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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 womens 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. Whats 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 womens 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 womens 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, womens 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