Old habits imperil Iraq as doctors warn of second wave

Abdulrahman Zeyad

BAGHDAD (AP) — In the busy emergency room of Baghdad’s main public hospital, Ali Abbas stood face uncovered, waiting for his sickly father. Dozens of other patients and their relatives mingled without masks.

It is a scene that confounds health workers in Iraq, who warn that the country is entering a new wave of coronavirus cases, in part because many shirk precautions.

“I do not believe in the coronavirus,” the 21-year-old Abbas said in the middle of the hospital floor, defying the facility’s rules requiring masks.

On Friday, Iraq was under its first full day of a new curfew imposed by the government in response to infection rates that have shot back up again after easing last autumn. The curfew runs all day Friday to Sunday, and from 8pm to 5am the rest of the week. Mosques and schools are closed, large gatherings prohibited, and the wearing of masks and other protective gear will be enforced, according to a statement from the government.

A complete lockdown, including closing airports and borders, is also being considered, two government officials said, speaking on condition of anonymity because they were not authorised to brief the media.

New cases, down under 600 a day just a month ago, have sharply increased, reaching 3,896 a day on February 18 and approaching September’s daily peak of more than 5,000. The Health Ministry said 50 per cent of the new cases are from the new, more infectious strain that first broke out in the United Kingdom (UK). Over 657,000 people have been infected by the virus in Iraq and 13,220 have died since February.

A volunteer sprays disinfectant as a precaution against the coronavirus, during the open-air Friday prayers in Sadr City, Baghdad, Iraq. PHOTOS: AP
ABOVE & BELOW: People walk outside emergency room of Baghdad’s main public hospital in Baghdad; and police talk to a civilian at the start of the new curfew

Doctors told The Associated Press (AP) they have seen the flare-up coming for weeks. They blame a careless public and a government unable to fully enforce virus protocols.

“I am a doctor fighting public ignorance, not the pandemic,” a pulmonologist at Baghdad’s al-Zahra Hospital Mohammed Shahada said. At al-Zahra Hospital, the year began with just four patients in the 90-bed isolation ward. By the start of February, that jumped to 30 severe virus patients. Shahada expects more in the coming weeks.

At his private clinic, some patients walked out rather than abide by his strict face mask requirement, he said.

A doctor at Baghdad’s Sheikh Zayed hospital Ismail Taher estimated that only one in 10 people walking into his hospital wear masks.

The Health Ministry said earlier this month a new wave was being driven by activities and large crowds in markets, restaurants, malls and parks, where greetings with handshakes and kisses are the norm.

The ministry also blamed “some people who are openly questioning the existence of the pandemic”.

That is a common sentiment.

“It is just the flu,” said Yahya Shammari, a 28-year old college graduate. “I went to the hospital twice with no mask on and I did not get infected.”

Rahem Shabib, 32, said he noticed how infection rates dipped following the Arbaeen pilgrimage in October.

The Arbaeen brings millions from around the world to Iraq for commemorations connected to the Seventh Century killing of Imam Hussein, the grandson of Prophet Muhammad (pbuh). This year, Iraq banned foreign pilgrims from attending, considerably reducing the numbers.

Medical sociologist at the American University of Iraq Mac Skelton said the dismissive attitude was not so much rooted in ignorance as in the realities Iraqis face.

Iraqis have endured so many calamities the past few decades, including wars, political violence and sanctions, that COVID-19 “may not stack up as a major problem”, he said.

Also government pandemic policies, centred on hospitals, do not mesh with how Iraqis cope with illness, said Skelton. Amid years of instability, Iraqis had to come up with their own strategies, because healthcare was either not available or they distrusted hospitals, which at the height of sectarian fighting became dangerous places to go to.

So they seek out pharmacists, nurses, help from neighbours, or even cross borders to treat illness.

“Most doctors are not that surprised, they know patients would refuse to go to hospital unless they were gasping for air and had no choice,” said Skelton, director of the university’s Institute of Regional and International Studies.

This also suggests Health Ministry statistics, based on tests at government labs, are an undercount, as many Iraqis may forgo testing altogether and opt to recover at home.

Iraq’s centralised health system, largely unchanged since the 1970s, has been ground down by decades of wars, sanctions, and prolonged unrest since the 2003 United States (US) invasion. Successive governments invested little in the sector.

The mingling of virus patients with others also exacerbated case numbers, doctors said. Shahada’s hospital was once reserved solely for virus patients; but no longer, and COVID-19 patients and others share rooms where CT scans, MRIs and X-rays are taken, Shahada said.

So far, Iraq has not faced shortages in medical supplies or ICU capacity. But that could change if cases soar, doctors said.

The Health Ministry said it plans to begin administering vaccines by the end of March. The government allocated funds to secure 1.5 million vaccines from Pzifer and signed a contract for two million more from AstraZeneca. Little has been announced about how inoculation will proceed.

Now more than ever, government officials worry it will be difficult to change entrenched habits.

As restrictions eased after September, life returned to Iraq. In Baghdad, restaurants are packed and face masks seldom seen. Further south in Basra, residents go about the day as though the pandemic never reached the southern shores, sharing meals in crowded cafes and shaking hands.

“Changing public awareness is the only way to stop another lethal virus outbreak,” Health Minister Hasan al-Tamimi told the AP at the sidelines of a recent press conference.