Dr. Marwa al-Khafaji’s returned home after 20 days in a hospital isolation ward only to be received by spite from neighbors who barricaded her family home’s gate with a concrete block.
For them, Khafaji had survived the novel coronavirus, but the stigma surrounding the disease would now be a more pernicious fight.
The young physician was catapulted into the front lines of Iraq’s battle with the virus in early March and The Associated Press (AP) followed her tale from inside a squalid quarantine room until she returned home.
Her experience has reflected Iraq’s worn out health system, especially during the pandemic with hospitals lacking supplies, medical staff intimidated by an unknown disease, in addition to the widespread stigma associated with the infection.
At least 115 people have died among more than 3,030 confirmed COVID-19 cases across Iraq, according to Health Ministry statistics. The daily rate of cases jumped after curfew hours were shortened for the holy month of Ramadan, from 29 on April 22 to 119 on Wednesday. Officials fear a flare-up would be catastrophic.
Iraqi officials described the ministry’s response as adequate and said Iraq was spared the exponential rise in cases seen in neighboring Iran and Turkey.
However, fear of stigma — driven by religious beliefs, customs and a deep mistrust of the health system — has been a main driver of the pandemic in Iraq, according to doctors, especially as people hide their illness and avoid seeking help.
For his part, ministry spokesman Saif al-Badr blamed the spread on people who had symptoms or came from an affected country and "didn’t disclose these facts due to arrogance.”
But Khafaji’s story, as well as interviews with half a dozen doctors and nurses, reveal a haphazard response with no comprehensive strategy from a hobbled government that until recently had only caretaker status.
“Inside quarantine, the future felt uncertain,” Khafaji said.
“Outside it’s no different.”
In mid-March, Khafaji, 39, grew alarmed when her elderly mother, Dhikra Saoud, showed signs of respiratory distress. The virus had just started to hit Iraq and had yet to leave its mark on the city of Karbala where she lives.
But the doctor connected the dots. Days before, her father showed mild flu-like symptoms that she treated at home. Now her mother was presenting the same, but in acute form.
She was certain it was coronavirus. But at three different hospitals, doctors refused to test her mother.
At each hospital visit, Khafaji’s mother was afraid the neighbors would hear where she was.
“I beg you. Take me home,” she said.
Her symptoms worsened, until a tearful Khafaji pleaded to a physician friend at 3 am: Please, “give my mother the test.” He agreed.
On March 19, policemen came to the house to take both mother and daughter to the hospital. Both had tested positive.
According to AP, here again was a repercussion of the stigma: People often refuse to be quarantined, so police are sent to force them.
Khafaji knew the shortcomings of the system she worked in. Inside quarantine, she experienced it from the eyes of a patient.
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 US invasion, with little investment from successive governments.
There are eight physicians and 1.4 hospital beds per 10,000 people. The country of 38 million has at most 600 ventilators, a Health Ministry official said. One Karbala doctor, Assel Saad Saleh, said his hospital sees 1,000 patients a day, well over triple its capacity.
“Patients get angry with lack of supplies, drugs and testing kits,” he said.
On April 10, Khafaji and her mother tested negative for the virus and could leave, only to return home and be met with cement blocks that neighbors had erected, blocking their home's front and back gates.
Even after they were removed, things weren't the same.
When her son goes to play in the garden, Khafaji hears other mothers calling their children back into the house.
By May, she was back putting in 12-hour shifts at the hospital on an $800 a month stipend, the average physician’s salary in Iraq.
At her request, she works in the waiting room, helping diagnose potential virus patients.
“Everyone has a limit,” she said. “I haven’t reached it till now.”
