As I sit with him in his Denver, Colorado, hospital office, Bolles shows me a collection of photos he took of wounded patients in Iraqi hospitals. The majority of them are horribly disfigured by various types of explosions. After viewing several photos, I begin to sense something missing but can’t quite put my finger on it. One picture shows a boy with a missing arm, another a woman in severe distress over the burns covering her body. Then it hits me. There aren’t any lines going into the patients. No IVs, no oxygen, no catheters. There aren’t any of the usual monitors in the background. The patients are lying in bed, with little more than a bedsheet and pillow.
While visiting Iraq, Bolles was invited to participate in a neurosurgery. “It was like operating here [in America] 30 or 40 years ago,” Bolles says. “In one hospital I was in, one CAT scan had been down for six months, and they had an MRI that worked intermittently. In the U.S., we use automatic saws and drills, but they didn’t have any automatic instrumentation. It’s back to the old days, and I was trained that way. A lot of young guys wouldn’t know what to do.”
In one of the most damning reports of American policy failures, “Iraqi Hospitals Ailing Under U.S. Occupation,” journalist Dahr Jamail cites a litany of horrors evident in Iraqi hospitals in and near Baghdad. At Arabic Children’s Hospital, patients brought their own food because the hospital lacked funds to provide meals. Chuwader Hospital operated with only 15 percent of their necessary water supply. The toilet on the intensive care unit at Al-Karkh Hospital looked like a sewage nightmare of the most noxious order.
I ask Bolles about the physical condition of Iraqi hospitals he visited in the North. “The hospitals that I went to are overburdened and antiquated,” he says. “Their operating tables are pretty basic, and there are a lot of people who are being seen who cannot be treated because the hospitals do not have the appropriate equipment. If patients need a vent [ventilator] for any long period of time, chances are they aren’t going to make it.”
“Are Iraqi hospitals unable to handle the level of severity we’re passing on to them?” I ask.
“I guess they aren’t,” he says. “They don’t have the ability to give patients care.”
“So the patients deteriorate?”
“Yes. Or they die.”
An expert in postcrisis stabilization in areas like Kosovo and Serbia, Frederick “Skip” Burkle was the first nonmilitary American sent by the Department of Defense into Baghdad following the initial coalition invasion in March 2003. His primary objective was to shore up the collapsed Iraqi health-care system, starting by setting up a surveillance system to figure out who was getting sick from what. In the surreal posthaze of an afternoon sandstorm, Burkle’s armored convoy sped through Baghdad streets as he snapped pictures and made rapid-fire observations. The mission was threatened repeatedly: Burkle’s five-Humvee convoy was ambushed three separate times within an hour.
“Our convoy was hit by small arms gunfire,” Burkle says. “Our shooters claimed they saw a 50-cal [machine gun] up in a nearby apartment house. I also heard an RPG [rocket-propelled grenade] go whizzing between our vehicles, but it did not detonate.”
Prior to entering the city, Burkle had predicted that Baghdad would be ravaged by looting, but he was surprised by the ingenuity of the actual strategy. “It centered on health care. The looters were able to destroy morale very quickly by looting the health-care system. It was highly organized, focused on hospitals, the public health-care system, pharmacies, and pharmaceutical warehouses, and it was unrelenting. Doctors and nurses had their homes looted if they left for work.”
During Burkle’s April 2003 visit to Yarmouk Hospital, a teaching hospital in Baghdad, he was shocked by what he saw.
“There was nothing in Yarmouk left after the looting. The only beds and stretchers were in the emergency department. They had only a handful of bed sheets. Everything had been torn off the walls: The cardiac monitors were gone, dialysis units were trashed, and the motherboard was stolen from the CAT scan. Patients were lying on the floors because their beds had been stolen.”
Burkle had gone to Yarmouk Hospital to convince the administrators to allow the head of the Department of Defense’s Office of Reconstruction and Humanitarian Assistance entry into the hospital for an inspection. Yarmouk officials balked, claiming that it would draw attacks from insurgents. During the meeting, a young bearded Shiite cleric entered the room and glared angrily at Burkle. The cleric left without saying a word. Soon after, Burkle learned that the cleric was Moqtada al-Sadr and that a fatwa had been issued calling for Burkle’s death (and in fact, Burkle’s successor was shot). Yarmouk Hospital has since received new desks and chairs, but patients reportedly continue to die as a result of medication shortages.
Burkle looks back at the radically different American attitude toward local medical support during the Vietnam war. “Vietnam was a time when the world respected the U.S. for that kind of commitment,” he says. “I think we knew about cultures back then, and the State Department had a much bigger role.” According to the report “Medical Support of the U.S. Army in Vietnam 1965–1970,” U.S. military clinicians treated some 220,000 Vietnamese civilians a month through the Medical Civic Action Program (MEDCAP) in 1970. As a result of the Military Provincial Health Assistance Program, teams of 16 Americans augmented the clinical staff in each of 30 civilian hospitals.
“I don’t think there are many MEDCAP missions at all now,” says Burkle. “There is no presence of U.S. military in Iraqi hospitals. Our troops get space-age medicine, but 70 percent of the Iraqis who get injured in the same blast die.”
In his book Military Medicine to Win Hearts and Minds: Aid to Civilians in the Vietnam War, Robert J. Wilensky points out that from 1963 to 1971, American medics engaged in nearly 40 million civilian encounters in Vietnam. AFTH Balad treats about 2,000 Iraqis a year. The quality of care that the military gives to Iraqis in field hospitals is indisputably superb, but the scope of treatment (which falls outside of military responsibility) is cause for serious concern. Although the Iraqi Ministry of Health has refused to report the number of injured civilians, the medical journal The Lancet estimates the number of seriously wounded Iraqis at nearly a million. According to the World Health Organization, there were a total of about 35,000 hospital beds in Iraq in 2005. The numbers suggest that the majority of injured Iraqis are treated in an overburdened Iraqi health-care system, if at all.