Iraq Report
 
No country for women <
 


Hard health for women



Accessing good health care in Iraq is a challenge for many people, as it is in most developing countries, however, women in particular face unique hardships when seeking healthcare in this war-torn nation. Dr Nabil Al-Khalisi provides a first-hand account of his experience working as a medical doctor in Baghdad and reveals the extreme difficulties many women face in accessing proper health care.

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.

Financial issues

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.

Violence

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.

Distressing incidents

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.

The future

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. Email: nabeelraad@gmail.com

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No country for women

The improved political representation of women in Iraq is in sharp contrast to their broader disempowerment, as highlighted by the persistence of domestic violence and early marriage, according to a new report by the UN Inter-Agency Information and Analysis Unit.

Women may hold 25% of seats in the Iraqi parliament, but one in five in the 15-49 age group has suffered physical violence at the hands of her husband. Anecdotal evidence alleges that “many women are being kidnapped and sold into prostitution”, and female genital mutilation is still common in the north, the report notes.

“The situation many Iraqi women and girls face is beyond words,” journalist Eman Khammas told IRIN in a telephone interview. “Before, I was a journalist, a professional; now, I am nothing.”

Khammas noted an underlying political climate of intolerance that has become increasingly poisonous for women. She was forced to flee Iraq after receiving death threats that effectively stopped her – like thousands of other Iraqi women – from working. She now lives in Spain.

Stay home

Women’s participation in the labour force has fallen sharply since 2003. Before the invasion, 40% of public sector workers were women, according to a report by the Brussels Tribunal, an anti-war organisation. Some sectors, such as the teaching profession, were almost entirely staffed by women, Khammas said.

She cited the “new, fundamentalist thinking”, which emerged after the 2003 invasion of Iraq that has been aggressively imposed by the militias, armed private groups purporting to uphold religious law.

The collapse of public social services has also limited access to education, health and jobs, while a high level of insecurity has pushed women out of public life and into the seclusion of their homes, and an ineffective judicial system has created an atmosphere of impunity, Khammas said.

The conservative attitudes of public sector officials has been reinforced by a government that supports keeping women at home, according to a 2007 report by the international women’s resource network, MADRE.

“In 2006, the Iraqi Interior Ministry issued a series of notices warning women not to leave their homes alone and echoing the directives of religious leaders who urge men to prevent women family members from holding jobs,” the report noted.

“Thus, the violence carried out by militias in the streets is backed up by more respectable political leaders, who support the call for a women-free public sphere.”

Escalating poverty has pushed Iraqi families into prioritizing schooling for boys, stifling future opportunities for women.

“For every 100 boys enrolled in primary schools in Iraq, there are just under 89 girls,” the UN Children’s Fund (UNICEF), said in a report released in September 2010. School enrolment figures for girls have been progressively declining, while drop-out rates have gone up in every academic year.

Getting out

Factors pushing girls out of schooling included “security risks, attitudes to girls and education, the state of the nation’s schools, what is taught and how it is taught, the skills and attitudes of teachers, family poverty,” UNICEF said.

Like Khammas, many other women have chosen to leave Iraq, but asylum does not necessarily end their difficulties. Neighbouring Syria is home to the majority of what the UN Refugee Agency (UNHCR) considers as Iraqi “persons of concern” – people who have left their home country out of fear for their safety but do not conform to the legal definition of “refugee”.

Of the 139,000 registered Iraqi persons of concern in Syria, 28% fall under female-headed households, the UNHCR Protection Officer in Syria, Aseer Al-Madaien, told IRIN in an email interview.

Many do not have work permits, which compounds the difficulties femaleheaded households face in neighbouring countries, where they struggle to make a living, “especially paying the rent”, while still “coping with family, social and community pressure”, Al-Madaien commented.

Their vulnerability can lead to exploitation. “There is trafficking happening among the Iraqi refugees, [but] the scope and modality is not known to us,” said Al-Madaien.

According to the UN Inter-Agency Information and Analysis Unit report, “Victims are trafficked internally and to neighbouring countries, including Syria and the Gulf states”. – IRIN

IAU – End Violence Against Women Campaign http://www.iauiraq.org/end-violenceagainst-women-campain.asp
 


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ate of upload: 17th Feb 2011

 

                                  
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