Zemen, a student from Baghdad, was injured
when a mortar shell landed at her high
school in 2006. Her surgery left her
without control of her arms or legs
and there is no system for providing
her with physical therapy.
Image courtesy of Faiza Alaraji
As Emps and I sat talking in the Iraqi ICU tent, I again looked at the various patients occupying the beds. Several children had missing limbs; other patients had a number of lines running out of their necks and torsos. At some point in our conversation, a graying Iraqi man entered the room and glared at both Emps and me with an expression of contained rage. His brother—a mummy of bandages—was attached to a ventilator, comatose. When the visitor sat down, he held his brother’s hand gently, and his face transformed into a mask of sorrow and acceptance. Barely 10 minutes later, the man stood up to leave the room, his shoulders slumped in despair.
“A lot of the time, they know the story before we do,” Emps said.
The Iraqis brought to Balad are the lucky ones. Not all wounded Iraqis are taken to a U.S. military hospital for treatment. If injuries happen away from areas patrolled by the American military, the responsibility of trauma care falls to local facilities.
Sixteen-year-old Zemen, a high school student in Baghdad, wore the same school uniform to class each day: a white cotton shirt and a long navy skirt. In October 2006, a mortar shell exploded in the schoolyard just as Zemen was walking outside between classes. Shrapnel tore through the cotton shirt into her skin and bones, ravaging Zemen’s neck and back.
At the emergency room of al-Numan Hospital in Baghdad, admitting doctors did what they could to slow Zemen’s bleeding. It would be five days before a surgeon would work on her.
Zemen survived, but spinal surgery left her with significant motor control problems. Her fingers twisted when she tried moving them, and her legs refused to obey the signals her brain sent. Nurses placed Zemen in a hospital bed, not knowing whether she would live. Forty-five days later, Zemen was finally discharged.
Zemen lives in her parents’ house in northern Baghdad. She passes the day confined to a chair, with family conversation her only amusement. Even electricity is in short supply. During the brief episodes when power is available, Zemen is able to watch a precious few minutes of television. Her father, a retired factory worker, sells cigarettes and vegetables from a meager stand in front of their house. The family is dependent on neighbors’ purchases to make ends meet.
Zemen might regain control of her legs and arms with physical rehabilitation. But there isn’t a place for her to get any care, and even if there were, it would involve risking one’s life to take her there. Her only hope is to leave Iraq for Jordan, where she can find effective health care. It can cost $400 for an Iraqi passport, and her family needs three. A car rents for $600. With a monthly income of less than $100, it isn’t likely that Zemen’s family will be able to afford the trip, much less the $5,000 in expenses once she arrives in Jordan.
Unlike the Iraqi man in AFTH Balad, Zemen has a face and a name. But the identity does her little good. She is trapped.
America once had a blueprint for humanitarian efforts in an occupied country. Before and during the Vietnam War, the United States had a coordinated and efficient system in place to maintain and stabilize health care for Vietnamese civilians, which was initially established by the U.S. Agency for International Development (USAID). In a joint effort by USAID and the U.S. Military Assistance Command, Vietnam, the military implemented four civilian-oriented programs. The combined effect of these four programs was an astounding level of health care. Even in the midst of the Vietnam War, the U.S. military succeeded in building three hospitals that provided 1,100 beds to civilians.
U.S. efforts to construct medical facilities in Iraq have been a miserable failure. The most egregious example is that of Basra Children’s Hospital, a stalled project supported by first lady Laura Bush. In late 2003, Congress allocated an initial $50 million. Three years later, construction had more or less ceased halfway through the project, and completion costs were estimated at $120 million. (The contract was recently transferred from a U.S. construction company to a Jordanian firm.)
The Geneva conventions require that the sick and wounded be treated with “particular protection and respect.” Article 56 of the fourth convention states that “the public Occupying Power has the duty of ensuring and maintaining . . . medical and hospital establishments and services, public health, and hygiene in the occupied territory.” More than a dozen articles in all govern necessary medical measures, from issues of medical supplies to physician security.
Throughout the 1980s, Iraq was widely regarded as the premier destination for medical care in the Middle East. The Gulf War, along with the ensuing years of trade embargoes, weakened Iraqi health care, but the policies of a despot nearly dismantled the national pride.
“The Iraqi system was in bad shape before we got there,” says Lt. Gen. (Dr.) James Roudebush, the Surgeon General of the Air Force. “Saddam spent about 50 cents a year for health care for each Iraqi his last year in power, while royal family members had entire hospitals devoted to their health.” Tommy Thompson, the former Secretary of Health and Human Services, has publicly decried the decline of health care under Saddam’s regime: “Doctors were forced to watch their patients die because they just didn’t have the supplies or medications they needed. And medical education was stifled for 25 years, which meant that new practices and technologies couldn’t be utilized, and in the end, people suffered.”
