Old habits imperil Iraq as doctors warn of second virus wave

Doctors in Iraq are confounded by widespread shirking of precautions against COVID-19 even as cases surge dramatically

Virus Outbreak Iraq Cemetery New Surge (Copyright 2020 The Associated Press. All rights reserved.)

In the busy emergency room of Baghdad’s main public hospital Ali Abbas stood face uncovered, waiting for his sickly father. Dozens of other patients and their relatives mingled without masks.

It’s a scene that confounds health workers in Iraq who warn that the country is entering a new wave of coronavirus cases, in part because many shirk precautions.

“I don’t believe in the coronavirus, I believe in God,” the 21-year-old Abbas said in the middle of the hospital floor, defying the facility’s rules requiring masks.

On Friday, Iraq was under its first full day of a new curfew imposed by the government in response to infection rates that have shot back up again after easing last autumn. The curfew runs all day Friday to Sunday, and from 8 p.m. to 5 a.m. the rest of the week. Mosques and schools are closed, large gatherings prohibited, and the wearing of masks and other protective gear will be enforced, according to a statement from the government.

A complete lockdown, including closing airports and borders, is also being considered, two government officials said, speaking on condition of anonymity because they were not authorized to brief the media.

New cases, down under 600 a day just a month ago, have sharply increased, reaching 3,896 a day on Feb. 18 and approaching September’s daily peak of more than 5,000. The Health Ministry says 50% of the new cases are from the new, more infectious strain that first broke out in the U.K. More than 657,000 people have been infected by the virus in Iraq and 13,220 have died since February.

Doctors told The Associated Press they’ve seen the flare-up coming for weeks. They blame a careless public and a government unable to fully enforce virus protocols.

“I am a doctor fighting public ignorance, not the pandemic,” said Mohammed Shahada, a pulmonologist at Baghdad’s al-Zahra Hospital.

At al-Zahra Hospital, the year began with just four patients in the 90-bed isolation ward. By the start of February, that jumped to 30 severe virus patients. Shahada expects more in the coming weeks.

At his private clinic, some patients have walked out rather than abide by his strict face mask requirement, he said.

Ismail Taher, a doctor at Baghdad’s Sheikh Zayed hospital, estimated that only one in 10 people walking into his hospital wear masks.

The Health Ministry said earlier this month that a new wave was being driven by religious activities -- including Friday prayers and visits to shrines -- and large crowds in markets, restaurants, malls and parks, where greetings with handshakes and kisses are the norm.

The ministry also blamed “some people who are openly questioning the existence of the pandemic.”

That’s a common sentiment.

“It’s just the flu,” said Yahya Shammari, a 28-year old college graduate. “I went to the hospital twice with no mask on and I didn’t get infected.”

Rahem Shabib, 32, said he noticed how infection rates dipped following the Shiite Muslim Arbaeen pilgrimage in October. “So God is stronger than COVID-19,” he said.

The Arbaeen brings millions from around the world to Iraq for commemorations connected to the 7th century killing of Imam Hussein, the grandson of Islam’s Prophet Muhammad. This year, Iraq banned foreign pilgrims from attending, considerably reducing the numbers.

Mac Skelton, a medical sociologist at the American University of Iraq in Sulaimaniyah, said the dismissive attitude was not so much rooted in ignorance as in the realities Iraqis face.

Iraqis have endured so many calamities the past few decades, including wars, political violence and sanctions, that COVID-19 “may not stack up as a major problem,” he said.

Also government pandemic policies, centered on hospitals, don’t mesh with how Iraqis cope with illness, said Skelton. Amid years of instability, Iraqis had to come up with their own strategies, because health care was either not available or they distrusted hospitals, which at the height of sectarian fighting became dangerous places to go to.

So they seek out pharmacists, nurses, help from neighbors, or even cross borders to treat illness.

“Most doctors are not that surprised, they know patients would refuse to go to hospital unless they were gasping for air and had no choice,” said Skelton, director of the university’s Institute of Regional and International Studies.

This also suggests Health Ministry statistics, based on tests at government labs, are an undercount, as many Iraqis may forgo testing altogether and opt to recover at home.

Iraq’s centralized health system, largely unchanged since the 1970s, has been ground down by decades of wars, sanctions, and prolonged unrest since the 2003 U.S. invasion. Successive governments have invested little in the sector.

The mingling of virus patients with others has also exacerbated case numbers, doctors said. Shahada’s hospital was once reserved solely for virus patients; but no longer, and COVID-19 patients and others share rooms where CT scans, MRIs and X-rays are taken, Shahada said.

So far, Iraq has not faced shortages in medical supplies or ICU capacity. But that could change if cases soar, doctors said.

The Health Ministry said it plans to begin administering vaccines by the end of March. The government has allocated funds to secure 1.5 million vaccines from Pzifer and signed a contract for 2 million more from AstraZeneca. Little has been announced about how inoculation will proceed.

Now more than ever, government officials worry it will be difficult to change entrenched habits.

As restrictions eased after September, life returned to Iraq. In Baghdad, restaurants are packed and face masks seldom seen. Further south in Basra, residents go about the day as though the pandemic never reached the southern shores, sharing meals in crowded cafes and shaking hands.

“Changing public awareness is the only way to stop another lethal virus outbreak,” Health Minister Hasan al-Tamimi told the AP at the sidelines of a recent press conference.

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Associated Press writer Samya Kullab in Baghdad contributed to this report.