Page last updated at 05:36 GMT, Friday, 1 May 2009 06:36 UK

Iraq's quiet healthcare crisis

Hussein (right) with fellow Iraqis at the plastic surgery clinic (photo by Natalia Antelava)
Hussein (right) and his fellow patients are the lucky few to get this kind of treatment

By Natalia Antelava
BBC News, Amman

The boy looked like an old man. His lips moved slowly, trying to stretch against his inflexible, badly scarred skin, and bandages covered his eyes.

But the voice that came out of his disfigured face was loud and cheerful and it filled the hospital room.

"I want to go back to Iraq, I miss my dad," Hussein said.

Six years ago, when Hussein was 11 months old, his grandmother took him along to a market near their house in Baghdad.

That day the market was ripped apart by a car bomb explosion, hours later Hussein was found, badly injured, next to his grandmother's body.

After several failed operations, his family became certain that he'd stay disfigured for the rest of his life.

What we do is not available in Iraq not because of the lack of skill, but lack of resources and security
Anonymous, surgeon

But a few months ago his mother heard about a free clinic in Jordan where doctors could restore the damaged tissue on Hussein's head.

It was only on the operating table in Amman, as Hussein was put under anaesthetic, that surgeons discovered that something else was wrong - the boy could not close his eyes.

"Because his skin is so stretched, he could not shut his eyes. That is very dangerous and could lead to blindness. So we operated on his eyes instead," Hussein's doctor says.

Dr Nagham Hussein, who is Iraqi herself, says she is not surprised that despite multiple surgeries no-one in Baghdad noticed Hussein's serious chronic condition.

"Doctors in Iraq are too busy saving lives. This kind of surgery is a luxury," she says.

Medical exodus

Tens and possibly hundreds of thousands of people are estimated to have died in Iraq in the recent years of war and violence, and many more have been injured.

Operation (photo by Natalia Antelava)
The operations may not be as dramatic as on TV, but indirectly they save lives

Those injuries from explosions and car bombs often cause long lasting damage and demand subsequent treatment. But it's not available in Iraq.

The UN estimates that more than 400 specialised doctors have left Iraq since hostilities began in 2003, hundreds of others have been killed. Understaffed hospitals lack staff, basic infrastructure and security.

Since 2006, a team of Iraqi surgeons in Amman have been trying to finish the work started by their colleagues in Iraq.

The reconstructive surgery programme is funded jointly by the non-governmental organisation Medecins Sans Frontieres (MSF) and the Red Crescent of Jordan.

"What we do is not available in Iraq not because of the lack of skill, but lack of resources and security," says the programme's head surgeon.

"The doctors in Iraq are the real heroes, we are just picking up the pieces, we are completing their work," he says.

The surgeon does not want to be named, for fear that doing even this kind of work under the umbrella of a Western organisation could put his relatives in Iraq in danger.

Also, as a result of security concerns the programme does not have a representative in Iraq. Instead it relies on an undercover network of doctors in Iraqi hospitals, who refer patients to Amman.

Lurking dangers

Over the last two years, 660 people went through the clinic, currently another 100 are on a waiting list back in Iraq.

Hussein (photo by Natalia Antelava)
I want to be a doctor when I grow up so that I can have a lot of money and buy chicken and fruit any time I want

"Word of mouth has made us relatively well known in Iraq. But there is a great deal of demand, and unfortunately we are probably not reaching people in rural areas who badly need the procedures we offer," the head surgeon says.

These procedures are sophisticated and surgeries often last many hours.

"These may not be TV-style emergency operations, but indirectly we are saving lives," says Dr Annick Antierens, MSF medical director at the Amman project.

"Some of our patients cannot have a life because they are so handicapped, others cannot eat because their face is so disfigured. And without these surgeries many can and will die."

In one of the clinic's two operating theatres, a heart monitor beeps steadily as a surgeon leans over a young man and cuts open his face. Across from him another doctor cuts into the patient's leg.

"They are taking bone from his hip and using it to reconstruct his face," the nurse explains in whisper.

Downstairs, back in his hospital room, Hussein and three other children are recovering from their surgery. The three girls are too ill and too weak to speak but Hussein chats away.

"I want to be a doctor when I grow up so that I can have a lot of money and buy chicken and fruit any time I want," he says.

Hussein still needs another operation - a tissue transplant on his head.

Eventually, once his bandages are off, he will be sent home. But the Iraq that he will be going back to is still violent, and dangerous and his hospital bed won't stay empty for long.

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