Iraqi families battle to save babies sentenced to death by the toxic legacy of war

Lying on the examination table, a months-old baby struggled to wrangle away the cold butt of the cardiac ultrasound machine hovering over her chest. Face wrinkled in effort and mouth wide open, Elina tried to shout to the top of her lungs, but no sound came out.

The little girl, born with a congenital heart disease, turned blue. For a dozen very long seconds, she twisted in the doctor’s hands, silently battling for oxygen, neither able to breathe nor to cry.

Finally, air and sound tore through the baby’s gasping mouth. “Calm down, calm down,” her mother pleaded, while a nurse rushed to the baby’s side with a tiny oxygen mask.

"Thirty years after the first Gulf war, twenty years after the 2003 US invasion and less than a decade after the start of the Islamic State insurgency, successive conflicts and a devastating array of economic sanctions have pushed much of Iraq’s healthcare system on the brink"

One after the other, dozens of infants lay on the examination table that day in the office of Dr Aso Faeq Salih, a pediatric cardiologist in the autonomous Kurdistan Region of Iraq (KRI). Like Elina, many had travelled hundreds of kilometres to reach his private clinic, located in the region’s eastern city of Sulaymaniyah, to seek the care they’d lost hope of finding anywhere else.

Every year, hundreds of Iraqi newborns die from congenital heart diseases, many of them treatable.

Thirty years after the first Gulf war, twenty years after the 2003 US invasion and less than a decade after the start of the Islamic State insurgency, successive conflicts and a devastating array of economic sanctions have pushed much of Iraq’s healthcare system on the brink and compounded environmental pollution problems that directly impact newborns health.

In this battered healthcare landscape, Iraqi families struggle to save their children, supported by a handful of local and international initiatives.

A battered healthcare system

Iraq’s medical sector used to be one of the “most advanced” in the Middle East. But the first Gulf War and a sweeping set of sanctions drastically slashed public spending on health and pushed many doctors to emigrate. The 2003 US invasion and rampant insecurity during the Islamic State’s reign of terror dealt the last blows to Iraqi hospitals, now in shambles and drained of their best staff.

“Public hospitals just don’t have enough equipment, I’ve seen them use the same oxygen mask on one baby after the next,” Lana, a young mother of two, told The New Arab at the heart hospital. When her daughter Lara was diagnosed with heart disease, two days after being born, Lana sold her jewellery, her phone and everything she could spare to put her through a private clinic. “With medicine and exams, each visit ended up costing at least 150,000 Iraqi dinars (100USD).”

But even there, doctors were powerless because Lara’s weight never reached ten kilograms – a crucial limit below which Iraq’s best cardiologists refuse to operate, for lack of adequate equipment.

In this devastated health landscape, heart defects that are considered treatable abroad too often prove fatal in Iraq. According to the latest available data from the World Health Organization, in 2016 at least 1,156 Iraqi infants (babies under the age of one) died of a congenital heart condition, out of around 1 million births that year. That same year, the United Kingdom recorded exactly 220 deaths – a fifth of Iraq’s – out of 775,000 births.

A glimpse of hope

Iraqi babies affected with congenital heart issues have few options for treatment. One of them is Dr Salih, an Iraqi cardiologist well-connected to cardiology teams abroad. On the cold January day when The New Arab visited his clinic, around forty families from all corners of Kurdistan, Iraq and even Syria crowded the waiting room until the evening.

Like a dozen other babies, Elina reached the clinic after an exhausting four-hour long bus journey organized by Love Them All, a volunteer-run charity founded in 2019 in Erbil to support Iraqi children with heart conditions. Using a school bus outfitted with oxygen tanks as an ad-hoc ambulance, Love Them All helps families seek diagnosis and treatment through monthly medical trips to Dr Salih’s clinic, and supports families to seek care abroad.

“We have certainly supported a few hundred cases who received care abroad, but we haven’t had the funds to pay for all surgeries,” Daniel Touma from Love Them All told The New Arab. “In most cases, we can only afford to cover the cost of the flight and ambulance, and far too often, families will sell their house and belongings, and borrow money from friends and family.”

One mother in her twenties told The New Arab she’d lost hope of saving her daughter due to the prohibitive price of surgery in neighbouring countries, until Love Them All helped them access surgery in another neighbouring country, covering part of the costs. “Maria had open-heart surgery and stayed there for four months,” the mother recounted. “If we hadn’t found an NGO, she would probably be dead now.”

Like Maria, a handful of Iraqi babies benefit each year from transnational medical projects. Some are flown as far out as Canada or Italy, provided the mother and child can obtain a medical visa or are seen by top foreign surgeons who fly in several times a year to perform surgery on Iraqi patients.

But these humanitarian projects are built on shifting sands. In 2014, the rise of the Islamic State in Syria and Iraq forced many international organisations to suspend activities in parts of the country and disrupted the regular visits of foreign medical teams.

Five years after the territorial defeat of ISIS, they are slowly trickling back in, but their absence already left a huge gap. And without medical follow-up during those years, some of their patients developed fatal complications.

A toxic environmental legacy

Iraq’s congenital heart crisis plays out against the backdrop of rampant pollution and the toxic legacy of war, two factors experts suspect are linked to abnormal rates of birth defects in parts of Iraq.

“We see and treat a lot of complex cases in this clinic, with multiple birth defects,” Dr Salih regretted. “Of course, there are multiple factors. One of them is probably consanguinity because in certain communities people continue to marry their relatives, but that doesn’t account for the majority of cases. There’s also a lot of environmental factors stemming from years of bombing, and pollution in general, including the poor quality of food, which is imported from neighbouring countries with no oversight.”

The link between war and birth defects has already been well-documented in other parts of Iraq. In Fallujah, central Iraq, an epidemic of birth defects was recorded in the wake of the 2003 US invasion. By 2010, birth defects showed up in an estimated 15% of all births – compared to only 3% on average in the United States.

Iraqi doctors and American researchers working in Fallujah pointed to the same culprit: 1991 and 2003 bombings against the area, which left behind a toxic fallout of depleted uranium, lead and mercury.

Due to the lack of adequate reporting and systemic research, activists have struggled to hold the US army accountable for its likely contribution to Iraq’s health crisis. Likewise, the lack of systemic data limits experts’ ability to assess the impact of conflict and pollution on health in Iraqi Kurdistan, but there are strong suspicions that chemical attacks carried out by Saddam Hussein against the Kurds still have an impact today.

Like Dr Salih, scientists worry that climate change will compound these issues through increasingly frequent dust storms, which can dramatically increase air pollution. Stirring up contaminated soil, storms can also pick up heavy metal pollutants and carry them over long distances, as has already been documented in central and southern Iraq. 

In the meantime, Iraqi children continue to bear the brunt of this conflict-fueled health crisis. Too weak to risk the exhausting journey home – a displacement camp for Yazidis where electricity is too sporadic to reliably power an oxygen device – Elina stayed for four weeks in intensive care in Sulaymaniyah, between life and death. At the beginning of February, she was evacuated to Italy to receive life-saving surgery not available in Iraq.

But for Dr Salih, what is needed is “local help.”

“We need people to come and do things here, not send patients out, because it’s very expensive, time-consuming, and very selective,” Salih highlighted. “For every two patients we send out of the country, we can treat ten here with the same resources.”

His dream of establishing a public hospital dedicated to children's cardiac care in Iraqi Kurdistan is only partly realised. The facility, built in Sulaymaniyah, opened to the public in September 2021 for outpatient consultations. But due to a severe lack of equipment, it is still unable to function as a hospital, and its 24-bed inpatient ward remains empty.

Lyse Mauvais is a freelance journalist based in Amman, Jordan. She covers environmental issues in the Middle East, with a focus on Syria and Jordan.

Follow her on Twitter: @lyse_mauvais