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Healthcare in Iraq

Guiding Principle

Healthcare in Iraq is based on a number of statutoryprovisions and regulations, which – theoretically –provide for comprehensive healthcare and social support for all Iraqis. However, in practice Iraqis barely receive minimal treatment in governmental hospitals and ambulances. Long waiting lists exist for even minor surgeries. Many idealistic insurance and healthcare laws have not been implemented. Severely ill Iraqis, including those in the Kurdistan Region, have to pay significant amounts for their treatment in private clinics or, in even more serious instances, to seek treatment abroad.

A.  Rules and Regulations related to Healthcare

The Iraqi health system is based on a number of laws and regulations. Below weprovide a short overview of the most important ones.

1.   The Constitution of the Republic of Iraq of 2005 (IQ-Const)

Healthcare inIraqis considered as a constitutional right of the Iraqi people. Thus, the constitution contains several general duties of the State in this respect. It is the State’s duty to take care of the general health of the population and to control diseases by building hospitals and health institutions. Specifically, the State shall take care of the social security and health of the individual and the family – particularly children and women (Art. 30, para.1 IQ-Const) and shall safeguard the social security and health of the elderly, sick, disabled, homeless, orphans or jobless (Art. 30, para.2IQ-Const). The Iraqi constitution also allows individuals and institutions to establish hospitals, healthcare and private treatment centres – however always under the supervision of the State (Art. 31 IQ-Const).

2.   Public Health Law No 89 of 1981 (IQ-PHthL)

The Public Health Law was issued to organize the general rules of public health. Certain institutions under the supervision of the Ministry of Health are in charge to organize the health sector and to take the necessaryprocedures toprovide healthcare for all Iraqis. The aims of the Ministry of Health are, among others:

  • To set up and manage institutions and health centres in all parts of the country;
  • To combat and control communicable diseases;
  • Toprovide healthcare for the family, maternity care, childhood and old age care;
  • Toprovide healthcare in schools;
  • To raise the standard of food for all people;
  • To establish controls and standards for health conditions and to observe the application of those rules, specifications and conditions;
  • Toprotect and improve the environment.

In addition to the enumeration of goals for the Ministry of Health’s work, the law alsoprovides for the establishment of a Council of the Ministry of Health, which is entrusted with

  • Health policy and planning and governing all the funds in connection with public health in the country;
  • Recommendations for the implementation of health policy in the country;
  • Control and monitoring the implementation of health plans;
  • Directives to ensure the development of the health services and for raising the; formation of personnel in the health sector;
  • Supervision of the work of the health boards in the governorates.

3.   Retirement and Social Security of Workers Law, Law No. 39 of 1971, (IQ-R&SSWL)

This law is a “typical” socialist law and aims to insure and care for workers in theRepublicofIraq. It shall developing the social standing of the workers’ class by providing healthcare and support after work injuries, etc. (Art. 2 IQ-R&SSWL).

According to this Law a Retirement and Social Security Fund of Workers was established (Art. 5 IQ-R&SSWL). If a worker falls ill and, according to an official medical report, requires a sickness leave, he/she will be paid his/her full salary, however not exceeding 8 days.

In case of several sicknesses over 8 days, the employer will be responsible to pay the worker a sickness leave with full pay for one month per year. The Fund will be responsible to pay to the worker for periods of sickness leave not covered by the employer (Art. 43 IQ-R&SSWL). In case the worker cannot be healed, he will receive a pension (Art. 45 IQ-R&SSWL).

Theseprovisions are basically identical to the ones contained in the Labour Law No. 71 of 1987. It applies in the Kurdistan Region as well.

4.   Law on the Foundation of the Health Insurance and Rural Healthcare, Law No. 211of 1975

According to this Law a fund was established, to provide health insurance and rural healthcare services. The target of this fund is to provide a certain level of healthcare throughout the country, but in particular in rural areas. Also this Law is applicable in the Kurdistan Region. However, in practice so far no effective health insurance has beenprovided.

5.   Law for the Establishment of Private Hospitals, Law No. 25 of 1984

This Law was issued to encourage the private sector to invest in healthcare, and to extend theprovision of health services by establishing limited liability companies to build private hospitals.

At least four doctors, who have practiced medicine in the State’s health institutions for 15 years or more can apply to the Ministry of Health for the permission to establish a company to build a (private) hospital. If the Ministry of Health agrees, the State willprovide a loan of not more than 60% of the costs or 750,000,000 Iraqi Dinars (approx. USD 635,000) at an interest rate of 1.5% only. This amount shall be paid back within 15 years from the end of the third year of commencement of the hospital’s work. The hospitalproject will be allocated free land and will remain under the supervision of the Ministry of Health. These hospitals will be exempted from income tax for three years from the time of commencement ofproviding healthcare services.

This law has caused the building of a significant amount of (small) private hospitals, especially in the bigger cities, including in the Kurdistan Region, since the mid-eighties.

6.   Law on Healthcare Funds for Governmental Employees, Law No. 101 of 1985

This Law was issued to organize the healthcare of governmental employees. The Funds will pay the expenses of treatments of the insured.

The healthcare services are determined by the Funds, and the employees may join a Fund with their families.

The State will not be responsible for the costs of the establishment of a Fund nor for its expenses during its existence. The Fund will receive its financing from the fees for the members, from gifts and donations of sponsors and fromprofits from investments of the Fund’s money.

The Law is applicable in the Kurdistan Region as well. However, as of today, in practice, the scope of this law is limited. Not many Funds have been established.

7.   Mental Health Law, Law No. 1 of 2005

This Lawprovides for the care of mentally-ill people inIraq. It containsprovisions on mental healthcare, measures to rehabilitation of the patients, preparing studies, etc. This Law is not applicable in the Kurdistan Region, because it was not adopted by the Kurdistan Parliament.

8.   Labor Law, Law No. 71 of 1987 (IQ-LL)

The Labour Law contains provisions as to the health and safety regulations at work, sickness leave for workers and specialprovisions for female workers. The Law contains the sameprovisions as the Retirement Law referred to above.

Female workers are not permitted to be employed for hard works or for works, which are harmful to their health (Art. 81 IQ-LL). And it is not allowed to employ pregnant women in areas of work which may cause harm to the woman and her child (Art. 82 IQ-LL). In accordance with the Law, an employed woman shall have a paid leave of 72 days for delivering the baby. She may take leave one month prior to the calculated date of delivery.

B.  Healthcare in the Day to Day Life

As is well known,Iraqis in a difficult political and financial situation. The public sector is neither qualified nor funded in a way toprovide adequate healthcare, in particular in more remote areas.

Governmental healthcare is free. However, for poor patients who cannot pay for their treatment in private hospitals and do not have the funds to pay for private doctors, there are long waiting lists for treatment. Many patients even die before they get any treatment. Wealthier patients, who can afford to bear the costs of treatment themselves, might either use private hospitals or go to neighbouring countries. State officials and the upper class often get their healthcare in Europe and theUnited States.

Many Iraqi doctors have left the country thus aggravating the shortage of qualified healthcare services: After 2003 more than 8,000 doctors were killed or left Iraq.

C.  The Healthcare in the Public Sector

Since the founding of the modern Iraqi State in 1921 the governments undertook to provide social and health services free of charge. In order to achieve this, the Iraqi government established hospitals and health centres. Also,Iraqwas among the first countries in the Gulf Region to establish a Faculty of Medicine.

In the seventies and the beginning of the eighties of the last century, healthcare in Iraq was probably at its height, not only by Iraqi standards but also by the standards of the entire region. However, due to the First Gulf War, the UN embargo since 1990, and the Second Gulf War in 1991, the healthcare in Iraqexperienced a serious setback.

As has been shown above, Iraqhas an extensive legal framework for the provision of healthcare services to its population. However, the reality is different. The last governmental hospital was built in 1986. Theoretically, healthcare is free, but the Government cannot meet the healthcare needs of its people. Iraq’s population grew rapidly over the last decades putting a tremendous pressure on the healthcare system – in addition to the political situation. At present, the governmental healthcare sector is semi-paralytic and cannot provide even simple needs of its population. In addition, although the government tries to improve the health sector, the under-investment of the healthcare sector, the increasing number of patients, terrorist attacks and corruption contribute to the dire state of the public health sector.

D.  The Healthcare in the Private Sector

The private healthcare sector forms an important part of Iraqi healthcare system because the State’s hospitals and clinics are not equipped and staffed with the best possible resources. In 2008 there were 80 private hospitals in Iraq, out of which 35 were in Baghdad, the rest in other cities.

Private clinics and private practices charge a significant amount of money for their services and are thus able toprovide decent healthcare for the wealthier Iraqis.

As per the Iraqi and Kurdistan Investment laws, (foreign) investments in the health sector attract incentives by the governments in Baghdadand Erbil, like tax exemption, free land, exemption from customs etc, an encouragement, which deserves attention by foreign investors.

E.   Summary

Iraq’s health system is problematic. Even though the laws are in place, due to the government’s lack of funds and due to other priorities, the ordinary Iraqi has to cope with a dysfunctional state healthcare system. The solution for many richer citizens is to pay for private treatment or for treatments abroad. Unless the security situation improves and more investments and tax income is achieved, the situation will remain difficult.

 

January, 2010 Azad M. Haji & Dr. Clemens Daburon
Meyer-Reumann & Partners – Erbil & Abu Dhabi Office
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