Discussing health issues in Iraq is in itself a distressing subject for health practitioners, but when the subject turns to women’s health it pushes the discussion to a new level of anguish. Although getting proper health care is a challenge for most people living in a developing country, such as Iraq, women, in particular, face adversity that is unique to them and can at times render their efforts hopeless.
The Middle Eastern cultures tend to objectify women and this is particularly prevalent in Iraq. As such, women are treated as objects and when an object gets sick then it is not a big deal. When a father has a sick son the alarm bells ring, however if his daughter is sick not much attention is paid to her situation. This culture values males more than females. particularly prevalent in rural areas.
A combination of this cultural objectification of women and their restricted movement, in many cases, results in women accessing healthcare only when the symptoms are severe and in some cases not at all. Unfortunately, seeking treatment at so late a stage, results in death in the worst cases or a long, drawn-out recovery in the more fortunate cases.
For example, women with breast cancer tend to only visit the doctor for the first time when the cancer is at an advanced stage. At this point medicine can do very little to help them. Visiting the doctor when the symptoms were first noticed would have provided a greater opportunity for successful treatment.
Economically, men are generally the breadwinners in Middle Eastern societies. This means women are generally submissive to men as most are totally financially dependent on them. This can cast a dark shadow on women seeking healthcare. The financial burden of healthcare for a women in some cases results in the male relative refusing to provide money for visiting a doctor. Thus, a man can simply determine the course of a woman’s health care based on his perception of her value, by asking the question: Is she worth the financial cost of health care?
However, it is not always the case that a woman is unemployed or dependant on her husband or male relative. I know tens of working women on whose salaries entire families depend; yet, their husbands control the cash flow. Traditions, religion and cultural heritage tell women to be submissive; entire generations are raised this way and the vicious cycle continues.
The terrorism and violence which swept Iraq in the past decade added a completely new dimension to the problems in Iraq in general and to women’s health in particular. Transportation became very costly, making it inaccessible to many. People were (and many still are) afraid to go outdoors on a regular basis.
Generally Iraqis in Bagdad try to stay indoors as long as possible for fear of being trapped in armed conflicts or blasts. Therefore, a sick person will wait at home as long as possible until the symptoms like pain, discomfort and disfigurement become unbearable and he or she is forced to seek medical treatment.
The most shocking image of the pain and suffering Iraqi women endure due to the insecurity is apparent in the hardships they suffer when they are pregnant. Crucial antenatal check-ups are, in many cases, omitted during early pregnancy, because the obstacles of getting to a primary healthcare centre are too great. What’s even more shocking is the number of cases of women who go into labour and are unable to get to the nearest hospital in time to give birth. Police and military check points cause delays by inspecting everyone, including ambulances. No one dares venture out after midnight because of the curfew (midnight to 4am) in Baghdad and some other parts of the country. During my medical practice, I received many cases like this. In one such case I had to deliver the baby of a 20-year-old woman in an ambulance because we could not make it to the hospital in time.
Another incident I experienced – one of many such incidents – highlights the plight of women seeking healthcare in Iraq. One evening, while doing an ER shift at a hospital in a poor part of Baghdad, an 18- year-old woman admitted herself, escorted by her sister. She was in a hurry and asked me to treat her quickly. I asked her what had happened and she told me that her husband had stabbed her with a screwdriver. She showed me four deep, heavily infected wounds in her left thigh. I asked her why she had not visited a doctor earlier. She replied, saying that her husband locked her in the house for a week as an additional punishment following the physical abuse.
I treated her and told her that she should let me report her husband to the police, but she told me to mind my own business, adding that she did not want to get into even more trouble and quickly left with her sister.
Another distressing incident happened during a visit to Al-Najaf in southern Iraq. There are two types of hospitals in the city, one that is strictly for women and managed by women, and another that mainly receives men, although it can receive women as well. The women’s hospital has an all-female staff and men are not allowed to enter, even if they are doctors. Due to the huge shortage of physicians in Iraq, the women’s hospital, in particular, lacks many specialists, such as anaesthesiologists. Despite this, women continue to visit this hospital in the knowledge that the care may not be that good because of the shortage of staff. They refuse to be examined and treated by a male doctor. And in some cases where the woman accepts the idea of being treated by a male doctor, their male relatives refuse to allow it.
Although more healthcare resources would help the plight of women in Iraq, this is not entirely the solution to the inequitable health care for women. What is required is a change in the way the people of Iraq view women in the society. Gender equality, women’s rights and access to proper healthcare are issues that are fundamentally intertwined and interdependent. Enabling unencumbered access to health care for women involves a fundamental shift in the mindset of the people of the country, to improve gender equality and ensure that basic, universal human rights are applicable to all women in Iraq. Education is the key to implementing this change.
● Dr Nabil Al-Khalisi, MD, worked at
the Iraq Medical City in Baghdad. He is
currently doing Public Health Research at
the University of Georgia. Dr Al-Khalisi
has written several articles about his
medical experiences in Iraq which have
been published in several publications
including the British Medical Journal.
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