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Last Updated: Saturday, 11 October, 2003, 22:22 GMT 23:22 UK
Hazards of an Iraqi hospital

By Martin Asser
BBC News Online correspondent in Baghdad

BBC News Online's Martin Asser is reporting from Baghdad six months after the fall of Saddam Hussein. We asked readers to tell us which aspects of life in post-Saddam Iraq they most wanted him to cover. One of your suggestions was to report how hospitals are coping after the withdrawal of humanitarian relief workers:

It is a very quiet afternoon in the surgical ward at the emergency section of al-Yarmouk hospital in western Baghdad - a couple of road traffic accidents, a possible appendicitis case and a poor old man with severe constipation.

The calm means the two young senior house officers have time to talk about the incredibly difficult circumstances they have to work under.

The nights are the worst, they say, when the ward overflows with victims of the wave of lawlessness which has swept Baghdad and its environs since the fall of Saddam Hussein's regime.

The bullet injuries have become routine though staff are severely stretched to cope. The main problem, they say, is the gangs of relatives armed with guns, knives and clubs who invariably accompany the wounded or dying patient.

Period of calm

"Usually by this time on Saturday morning the ward is full," says Dr Assad looking down the ward of 12 beds. "We have to treat people on the floor."

Patient at al-Yarmouk hospital in western Baghdad
There can be little privacy for the patients
"Unfortunately, most of the curtains to give patients privacy are gone," adds Dr Samir after examining the women with possible appendicitis over her clothes. "They were used during the war as burial shrouds, and we haven't been able to replace them."

The woman had become ill on Friday evening but the family did not risk bringing her the 30 kilometres from Mahmoudiya at night because of the twin fears of fedayeen attacks and jumpy American soldiers along the way.

Nor did they want to take her to the hospital in Mahmoudiya, her relative says, because they "don't have enough doctors and equipment there".

There are no visiting hours at the Yarmouk. Relatives are always needed at all times to help care for the patients.

"Usually people come in escorted by lots of relatives," says Dr Samir. "We send them all away apart from one who is left to help us with treatment."

The hospital does not have enough nurses, he explains, nor a working telephone system, so the relative often finds himself being sent to get drugs from the pharmacy or to go and fetch a doctor who is "on call" but with no way of calling him.

But, says Dr Assad, often the relatives will not go away.

Guards need guards

"One week ago, there came a man who had been shot dead. I knew he was dead, I felt him, he was completely cold and there was nothing we could do," Dr Assad says, chuckling sardonically despite what must have been a frightening experience.

Reception at al-Yarmouk hospital in western Baghdad
The relatives often pose the greatest challenge
"So the people who'd come with him started shouting at me that I'd done nothing to help him and threatening me unless I 'brought him back' - back from the dead, imagine!

"And if I'd done what we call 'show business' - performing CPR to pretend to save him - it probably would have been worse. They'd have accused me of killing him by what I'd done. Things like that happen all the time."

"Last night," Dr Samir chips in, "we'd received a man who'd shot his father and sister and a neighbour in a family row. Thirty people from the neighbours family came to kill him."

The Yarmouk does have a detachment of guards, from Federal Police Security, who are meant to protect doctors and nurses from such assaults but, as Dr Assad points out, "the FPS need bodyguards themselves".

The security guards carry arms and have all undergone a week's training by the US Army but they are often far outnumbered by the mobs who come to berate hospital staff.

So both guards and doctors told the BBC that sometimes they just hide their badges and guns or white coats and lie low.

Red tape

About two hours into what is meant to be a long sojourn in the surgical ward, the medical official in charge of the emergency section - Dr Jamil - approaches and introduces himself, smilingly but without the warmth one experiences with most smiles one receives in Iraq.

Unknown child at al-Yarmouk hospital in western Baghdad
People seem able to walk into the hospital off the street
"I assume you have obtained the necessary permission to be here from the ministry of health," he says, without any of the usual pleasantries.

It surprised me considerably as I had been welcomed without question by both the FBS officers and the doctors on duty, who were more than keen to share their troubles.

But apparently, in this hospital - where hordes of armed men maraud at will through the wards, in a country where you don't need press pass accreditation to work or even a visa to cross its border - I had encountered my first red tape.

"Try and get your permission," said Dr Assad. "Then come back on Thursday evening and you'll really see something."

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