Business as usual

In the international coverage of Iraq's crumbling healthcare system, one faction has remained largely silent. Joanne Bladd learns what daily life is like for the dentists left behind.

The note was pinned to the door of the Baghdad dental clinic late last year. Scrawled and unsigned, it threatened the owner, warning the dentist to leave his practice within 24 hours.

No one knows who sent the note, says Dr Rafi Aljobory, but it is far from an isolated incident. "You must expect a bullet," he shrugs. "For five years this has continued, so we have learnt to have a sense of humour about it. One week in Iraq is like a lifetime elsewhere."

Aljobory, the president of the Iraqi Dental Association (IDA), is one of a shrinking number of dentists still living and practising in Iraq. Since the US-led invasion, an estimated 50% of the country's dentists have fled their practices, relocating to the North or joining the exodus of professionals driven abroad by the unrelenting violence.

Aljobory's own house has been bombed and he has been forced to move several times. A vast majority of those exiled are the most senior dentists, and the dangers have increased for those who remain.

Professor Hussain Faisal Al-Huwaizi can't remember the last time his clinic stayed open in the afternoon. A few years ago, when things were more normal, his practice would at times remain open well into the evening.

Not any more. Now Al-Huwaizi, vice dean of the College of Dentistry at the University Of Baghdad, shuts up shop by noon to ensure he and his staff are home before dark.

"When you are all living in the same situation, it becomes normal," he says, tiredly. "We are all under pressure, but it is a generalised threat. You learn to live with it."

He recalls how, before the invasion, dental practices jostled for business in Baghdad's busy center. "In one street, there were previously 20 dentists. Now, you can see maybe six."

The fall from the top

Iraq's healthcare system was once a showcase for the rest of the Middle East. Its dentists often studied in Britain or the US, and the country's dental schools boasted high standards.

But more than a decade of international sanctions, followed by years of war, have left healthcare in Iraq little better than that seen in developing countries.

"Like everything else here, the dental industry is struggling to stay alive," is how Dr Mohammed, a government dentist, describes it. "When the war ended, we thought Iraq would be open to the world...but we were shocked by the isolation we live in."

When war broke out Mohammed, like almost one million of his compatriots, fled to Jordan after his family received death threats from militias. He was unable to find work and so returned to Iraq a year ago.

He is now employed as an intern dentist in Iraq's Ministry of Health where, he says, dental services are deteriorating daily.

"The majority of well-known and specialised dentists fled Iraq; they were either threatened, killed or were afraid to stay," he says. Three dentistry college professors were jailed recently, he reveals, and are still being held without charge.

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