Although according to official figures and based on monitoring the media and following social media websites, Iraq continues to rank low on the list of countries affected by the coronavirus, compared to Iran, one of the epicentres for the spread of the virus, and considering the heavy transport and human movement traffic with it, all circumstances are fit to transform that global threat into an existential threat for the Iraqi people, no less dangerous than the overrun by ISIS of large areas of the country in 2014.
The disgraceful situation reached by the health sector in Iraq represents one of the most salient features of the failure of the new Iraqi regime. Despite the allocation of tens of billions of dollars to the rehabilitation and reconstruction of hospitals and health centres of different specializations and degrees, the health institutions in the country today are extremely far from reaching the stage of providing services with the standards expected from a “rich’ oil country. Published studies on the state of the health system in Iraq refer to a set of problems that not only render it unable to counter the spread of the coronavirus epidemic, but also incapable of performing its normal functions. This made it come at the rear of the global ranking, as it ranked 176 according to the assessment of the World Health Organization. This disgraceful state of the health sector is attributable to a number of reasons, mainly:
1. Shortage of finance and the low priority given to health in the government budget, which had a direct impact on the access of individuals to good health care and their exposure to financial difficulties or their descent into poverty as a result of direct spending on health services. Out of the general budget for 2019 of nearly 133 trillion Iraqi dinars (more than 110 billion dollars), the health and environment sectors together were allocated 6 trillion dinars (5 billion dollars), i.e. 4.5 percent of the budget. This is not expected to get better in the 2020 budget which faces an unspecified deficit of no less than 50 trillion dinars. This percentage is considered low, equivalent to less than 1 percent of Iraq’s gross domestic product (GDP) compared to 3.6 percent in Jordan, 3.8 percent in Lebanon and 4.1 percent in Iran.
2. Degradation of the health sector infrastructure: figures indicate that there are 2765 primary and secondary health centres, representing 7.2 percent for every 100 thousand people, which means that Iraq is in need of an additional 3000 health centres to match international standards. According to the figures provided by the Iraqi Central Statistical Organization for 2016, there are 260 government hospitals (a number of which became out-of-service as a result of the war against ISIS, with a few having an intensive care unit), 121 private hospitals (the great majority of which offer limited services, and are extremely expensive so that they are inaccessible to the public and lack intensive care units). This number of hospitals covers nearly 40 million people, according to the estimates of the Iraqi Ministry of Planning for 2019.
3. Shortage of doctors and nursing staff who are poorly distributed and inadequately trained, in addition to the unfavourable working conditions and security threats, whether from armed groups, criminal organizations or tribes, which led to the migration of competent medical staff.
4. Failure to follow modern methods in managing human resources and the impact of political pressures in imposing unsystematic practices, in addition to the lack of coordination between the health system and educational institutions run by the Ministry of Higher Education and Scientific Research.
5. The uncalculated application of decentralized administration by shifting some powers from the Ministry of Health to local governments which led to the establishment of wrong practices, doubling the gaps and misallocation of human resources.
The resigned government, whose head chose to enter into a state of “voluntary absence” from administering the tasks of his office, seemed indifferent to the accelerating developments regarding the spread of the coronavirus. This was despite the warnings made by public health experts and specialists in contagious diseases and viruses that the precautionary measures taken by the ministerial Crisis Cell are not commensurate with the event, especially in terms of the mere deployment of thermal screeners at airports and border crossings and the failure to take immediate decisions to stop air flights and maritime shipping between Iraq and China. This was not heeded even after the advent of the virus to Iran and the successive news of recording more infections among Iranians in the cities of Qom and Mashhad, the two most important tourist destinations visited yearly by hundreds of thousands of Iraqis to visit the holy Shiite shrines, in addition to thousands of patients who come to Iran for treatment in its hospitals.
On the other hand, hours after the first coronavirus infection was recorded in the city of Najaf on 25 February by an Iranian student in the religious seminary, the Crisis Cell took the decision to ban entry of Iranian nationals to the country for 15 days and suspend flights between both countries. For its part, the Ministry of Education decided to postpone exams and extend spring holidays, while the Ministry of Higher Education decided to shut down universities and adopt online learning. This was considered by many an acknowledgement of the failure to counter the situation amidst increasing complaints by staff of the Ministry of Health of the lack of the most basic preventive supplies, such as medical masks and gloves, let alone the absence of integrated protection and ignoring to put thousands of returnees from Iran in quarantine, trusting them for a self-imposed home quarantine which they violated.
Soon afterwards, the outcomes of government negligence began to emerge with the recording of more infections with the virus throughout the country and the occurrence of a fixed death rate of around 10 percent compared to the total number of infections. This drived observers to express strong doubt about the credibility of the officially announced figures and assume that the number of infections in Iraq far exceeds that announced.
According to announced figures, the total number of infections so far (24 March) reached 266 cases, while there were 23 deaths. However, there are factors suggesting that the actual numbers exceed the announced figures. These are as follows:
1. Limitation by the Iraqi authorities of laboratory sample tests to severe cases and contacts, in addition to laboratory errors that revealed initial negative results for some people which made them feel free to resume their social life, together with the official blackout on the number of deaths, often justified by the health authorities as attributable to old age and weak immunity as a result of the use of cancer and allergy medicines.
2. Refrainment by most of the infected people from revealing their illness due to social reasons and to avoid the stigma associated with those who have been quarantined, or to evade being quarantined in government hospitals that lack decent accommodation conditions, let alone the ill-treatment by medical staff as leaked footage revealed a significant degree of tension, fear and lack of professionalism in dealing with those in quarantine.
3. Lack of awareness by the society of the risks of the virus, and the state of general indifference that was demonstrated during the days prior to the declaration of curfew in crowded markets, malls and cafes, taking advantage of the suspension of schools and universities and working hours at government institutions, in addition to the squares of sit-ins and demonstrations where protest activities continued as usual.
Most serious of all was what the Minister of Health Dr. Jaafar Allawi disclosed in a TV interview on 14 March when he said that the government refrained from providing the financial allocations necessary to counter the threat of an epidemic spread, as his ministry was only given 5 million dollars out of the 150 million he requested to cover the expenses of only one month. He also acknowledged that Iraq will not be capable of countering the spread of an epidemic like the one seen in Iran. He hinted at the possibility of declaring a state of emergency within days, which was reflected on the decisions of the Crisis Cell on 15 March, which recommended the following:
a. Imposing a full curfew in Baghdad starting from Tuesday 17 March, 11 p.m., till Monday 23 March, 11 p.m., and a closure of all ministries and governmental and non-governmental institutions, except for the security, services and health departments, authorized media outlets, diplomats and movement of goods and foodstuff.
b. Assigning the relevant quarters launching fumigation campaigns and health visits to areas designated by the health services in Baghdad.
c. Authorizing governors to impose curfews in their respective governorates.
d. Suspending flights as of 17 March till 24 March.
Politicization of the virus
It is noteworthy that the Government, represented by the Crisis Cell and political powers opposed to the protest movement, insisted, in their statements and traditional and alternative media outlets, on including the dispersal of sit-ins and the cessation of demonstrations in the list of precautionary measures necessary to counter the possibilities of the spread of the coronavirus, even weeks before the first infection was recorded, and before the public opinion felt that actual efforts were made to raise the readiness of the health institutions, the allocation of an emergency budget, the development of plans to build mobile hospitals and quarantine establishments, in fact the government procrastinated in closing the Iraq-Iran borders and suspending flights to Iran after the spread of the epidemic there.
In the same context, Muqtada Al-Sadr adopted the same demand in the initiative he put forward via his Twitter account after his return from the Iranian city of Qom, following the spread of the virus there, without taking the initiative, as the leader of the largest popular movement, to set an example to his followers by subjecting himself and his companions to medical screening and staying in quarantine for the recommended period.
Interestingly, the Sadrist movement leader implicitly criticized the Shiite authority in Najaf which had issued a directive about the suspension of study at the religious seminaries and the call-off of the Friday prayers in Karbala, and gave a green light to administer the Imam Ali mausoleum by closing it down to visitors after the detection of an Iranian student infected with corona, as was the case with the other Shiite shrines. Al-Sadr criticized those measures considering that it was unacceptable to close those holy sites which are visited by believers seeking recovery because of the potential of getting infected by a contagious disease. He repeatedly attempted to break the ban by visiting the mausoleum and pressing its management to re-open it to the public. Within the same context, Al-Sadr supported the conduct of the Friday prayers at the Kufa Mosque on 6 March, confirming that those who observed it (Sadrists) in defiance of Saddam Husseins’s regime were not to give it up because of a virus. This invited an indirect response from the supreme Shiite cleric Ali Al-Sistani in answer to a query from one of his followers on the necessity of avoiding religious gatherings to prevent the spread of the virus.
This clash of positions was interpreted as part of Al-Sadr’s efforts to organize his supporters and make up for the loss of trust of the non-partisan Shiite public opinion and restore his prestige after Mohamed Tawfik Allawi, whom he sought to impose on protesters by force, failed to gain Parliament’s confidence, in addition to his will to debate with the superior Shiite cleric who refrained from exercising his influence to pass Allawi. The challenge by Al-Sadr reached its peak when he urged his followers to pay a visit to the shrine of Musa al-Kadhim in Baghdad on his death anniversary, in opposition to the view of the authority and a large portion of the public opinion which launched over social media websites a campaign entitled “Stay at Home” to encourage people to abide by the advice of public health experts.
On the other hand, Iran’s allies were quick to politicize the reaction towards the spread of the coronavirus. After weeks of putting forward the theory of the responsibility of the United States for the epidemic which broke out in China, they concluded that its transition to Iran without passing by Pakistan and Afghanistan constituted a strong evidence that the virus was a US-initiated biological attack. Thus, the reaction of the political and media community associated with the loyal factions was strong and violent towards the demand of the Iraqi public opinion to close the borders, which spread in the social media under the name “Close the Borders”. Amidst panic from the spread of the epidemic, “loyalists” attempted to use the crisis as a justification to press for re-assigning Adel Abdul-Mahdi the task of forming the new government, before competing for popularity against the Sadrist movement which launched a voluntary campaign to disinfect streets and public utilities, through driving the Al-Hashd Al-Shaabi (the Popular Mobilization Forces) to take part in the disinfection and health awareness efforts.
Due to the spread of the coronavirus, Iraq faces significant and multilevel economic and financial challenges, mainly:
1. Fall in oil prices: Iraq relied for its draft 2020 general budget on an estimated oil price of 56 dollars a barrel, with an estimated deficit of more than 40 billion dollars. However, with the fall in global oil prices by 25 percent, it became certain that the deficit will double, even under the optimistic scenario that countries of the world will overcome the critical stage of the spread of the virus and China, the most important consumer of Iraqi oil, will resume its previous industrial activities. This is due to the pessimistic forecasts published by the International Energy Agency regarding the continued reduction in world demand for this year by more than 1 million barrels per day for purely economic reasons in addition to the price war that broke out between Saudi Arabia and Russia after they failed to extend their agreement to cut production. If the epidemic continues to spread, albeit with the same pace, and oil prices continue to fall, the Iraqi government will have to resort to the country’s monetary reserve of nearly 80 billion dollars, risk financial exposure and exert severe pressure on the price of the local currency. This will necessarily lead to a fall in the value of bank and citizen savings and a reduction of the purchasing power of over 7 million civil servants, pensioners and social benefit recipients, and thus the descent of new categories into poverty which recently recorded unprecedented levels, particularly in the southern governorates where, according to the latest statistics published by the Ministry of Planning, the rate of poverty ranged between 26 and 52 percent. This does not include the costs of preventive measures, health sector spending, humanitarian aid to citizens in case the number of infections by the virus increases to a level equivalent to that in the most affected countries, such as Iran and Italy, let alone the expected rise in the prices of foodstuff and sanitary supplies, of which Iraq imports most of its needs in hard currency.
2. Cessation of investments in the infrastructure: in this respect, it seems that the implementation of the Iraq-China agreement, known in the media as “oil for reconstruction”, that was signed by resigned Prime Minster Adel Abdul-Mahdi at the end of last September, now requires an increase in the amount of oil produced that Iraq has to pledge to the agreement finance fund in case it wishes to avoid falling into the trap of “poisonous” Chinese loans, given that the money accumulated in the fund could be used to purchase requirements for countering the epidemic and hire experts in this field, specifically from China which dispatched in the beginning of March a shipment of medical equipment with a medical mission.
3. Endangering the oil industry: the majority of Iraq’s oil production of 4 million barrels per day comes from oil fields developed by foreign companies within the frame of the so-called “licensing rounds”. This means that the spread of the virus among the workers and staff of those companies will lead to a real catastrophe, despite their precautions, most importantly the prevention of contact with the local population. This led to the dismissal of thousands of Iraqi workers, which is only an initial example of the implications that Iraq will have to deal with.
4. Fall in consumption rates: in spite of the rentier nature of the Iraqi economy, 95 percent of which depends on oil revenues, 65 percent of which are spent on paying the salaries of 5 million employees in the public sector, the lives of many times this number depend completely on the growth of the levels of consumption of goods and services by wage earners and pensioners. This was already showing a remarkable decrease, which was reflected in the stagnation of the markets, thus threatening the fate of a wide sector of the labour force.
Future scenarios regarding the corona epidemic in Iraq
First scenario: the spread of coronavirus and the declaration of a state of maximum emergency. This scenario is based on a set of givens, mainly:
1. Procrastination, for more than two months, by the Iraqi government in the closure of the borders and the cessation of flights with Iran, the absence of a real guarantee that the measure will be implemented in the first place due to control by the Shiite militias of border crossings with Iran and the continuation of their operation away from the authority of the state, through allowing the passage of trucks of goods and tankers of smuggled oil, in addition to permitting the entry of Iranian citizens and securing their arrival at the Shiite shrines without being intercepted by the security forces, as was the case in Samarra when the “Peace Brigades” forced checkpoints around the city to allow the entry of a bus carrying a group of Iranian visitors to the Al-Askari shrine of the two Imams, in addition to the continuation of unofficial commercial transport traffic between both countries to benefit from the fall in the prices of imported goods because of the crisis, which represents an additional risk.
2. Deterioration of the conditions of health institutions and the continuing complaints by their staff of not having received protective equipment, especially outside main cities, in addition to the fall in the level of qualification of a significant percentage of them to deal with persons suspected of being infected with the virus. This could transform hospitals and health centres into locations for the spread of the epidemic rather than countering it. Allegations emerged that this happened to companions of patients staying at the Baghdad Medical City, one of the country’s biggest hospitals.
3. Failure to implement the laboratory test except on severe cases or those with apparent symptoms, and lack by laboratories beforehand of standard protection and testing equipment; images published by the Central Laboratory in Baghdad have revealed a catastrophic situation in which samples are tested in a primitive manner on normal tables in rooms lacking in any type of ventilation systems except windows, which certainly warns of cases of leakage of the virus.
4. Politicization of dealing with the crisis which was exercised by several parties, mainly the Sadrist movement leader who found in the challenge of measures to impose a lockdown on the Shiite shrines and the suspension of the Friday prayers at the Kufa Mosque an opportunity to show his strength and control over his followers by urging them to continue to hold the Friday prayers at the Kufa Mosque and mosques of Sadr City and to hold the ceremonies of the visit to the Musa Al-Kadhim shrine to mark the anniversary of his death. This is something that, if it continues, will have serious implications during the upcoming religious days, mainly the Najaf visit of mid-Shaban and the anniversary of the martyrdom of Imam Ali on upcoming 19 Ramadan.
5. Religious employment, as the positions taken by a number of leading Shiite and Sunni clerics, calling for religious gatherings despite the threat of the coronavirus, based on the metaphysical assumption that prayer is the treatment and shield of true believers, played an effective role in increasing indifference on the part of the general public, especially the poorly educated and the illiterate.
6. The social challenge, as the obstinacy of categories of the society in resuming their normal activities of visiting relatives, holding banquets, weddings and mournings, and visiting patients and religious sites is considered the gravest factor that can lead to the spread of the virus. This was tested by the security forces when they attempted to place in quarantine the family of a deceased person in the governorate of Maysan and prevent holding the condolence ceremonies as one tribe member threatened with the use of arms and referred to their relationship with the Sadrist movement.
7. The economic factor: while the Iraqi government ignores the issue of providing the basic needs of the population, especially those of the poor, disabled, workers and craftsmen who work for their daily subsistence, it is inconceivable to achieve a reasonable adherence to basic preventive rules, such as curfew, staying at home and cessation of personal interaction with others.
Second scenario: containment of the virus and maintenance of a low infection rate. This scenario is based on a set of givens, mainly:
1. The slow spread of the virus despite the return of tens of thousands of Iraqi citizens from Iran a few weeks ago, which indicates that there are natural obstacles to it, mainly the high temperature compared to Iran, China and Italy.
2. The start by the Iraqi authorities, whether federal or local, of the strict implementation of preventive measures such as curfew, lockdown of shrines, restaurants, cafes, and markets for unnecessary goods, along with the closure of inter-governorate roads and the ban of entry to and exit from towns with confirmed infections with the virus.
3. Increased financial and technical support for countering the virus. A Chinese medical mission has arrived in the country with a shipment of equipment and medicine. In addition, a grant of 38 million dollars was provided by the United States, and another of 10 million dollars by Kuwait, amidst expectations that the amount of grants will increase, especially from Washington that has in Iraq thousands of its soldiers who have to work closely with their Iraqi counterparts during joint military operations against the remnants of the ISIS organization.
Zeinab F. Shuker | 21 Jan 2021
EPC | 12 Jan 2021
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