Traditionally, the lead responsibility for humanitarian efforts has fallen to USAID, as it did in Vietnam. But in a move that Burkle calls “unprecedented,” President Bush transferred that authority to the Department of Defense in 2003, leaving a single agency in charge of both engaging the enemy and patching up the people they blow apart.
“The Bush Administration violated every single tenet that has been known in humanitarian circles for decades,” says Dr. Frederick Burkle.
At the beginning of the Iraq occupation, the Department of Defense sent Burkle to run the country’s Ministry of Health; he had previously headed up a trauma center during the first Gulf War and for more than 20 years has led recovery efforts in war-torn areas from Somalia to northern Iraq. Burkle proposed a plan that included establishing a health-surveillance system, decentralizing health care, and ensuring medical services for the large number of demobilized Iraqi soldiers—since, as many previous wars have shown, neglected soldiers will keep on fighting. The Bush Administration replaced him after two weeks, claiming it wanted a “loyalist” in the position, Burkle says. He was recently invited back to Baghdad to offer consultation but declined the opportunity. He sees it as an exercise in futility.
“The Bush Administration violated every single tenet that has been known in humanitarian circles for decades,” Burkle says. “Whatever plans were implemented were ad hoc, and the military was given very little help from the CPA [the Coalition Provisional Authority, a temporary government in Iraq that was established by the United States]. What can be done?”
Knowing his experience in rebuilding other health-care systems, I ask Burkle how long it would take to restore Iraqi health care to its revered pre–Gulf War days, assuming the effort would be conducted perfectly and without setbacks. “Oh, my God,” he says. “I can tell you that in Africa the recovery rate of its countries takes about a decade. It is going to take a long time for Iraq to come back. Even if there is a will, there are no doctors or nurses. It’s going to take a long time, just for medical and nursing education alone.”
Burkle explained that neighboring countries like Jordan and Syria are providing the most medical care to refugees—if the Iraqis can actually make it out of the country.
“They will never see the country they had before,” Burkle explains. “People have split and divided along ethnic, tribal, and religious lines. I think the legacy is that we have given them a license to divide Iraq, and it will never be the same, for good or bad.”
Before the CPA dissolved in June 2004, it issued a summary of its accomplishments, stating that “the entire country is at prewar capabilities for providing health care.” Every indication points to the contrary. Iraq’s infant mortality rate increased 37 percent after the 2003 invasion. “It is now among the very worst countries, along with Sierra Leone, Liberia, and Afghanistan,” says Burkle, whereas it used to be one of the best in the Middle East. One in eight Iraqi children perish before their fifth birthday, according to a report by Save the Children.
Hospitals operate without enough X-ray machines, ventilators, or ambulances to meet patient demand. The International Committee of the Red Cross issued a recent report stating, “The humanitarian situation is steadily worsening, and it is affecting, directly or indirectly, all Iraqis. . . . The plight of Iraqi civilians is a daily reminder of the fact that there has long been a failure to respect their lives and dignity.”
Standing next to the faceless Iraqi man, I feel undone by paradox. As an American, I take a certain amount of pride in the fact that our country is providing him with the greatest trauma care ever afforded a civilian war casualty. He won’t die on our watch—we will spend any amount of money to make it so. But our best intentions unravel the moment he leaves AFTH Balad. If he goes to Medical City, he may not survive the week. If he regains some ability to communicate, if he can write a note or speak some words, the pieces of his identity may begin to float together. Then he may be returned home. Like Zemen, the Iraqi without a face will require the efforts of his entire family to sustain him each day. He will battle infections, prescription drug shortages, and blindness. Shiite or Sunni, there won’t be any rehab, disability payments, or Medicare. For him, there is no promise of health or peace.
