When Hiro Amin's sister, a girl from Khanaqin, drowned in June 2022 and her body was taken to the district hospital, the body was not returned to the family since the doctor requested that an autopsy be conducted before burial to determine the cause of death.
In general, some suspicious and sensitive deaths force the doctor to decide to investigate. Here started the problems for Hero's family.
The problem stems from the fact that the forensic medicine in Khanaqin has been closed for more than a year by the Iraqi Ministry of Health and the bodies need to be sent to Baquba - the capital of Diyala province.
The Iraqi ministry of health has decided to have one forensic medicine at the center of the provinces and shut all others in districts and sub-districts out of the city centers as part of government’s austerity plan.
"We asked an ambulance to transport the body, but the hospital administration said it was not our job," Hero said.
We asked an ambulance to transport the body, but the hospital administration said it was not our job
After much discussion, according to Hiro, the hospital administration told them, "If we issue an ambulance, you will have to pay 100,000 (Iraqi) dinars (IQD) ($70) to go back and forth.”
Hiro's family is not in good financial condition and considers the money too much, so they decide to take a hearse outside the hospital for 50,000 IQD and head to Baquba.
The road from Khanaqin to Baquba is not bad in general, but in some places it becomes one-sided. It usually takes about three hours to get to Baquba and back.
“On the one hand we were suffering from the loss of our sister, on the other hand the danger of the road, especially at night... My father and relatives brought their cars and we went that way. We postponed the burial to the next day because it was too late," she added.
This is the monthly story of dozens of families in Khanaqin who are forced to take the bodies of their relatives to Baquba for the forensic medical examiner to write his report. Any family that is asked for a medical report, if it does not, will not get a death certificate and will likely be forced to remove the bodies from their graves again for autopsy.
Iraq’s public healthcare system which was once one of the most advanced in the region now is in serious crisis. There’s a shortage of drugs and the medical staff to administer it. Over the past three decades the country has been ravaged by Iraqi-Iran war, Saddam Hussein’s invasion of Kuwait, ousting of Saddam regime followed by sectarian violence, the war against al-Qaeda and the rise of Islamic State in Iraq and Syria ISIS.
The political chaos after 2003, pushed an estimated 15,000 out of 52,000 registered Iraqi doctors to leave the country. The young student doctors primarily seek training and life abroad rather than permanent state employment.
"We ask the relevant authorities to make serious efforts to reopen the forensic medicine in Khanaqin, we have lost a loved one and we know how important this department is for the people of Khanaqin," Amin sobbed.
We have lost a loved one and we know how important this department is for the people of Khanaqin
According to officials of the Khanaqin health department, the forensic department has been closed throughout the province except the forensic department of Baquba.
The Khanaqin department had two specialists and four staff.
"The lack of a forensic department has created a lot of problems for us. Khanaqin is relatively remote compared to other districts of Diyala, so the opening of the hospital will be very important for the people of Khanaqin," said Dr. Shiwan Shakir, director of Khanaqin public hospital.
"There are many deaths that we cannot issue death certificates for because they need to be investigated, so we have to send them to Baquba,which sometimes it gets us into trouble,” Shakir added.
"The ministry said it costs them a big budget, especially the salaries of doctors and staff, so they made it a forensic physician in Baquba.”
Khanaqin District, home to 90,000 Kurds, Arabs and Turkmens, Sunnis and Shias, is part of Diyala province and is one of the disputed territories which extends from Khanaqin, on the border with Iran, to the northern oil-rich city of Kirkuk up to Shingal (Sinjar), home to the Ezidi community, in Mosul, in the far west, on Iraq-Syria borders.
Article 140 of the Iraqi constitution stipulates normalization, a population census and a referendum on the status of the disputed territories between the federal Iraqi government in Baghdad and Erbil-based Kurdistan Regional Government KRG, yet it has not been materialized up the preset, leaving the area in security gap, missing basic public services.
Most of the disputed territories were under control of the Kurdish Peshmerga forces up to October 2017, when the Iraqi Security Forces ISF took over control of these territories following the defeat of ISIS.
Unlike Kirkuk and other disputed areas, the KRG Peshmerga forces, the police, and the Asayish (Kurdish security) returned and were stationed in Khanaqin to safeguard some offices affiliated KRG in the district.
"We have several ambulances, but the ministry has given us only to transport the wounded and emergency patients, so we cannot transport the dead, the relatives of the dead must take this task themselves," he elaborated.
He denied that they charge the families if their ambulances take the bodies to Baquba forensic medicine.
"There is no such thing. We just told them they could go outside the hospital and get a car because we cannot transport the body. It is the decision of the ministry," he said.
"Sometimes the relatives of the deceased who want to take him to Baquba rush into the hospital and some of them get angry and break the windows and equipment of the hospital, all because of the lack of forensic department," he said.
The limited public healthcare services provided at the public hospitals has pushed the Iraqi since 2003 to look for better health services in private clinics and hospitals which charge double times higher than state hospitals marred with poor services, administration and corruption alike other public utilities in the war-torn country.
In 2019, the Iraqi government allocated just 2.5% of the state’s $106.5 billion budget to its health ministry, while security forces received 18% and the oil ministry 13.5%.
Over the past decade, data from the World Health Organization WHO shows, Iraq’s central government has consistently spent far less per capita on healthcare than its much poorer neighbors - $161 per citizen each year on average, compared to Jordan’s $304 and Lebanon’s $649, a report by Reuters found.
Sarwar Ali, a health sector activist in Khanaqin, said he has observed the problems caused by the lack of forensic physicians, “the most obvious of which are the lack of transportation and the extra costs of renting cars and coffins and the distance to the hospital, beside other problems in the hospital.”
"The number of ambulances in Khanaqin is very small. We have raised the demands of the health sector from Khanaqin to both the Iraqi and Kurdistan Regional Governments, although it has not yet been fruitful yet, but will continue to seek treatment," he added.
Hero's name was changed for this report at her request.
