Iraq’s Anatomy–Triage at a Baghdad Hospital

An Iraqi doctor-turned-journalist takes us into a rarely glimpsed Iraqi war zone–the ER.

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If you need a blood transfusion at Baghdad’s Al Yarmouk hospital, you can get one—so long as someone’s there to donate blood on your behalf. If you need an operation, you can have one of those too—though your only anesthetic might be your friends and family holding you down. One big explosion can dry up the hospital’s saline supplies for a week, leaving the next explosion’s victims without the necessary treatment. And where triage is within a war zone doctors and ambulance drivers are regularly threatened and harassed.

Instead of respites from the chaos outside, hospitals in Baghdad are some of the city’s most dangerous places. They have also been mostly closed to journalists. Until now. Iraqi filmmaker and former doctor Omer Salih Mahdi spent six weeks filming life inside Al Yarmouk and out on the streets with the hospital’s ambulances. His documentary “Baghdad Hospital: Inside the Red Zone,” premiering tomorrow night on HBO, offers a rare and raw glimpse into the day-to-day workings of what he calls “a field hospital in a civil war,” far from American soldiers and at the mercy of the warring forces that cause chaos both inside and outside its walls.

“You won’t see a film like this again,” warns Dr. Mahdi. Stymied by aggressive militiamen, nervous doctors, and the threat of insurgents, the filmmaker braved beatings, interrogations, and death threats. His safety in the hospital was so precarious, he says, that in the end he chose to stop filming altogether because the director of security—the man who approved the project and allowed him in the hospital each day—was shot and killed. “Several times I thought the film would never happen,” he says.

What is most evident from the footage Madhi did manage to capture is the chaos. From ambulances and hospital beds, injured Iraqis wonder aloud why their countrymen are fighting one another. Far from harboring radical sectarian views, these civilians seem overwhelmed and bewildered, not only by the violence but by the sheer number of perpetrators. Towards the end of the film, the camera stays for several minutes with three people in an ambulance, all yelling and very angry, saying they want Saddam back. “It’s how Iraqis think now,” says Dr. Mahdi. “They say that they wish they could go back to Saddam’s days. They weren’t good days. They were bad in different ways, but at least people had security.”

Trained as a doctor at Baghdad University, Dr. Mahdi practiced medicine in Iraq for nearly four years until he quit to become a journalist in early 2005. In a stroke of luck, Madhi met veteran New Yorker reporter George Packer and NPR’s Deborah Amos and began working for them as a translator. The journalists showed him the ropes, connecting him with his first assignments on the streets of Iraq. He went on to study filmmaking with Guardian Films in London before returning to Iraq to make “Baghdad Hospital.” Now pursuing a master’s in journalism on a Fulbright scholarship at Ball State University in Indiana, the 30-year-old spoke with Mother Jones about the dire state of medical care in Baghdad, his thoughts on Iraq’s future, and those six weeks inside an Iraqi hospital.

Mother Jones: You were still practicing medicine during the first two years of the war. How did your work change during that time?

Omer Salih Mahdi: Life totally changed. Before the war, we hardly received any major trauma, maybe one or two per week from traffic accidents or something. After the war we started to receive a lot of people on a daily basis, for explosions, shootings, stabbings. At the same time we started to lose security in the hospital. Even in the ER we were not protected from any threat. And there were a lot of times when people would come into the hospital and they were angry—they lost their relatives, their colleagues—and they blamed the doctors. A lot of doctors were beaten; they were humiliated. It is very difficult to be a doctor in Iraq.

MJ: Did the Americans provide any security for the hospitals?

OSM: When Baghdad fell we were really alone. But after that the Americans came to the hospitals. They put their military tanks in front of the hospital gates, and they provided us with security. They started to secure the hospital from the looters, and also to help the doctors work in a safe environment. After several months, though, when they established the Ministry of Health, they left the hospitals. They started to put people—they called them hospital protection forces—civilian people who had been hired to carry weapons and to protect the hospital. But they were very weak, and there were a lot of incidents in Al Yarmouk Hospital when the Iraqi military came inside and they started threatening doctors and shooting, doing a lot of horrible things. Doctors still feel under threat.

MJ: Do the doctors currently have adequate supplies?

OSM: There is shortage on every level, of medication, anesthesia, equipment. And that was before the war. It got worse after the war. We were telling people to bring medications from outside because they weren’t available in the hospital.

MJ: Did anyone try to petition the Americans for additional resources?

OSM: Usually we cannot contact the American military. If the doctors need to do something they are supposed to go through the Iraqi Ministry of Health. That’s the rule there. Despite the fact that there’s no law on the street, inside the hospital there’s this strong bureaucratic method of dealing with things. Unfortunately the ministry is really corrupt and busy with a lot of things other than making sure services are supplied to the people. At the hospital there are no medications and nobody to care for a lot of patients who are staying there. Even the morgues. Every hospital should have some refrigerator that they keep the bodies inside, but most of them are broken. Bodies are literally lying on the ground in the sun, in the heat. It’s horrible.

MJ: In the film you describe the lack of anesthesia. But other details, like the bodies in the morgue, don’t appear in the film. How did you decide what to show?

OSM: I wish I could have captured more, but it was very difficult to film inside the hospital or outside in the street. The hospital is under the control of the [Mahdi Army] militia, and they as well as the Iraqi security forces were angry to see a cameraman with a camera rolling inside the hospital. I was ordered several times not to film and prevented throughout from entering the ER. I was taken and interrogated by the militia, by the Iraqi security forces. Then on the streets, of course, there are insurgents controlling the neighborhood where the hospital is, and Iraqi military checkpoints where they will be very suspicious if they see somebody inside a car carrying a camera. They will think he’s an insurgent and even shoot him. Several times I thought the film would never happen, because of the difficulties I was facing every day.

MJ: Based on your experiences in both countries, what is your opinion on how the American media covers the war?

OSM: I’ve been told several times that people here blame the media for not covering the war in a proper way. But because I’ve worked in Iraq with foreign journalists I believe they’re doing their best to get the story out. People there are very scared to speak to journalists and very scared of journalists’ cameras. And the Iraqi government itself does not want the truth to go out. They put very strict rules on the work of journalists, how they can move, what kind of information they can get, the places they can go. I think the American media do what they can to get the story of the Iraqi civilians.

At the same time I think it makes sense that the coverage is more about American troops, since most Americans are concerned about their sons and daughters who are fighting. It’s also easier to do than to cover Iraqi civilians.

MJ: I noticed that not a single American soldier appears anywhere in the film, not even in the background. My sense, and I think the sense of a lot of people here, is that American troops have more of a presence, at least in Baghdad.

OSM: American troops now are decreasing their availability, and handing over responsibilities more and more to the Iraqi government. At the hospital, the whole time I was there, they came only once, and that was after a huge explosion, so they just came to check on the situation in the hospital. But otherwise they never came again. As it should be, they think that the hospitals are under the control of the Ministry of Health, and that the Iraqi government is taking care of the hospitals. At same time, nobody can go to the Americans and ask for help. The biggest crime in Iraq now is to be seen dealing with the Americans or with other foreigners.

MJ: What does that mean in terms of whether the Americans should remain in Iraq?

OSM: In Iraq we have a really corrupted system and a really weak government. They are not working hard to stabilize things, and they are modulated by forces from outside. You also have the gangs and the militias who are controlling certain neighborhoods. The American troops are the only strong, neutral authority available there. A lot of people feel safe only when they see American troops or an American checkpoint. They feel scared and suspicious if they see an Iraqi military checkpoint, because a lot of kidnapping and killing is done by people wearing Iraqi security uniforms. So my personal opinion, and the opinion of all the people I know, is that the day the Americans leave is the day before a full-scale civil war. There will be mass killing because of the fighting over who wants power. The American presence is the only thing that prevents a huge escalation in civil war.

MJ: Would you call it a civil war now?

OSM: What else can you call checkpoints, people standing in the streets carrying guns, taking people? People with ordinary clothes carrying guns, covering their faces, controlling the neighborhoods? Isn’t this a civil war?

MJ: What would need to happen to end it?

OSM: The only hope we have is to have some major change in Iraq, like to remove this government that we have and to bring some powerful, secular, technocrat people to control the system there— people who are not affiliated with insurgent countries, neighboring countries; people who don’t have an agenda. That’s the only way I can see things will improve in Iraq.

MJ: The accuracy of civilian casualty counts is an ongoing point of dispute. Different organizations have numbers as low as 50,000 and as high as 600,000 or more. What do you think is accurate?

OSM: You’ve seen the film. At Al Yarmouk, they might receive 50, 60 casualties in a day, and that’s only one hospital in one part of Baghdad. So I believe that the number is really high, that it exceeds 600,000. Also, a lot of people are killed and buried without any registration in certain areas where there’s no government control or no access to official records. Personally, I lost my father last summer. All the friends I know and all the relatives I know have lost somebody, or they know somebody who’s been killed or been disappeared. So I think the casualties are really high. Still, it’s very difficult to get information, especially with our government trying to withhold it— they just don’t want to say the truth, and they’re trying to give the wrong picture. I mean, even now when they’re saying that casualty numbers are decreasing, this is because people have either fled Baghdad or fled Iraq, or because they are hiding in their houses. And besides, I really don’t see any difference if there are 200,000 or 600,000. No one should be killed in this way. I don’t know why people seem to only want higher numbers so they can say it’s a bad situation. One person is enough.

MJ: At the end of the film you express your admiration for the doctors who continue working at the hospital. Do you feel at all that you should still be in Iraq, and working as a doctor yourself?

OSM: As a doctor I felt that I couldn’t sustain it; I couldn’t watch people die without doing anything. That’s why I made this film. For me, being a doctor was being weak, being vulnerable, being alone. As a journalist, I have the opportunity to talk to people, and to have people listen to me speaking as an insider, as a witness to the situation there. I’m sure there are some people who can do something, who can change something.

MJ: Do you think it’s the fault of the Americans that the situation in Iraq is as bad as it is?

OSM: Iraqis are hopeless; they can’t do anything. So they really believe that help should come from outside, or from other countries that have relation to this particular issue. But it’s really not the time to say whose fault. Let’s just move forward. I mean, even now— the other day our prime minister was on TV comparing these times to Saddam’s times. Why do we need to compare? Saddam is over and his days are done, so we should do better. We should be living better lives than our lives under Saddam, not worse.


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