is likely true in Iraq, though displacement was not specifically queried in our study [ 23 ]. While health workplace violence is a worldwide problem, its nature is shaped by local context.
In some places, health workers are accused of spreading the diseases [ 9 ]. In the first half of some COVID linked attacks on health workers in 61 countries had occurred [ 24 ]. India and Mexico have been identified as hotspots of violence against health workers during the pandemic [ 25 ]. There have been several reports in India of community members attacking health workers and the families of doctors ostracized [ 26 ]. Difficulties with physician-patient communications has been identified as a weak point in reducing health worker violence in India.
Mexico has seen a large number of attacks against health workers, many fueled by the misinformation about COVID, a widely reported problem in Latin America [ 28 , 29 ]. A history of societal violence and mistrust of government have been cited as a predisposing factor in increased health care violence during the pandemic in Colombia, India and Libya [ 23 ].
Although there has been extensive documentation of the events and the reactions among health workers, less attention has been paid to the structural issues contributing to the violence. In this Baghdad study, the participating doctors categorized a number of contributing hospital or health systems issues. These largely paralleled pre-COVID findings in surveys of Baghdad hospitals and PHC clinics as well as the opinions of medical students about relationships between health workers and patients [ 16 , 17 ].
Many of these same factors were associated with health worker violence in Pakistan [ 30 ]. In India dissatisfaction with inefficient service systems, long waiting time, overcrowding, and few staff or resources, were thought to instigate episodes of violence [ 31 ].
Poor communication between doctors and patients was felt to be a major contributor in India. Inequities in access to services is a structural factor also identified in India [ 31 ].
In Iraq, insufficient hospital security measures were at the top of the list of reasons for violence in this study, and also noted previously in Baghdad hospitals [ 16 ]. Violent workforce events are widely underreported to hospital authorities in this study as well as elsewhere [ 5 ].
In our study underreporting was likely because doctors had limited expectations these incidents could be addressed with constructive approaches. Most respondents stated that the increased workplace violence during the pandemic had not caused hospitals to increase security, nor did they expect local authorities to be sympathetic. Among those doctors who reported that their hospital had increased security there was a perception that these measures had, to at least some extent, reduced the risk of hospital violence.
Little study has been given to the characteristics of the perpetrators of violence. Some, such as disruptive behavior among adolescent males, alcohol intoxication, low educational attainment and persons accompanying emergency cases were more likely to be responsible for violence in an India study [ 31 ]. An alert hospital security service could identify such persons early, lessening the potential for violence and ensure some accountability for belligerent actions. A proactive institutional support for provider protection in Thailand proposed a multi-phased approach beginning with zero-tolerance policies and providing the skills to enforce them.
A second phase includes a personal protection committee, a surveillance process, and aggressive behavior training programs for health workers [ 32 ]. There are measures that hospitals can take beyond security enforcement. Developing systematic, participatory, and culture-sensitive, non-discriminatory approaches for staff facing violence has been used [ 31 ]. Often these interventions are based on de-escalation methods, simulation methods, the sensitivity training for professionals, and changes in the health care management process.
Training can help identify the warning signs of violent behavior to guide the development of prevention strategies to diffuse a violent situation. The need for hospitals and physicians to improve listening and communication skills has been identified [ 31 ]. Training can also help health workers with coping strategies when facing acts of violence and managing their longer-term emotions.
Changes to the setting such as altering patient loads, restricting the number and types of visitors allowed, and the adjusting the size of health units could also be considered. Addressing the underlying dissatisfactions such as waiting times, access to services and medicines, staffing levels, and other quality of care matters are fundamental health systems issues with which Iraq has been struggling for many years. Laws and ordinances have been frequently suggested as approaches to control workplace violence, and indeed this was the second most common suggestions from Baghdad doctors after that of improving security.
Although legal statues have been reinforced in India to reduce hospital violence, their impact is still uncertain [ 33 ]. Finally, there were some Iraqi doctors who said the only option was to leave, either leaving the current hospital posting, or leaving the country. A study of this nature has many limitations. Although the survey team made several visits to each hospital, some doctors were not included.
The study did not include nurses or other health workers who may have had different exposures to hospital violence. We did not sample patient or patient families to understand their perceptions. Experience of Iraqi doctors dealing with the pandemic in other Iraqi cities may have been different. Questionnaires may not have captured many of the complexity of hospital violence or the complicated emotions generated in a complex and insecure environment.
Finally, doctors may have been reticent to communicate sensitive events. In depth interviews about the origins of the violence, and interviews with patients, hospital management, and security personnel could have provided additional perspectives. This would be an important next step. The pandemic has exacerbated what was already a major problem with patient dissatisfaction and workplace violence in Baghdad hospitals.
The extent of violence is most certainly underreported to hospital authorities. Younger doctors were especially affected by hospital violence.
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