Dear friends,
This article was published last week in the British Medical Journal about our new health minister, I really dont like to be in his shoes now.
Best regards.
An unenviable role -- Dyer 335 (7615): 326 --
BMJ 2007;335(7615):326 (18 August)
Owen Dyer, journalist
London
owen_dyer@hotmail.com
Running Iraq's health department is not only logistically difficult but
dangerous. Owen Dyer talks to the new minister about the challenges
Iraq's beleaguered government has sought outside help to run its troubled health
ministry—in the form of a Kent psychiatrist. Dr Sabah Sadik, who until recently
was medical director of Kent and Medway NHS and Social Care Trust, will take on
a ministry heavily infiltrated by the political faction loyal to Shiite cleric
Moqtada al-Sadr and its feared militia, the Mahdi Army. "A lot of
people—especially Iraqis—have told me I'm crazy to go," he said.
Six Sadrist ministers quit the government in April, including Ali al-Shemari,
the health minister. Iraq's government saw an opportunity to break the militia's
grip on the health system, says Dr Sadik. "That's the main reason why I've
decided to accept this job now. There seems to be a new determination to get the
sectarianism out of the ministries and appoint neutral technocrats. If that is
serious, I'm willing to be one of them."
Dr Sadik qualified in Baghdad in 1974, and has worked in Britain for nearly
three decades. He comes from a "very liberal Shiite family," but lived from age
10 in Baghdad's heavily Sunni Kharq district, attending the same secondary
school as Saddam Hussein. He spent a year in Iraq in 2004-5, working as national
adviser for mental health.
Unstable system
Five health ministers have come and gone since the 2003 invasion, but Iraq's
health system has continued its long slide into disrepair. A report published by
Oxfam last week showed every public health indicator heading in the wrong
direction.1
The health ministry's problems, however, go far beyond a lack of resources. As
the Sadrists' grip tightened throughout 2006, the ministry descended into
gangsterism. In an effort at inclusiveness, Sunni parties were allowed to
nominate one deputy health minister. Their candidate, Ali al-Mahdawi, entered
the health ministry last June for an appointment with the minister, Mr
al-Shemari. He and his bodyguards have never been seen since.
Last summer, horrific stories began to emerge of Shiite death squads prowling
Baghdad's hospital wards. It's unclear to what extent the health ministry
controls these men. Many wear the uniforms of the Facilities Protection Service,
ministerial private armies staffed with party militia. The service is
particularly notorious, and numbers about 15 000 armed men.
Last autumn, the health ministry became embroiled in a violent feud with the
Sunni controlled Ministry of Higher Education, culminating in armed attacks on
both ministry headquarters.
Restoring confidence
Will Dr Sadik purge the ministry? "It's fair to say," he acknowledges, "that the
Sadrist influence runs through the ranks. In Iraq, everyone expects the new man
to clean everyone out and replace them with his own people. They expect a
dictatorial leadership style. I prefer not to operate that way. I think everyone
deserves a chance to show that they can look beyond sectarian loyalty and work
for all Iraqis. But if someone can't do that, then yes, ultimately they must
go."
Some have already gone. A kidnap ring operating from the heart of the ministry
was shut down last August when US forces arrested seven bodyguards of Mr
al-Shemari. But in November, deputy health minister Ammar al-Saffar was
kidnapped from his home. He has never been found. The next day, two bodyguards
of another deputy health minister, Hakim al-Zamili, were killed when his convoy
was ambushed. "We as health ministry officials have become targets," Mr
al-Zamili told reporters.
This February, US forces named a suspect in Mr al-Saffar's disappearance—his
fellow health minister Mr al-Zamili, whom they arrested in his office along with
five bodyguards. Mr al-Zamili was also accused of diverting ministry funds to
the Mahdi Army.
Dr Sadik is aware of these incidents, but he is not deterred. "Certain political
groups may be unhappy with my appointment. But there is always the knowledge
that if you don't do it, who will?"
"I'm under no illusion that progress will be quick or easy. But I think there
are some quick fixes available. Communications within the government can
definitely be improved," says Dr Sadik, who recounts that during his year as
Iraq's national adviser for mental health, he never met his health minister.
"My first priority will be to go to the hot spots myself. People won't trust
their government if it won't show its face." He plans an early visit to the
bitterly divided province of Diyala.
Dr Sadik does not dispute the widespread claim that more than half of Iraq's
doctors have fled the country. "There were 150 psychiatrists in Iraq in 2003.
Now there are 65. I believe that's representative. But no doctors are getting
jobs in neighbouring countries any more, as they've stopped giving work visas.
"My greatest concern is for those who can't afford to leave, who must stay and
face difficult conditions." He worries about nurses, whom he considers key to
rebuilding the health system. "We must quickly raise salaries for both doctors
and nurses," he says.
On the US led invasion, Dr Sadik pronounces himself "ambivalent." He is critical
of reconstruction efforts and describes casualties in Iraq as "unknowable but
unacceptably high."
He is awaiting confirmation by Iraq's parliament, which is now in recess for
August and has recently been short of a quorum because of walkouts by members of
parliament.
When he does leave for Iraq, his British born wife and four sons will stay in
Kent. "They will visit later," he says, "when things settle down a bit."
Competing interests: None declared.
References
Oxfam. Rising to the humanitarian challenge in Iraq.
www.oxfam.org/en/policy/briefingpapers/bp105_humanitarian_challenge_in_iraq_0707
This article was published last week in the British Medical Journal about our new health minister, I really dont like to be in his shoes now.
Best regards.
An unenviable role -- Dyer 335 (7615): 326 --
BMJ 2007;335(7615):326 (18 August)
Owen Dyer, journalist
London
owen_dyer@hotmail.com
Running Iraq's health department is not only logistically difficult but
dangerous. Owen Dyer talks to the new minister about the challenges
Iraq's beleaguered government has sought outside help to run its troubled health
ministry—in the form of a Kent psychiatrist. Dr Sabah Sadik, who until recently
was medical director of Kent and Medway NHS and Social Care Trust, will take on
a ministry heavily infiltrated by the political faction loyal to Shiite cleric
Moqtada al-Sadr and its feared militia, the Mahdi Army. "A lot of
people—especially Iraqis—have told me I'm crazy to go," he said.
Six Sadrist ministers quit the government in April, including Ali al-Shemari,
the health minister. Iraq's government saw an opportunity to break the militia's
grip on the health system, says Dr Sadik. "That's the main reason why I've
decided to accept this job now. There seems to be a new determination to get the
sectarianism out of the ministries and appoint neutral technocrats. If that is
serious, I'm willing to be one of them."
Dr Sadik qualified in Baghdad in 1974, and has worked in Britain for nearly
three decades. He comes from a "very liberal Shiite family," but lived from age
10 in Baghdad's heavily Sunni Kharq district, attending the same secondary
school as Saddam Hussein. He spent a year in Iraq in 2004-5, working as national
adviser for mental health.
Unstable system
Five health ministers have come and gone since the 2003 invasion, but Iraq's
health system has continued its long slide into disrepair. A report published by
Oxfam last week showed every public health indicator heading in the wrong
direction.1
The health ministry's problems, however, go far beyond a lack of resources. As
the Sadrists' grip tightened throughout 2006, the ministry descended into
gangsterism. In an effort at inclusiveness, Sunni parties were allowed to
nominate one deputy health minister. Their candidate, Ali al-Mahdawi, entered
the health ministry last June for an appointment with the minister, Mr
al-Shemari. He and his bodyguards have never been seen since.
Last summer, horrific stories began to emerge of Shiite death squads prowling
Baghdad's hospital wards. It's unclear to what extent the health ministry
controls these men. Many wear the uniforms of the Facilities Protection Service,
ministerial private armies staffed with party militia. The service is
particularly notorious, and numbers about 15 000 armed men.
Last autumn, the health ministry became embroiled in a violent feud with the
Sunni controlled Ministry of Higher Education, culminating in armed attacks on
both ministry headquarters.
Restoring confidence
Will Dr Sadik purge the ministry? "It's fair to say," he acknowledges, "that the
Sadrist influence runs through the ranks. In Iraq, everyone expects the new man
to clean everyone out and replace them with his own people. They expect a
dictatorial leadership style. I prefer not to operate that way. I think everyone
deserves a chance to show that they can look beyond sectarian loyalty and work
for all Iraqis. But if someone can't do that, then yes, ultimately they must
go."
Some have already gone. A kidnap ring operating from the heart of the ministry
was shut down last August when US forces arrested seven bodyguards of Mr
al-Shemari. But in November, deputy health minister Ammar al-Saffar was
kidnapped from his home. He has never been found. The next day, two bodyguards
of another deputy health minister, Hakim al-Zamili, were killed when his convoy
was ambushed. "We as health ministry officials have become targets," Mr
al-Zamili told reporters.
This February, US forces named a suspect in Mr al-Saffar's disappearance—his
fellow health minister Mr al-Zamili, whom they arrested in his office along with
five bodyguards. Mr al-Zamili was also accused of diverting ministry funds to
the Mahdi Army.
Dr Sadik is aware of these incidents, but he is not deterred. "Certain political
groups may be unhappy with my appointment. But there is always the knowledge
that if you don't do it, who will?"
"I'm under no illusion that progress will be quick or easy. But I think there
are some quick fixes available. Communications within the government can
definitely be improved," says Dr Sadik, who recounts that during his year as
Iraq's national adviser for mental health, he never met his health minister.
"My first priority will be to go to the hot spots myself. People won't trust
their government if it won't show its face." He plans an early visit to the
bitterly divided province of Diyala.
Dr Sadik does not dispute the widespread claim that more than half of Iraq's
doctors have fled the country. "There were 150 psychiatrists in Iraq in 2003.
Now there are 65. I believe that's representative. But no doctors are getting
jobs in neighbouring countries any more, as they've stopped giving work visas.
"My greatest concern is for those who can't afford to leave, who must stay and
face difficult conditions." He worries about nurses, whom he considers key to
rebuilding the health system. "We must quickly raise salaries for both doctors
and nurses," he says.
On the US led invasion, Dr Sadik pronounces himself "ambivalent." He is critical
of reconstruction efforts and describes casualties in Iraq as "unknowable but
unacceptably high."
He is awaiting confirmation by Iraq's parliament, which is now in recess for
August and has recently been short of a quorum because of walkouts by members of
parliament.
When he does leave for Iraq, his British born wife and four sons will stay in
Kent. "They will visit later," he says, "when things settle down a bit."
Competing interests: None declared.
References
Oxfam. Rising to the humanitarian challenge in Iraq.
www.oxfam.org/en/policy/briefingpapers/bp105_humanitarian_challenge_in_iraq_0707
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