Special Report: Health Services in Iraq

Militias Jeopardise New Basra Hospital

   

Campaign of intimidation and violence leaves ambitious project way behind schedule.

By an IWPR reporter in Basra (ICR No. 233, 19-Sep-07)

A state-of-the-art children’s hospital which was meant to improve the quality of healthcare in the southern province of Basra has been severely delayed as a result of attacks on project staff.

Since the project to build the new paediatric and teaching hospital in Basra began, dozens of people working on it have been killed; it has run significantly over-budget; and some doubt if it will ever be finished.

Hospitals in Basra, which is home to two million people and some of the country's largest oil reserves, lack vital medicine, supplies and staff. A healthcare crisis has now hit the province, which has seen a rise in life-threatening diseases, such as typhus and kala azar - a potentially fatal illness transmitted by a sandfly parasite.

In May 2005, hopes were raised that healthcare for children in the province would improve when the cornerstone of a state-of-the-art paediatric and teaching hospital was laid. Among those promoting the construction of the Basra Children's Hospital were United States Secretary of State Condoleezza Rice and Laura Bush, wife of US president George W Bush.

The project was set to finish on December 31, 2005, but more than a year and a half after its scheduled completion date, the planned new facility remains a building site.

The US Agency for International Development, USAID, gave the 50-million US dollar contract for the hospital to Bechtel Corporation - the largest engineering company in the US - in August 2004. Project HOPE, a non-governmental organisation, promised to provide 30 million dollars in medical equipment and training for hospital staff.

The construction of the hospital was part of the US government's 18.4-billion-dollar reconstruction package for Iraq, an estimated 2.4 billion dollars of which went to Bechtel. The San Francisco-based company was also given other reconstruction contracts that included rebuilding power, water and sewage plants across Iraq.

The finished hospital would cover 71,000 square metres and have 94 beds - with plans for at least double the amount of beds in the future. Its facilities were to include three operating rooms, an emergency ward, a cancer treatment ward, up-to-date medical equipment, laboratories which could be used by medical students at the University of Basra, and dormitories for physicians.

At that time, Basra was in many ways an ideal location for development and reconstruction projects. It was quiet immediately after the fall of former Iraqi president Saddam Hussein's regime - its Shia population had suffered greatly under the dictator and was glad to be rid of him.

Bechtel said in a later report, from September 2006, that in the early days of the project it had believed Basra "was one of the most peaceful locales in Iraq".

But then Shia militias started to take over the city. They targeted hospitals in particular, threatening doctors, demanding control over medical facilities, and even re-naming them. One of the largest hospitals in Basra has officially been renamed al-Sadr Hospital, following pressure from members of the Shia cleric Muqtada al-Sadr’s Mahdi army.

The Basra Children's Hospital project ran smoothly for a couple of months before the bloodshed began.

One by one, project workers were targeted. Bechtel's site security manager, a former colonel in the Iraqi army, was murdered in July 2005. The site manager received death threats and resigned, and Bechtel's senior Iraqi engineer quit after his daughter was kidnapped.

The regional director of the project, Bassam Albu-Riyala from Jordan, moved his office to Sulaimaniyah in northern Iraq after being threatened. The project's chief engineer, Hussein al-Samarai, a Sunni, also left Basra because of intimidation. Twelve employees of a subcontractor in charge of the hospital's electricity and plumbing were killed in their offices. Eleven workers of another company supplying the project's concrete were murdered too.

Senior Bechtel executive Cliff Mumm said the company constantly reviewed security and was satisfied with the protection it offered its people.
"We didn't stay under duress," he said. "I think all of our people…got involved in [the project], and no one wants to leave a job half-done."

But in the face of escalating intimidation, other companies decided to get out.

Subcontractor Fayha Company, which supplied concrete blocks to the project, cancelled its contract after its workers were executed. Another subcontractor Ibtikar Company also quit when militants attacked their office and threatened to kill all their staff if they didn’t stop work on the project. Ibtikar later resumed its work, but under a new name.

Director of the project Talal Hussein al-Saloom - who works for Mid Contracting, one of the largest construction companies in Jordan, and formerly one of Bechtel's primary subcontractors - said that the project came under attack because it was difficult to convince locals that its aim was to create a children's hospital, and not a prison or a detention camp to be used by the Americans.

“Eventually, everyone realised that it’s a vital national project,” he said.

The security problems have caused massive delays in the project, which has also run vastly over budget.

In mid-2005, Bechtel warned USAID of delays and increased costs as a result of violence and labour disputes. In March 2006, it estimated that that the hospital would not be complete until July 2007 and that costs had soared to 98 million dollars.

Just three months later, the Special Inspector General for Iraq Reconstruction estimated that the project would cost 150 million to 170 million dollars.

The US government then dropped Bechtel for falling nearly a year behind schedule and exceeding the budget. The construction company consistently cited security problems as the main reason for increased costs.

Work on the project resumed in August 2006 with the US Army Corps of Engineers taking over as project management in the autumn of 2006, and Mid Construction staying on as the primary subcontractor.

As of spring 2007, about 60 per cent of the construction work had been completed.

Mumm, whose employer Bechtel no longer works in Iraq, said he doubted that the hospital could be finished under the current circumstances in Basra, which is now controlled by rival Shia militias.

However, Saloom said project staff are now are on good terms with local militias and clerics in the city. The construction deadline now is September 2008, and the hospital is expected to be fully furnished, equipped and receiving patients by January 2009, he said.

Acting minister of health Amir al-Khuzai remains hopeful that Basra Children's Hospital will be completed, “despite all of the challenges, it is in everyone's interest”.