BAGHDAD (AP) – In the bustling ER of the main public hospital in Baghdad, Ali Abbas stood with his face uncovered, waiting for his sick father. Dozens of other patients and their relatives mingled without masks.
It is a scene that confuses Iraqi health professionals, who warn that the country is entering a new wave of coronavirus cases, partly because many avoid precautions.
“I don’t believe in the coronavirus, I believe in God,” said Abbas, 21, in the middle of the hospital floor, defying the establishment’s rules that require masks.
As of Friday, Iraq was under its first full day of a new government imposed curfew in response to infection rates that increased again after declining last fall. The curfew is open all day from Friday to Sunday, and from 8 pm to 5 am the rest of the week. Mosques and schools are closed, large meetings prohibited and the use of masks and other protective equipment will be applied, according to a government statement.
A total blockade, including the closure of airports and borders, is also being considered, said two government officials, who spoke on condition of anonymity because they were not allowed to inform the media.
New cases, below 600 a day just a month ago, increased dramatically, reaching 3,896 a day on February 18 and approaching the September daily peak of more than 5,000. The Ministry of Health says that 50% of new cases are the most infectious new strain that has emerged in the UK. More than 657,000 people have been infected with the virus in Iraq and 13,220 have died since February.
Doctors told the Associated Press that they saw the outbreak coming weeks ago. They blame a careless public and a government that is unable to fully enforce virus protocols.
“I am a doctor who fights against public ignorance, not against 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. In early February, that number jumped to 30 patients with serious viruses. Shahada expects more in the coming weeks.
At his private clinic, some patients left instead of fulfilling their strict facial mask requirement, he said.
Ismail Taher, a doctor at Sheikh Zayed Hospital in Baghdad, estimated that only one in ten people who enter his hospital wear masks.
The Ministry of Health 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, shopping malls and parks, where handshake greetings and kisses are the norm.
The ministry also blamed “some people who openly question the existence of the pandemic”.
This is a common feeling.
“It’s just a flu,” said Yahya Shammari, a 28-year-old university student. “I went to the hospital twice without a mask and I was not infected.”
Rahem Shabib, 32, said he saw how infection rates fell after the Shiite Muslim Arbaeen’s pilgrimage in October. “Therefore, God is stronger than COVID-19,” he said.
Arbaeen brings millions from around the world to Iraq for celebrations related to the 7th century assassination of Imam Hussein, the grandson of Prophet Muhammad of Islam. This year, Iraq has banned the participation of foreign pilgrims, significantly reducing the number.
Mac Skelton, a medical sociologist at the American University of Iraq in Sulaimaniyah, said that the attitude of contempt is not as rooted in ignorance as in the reality that Iraqis face.
Iraqis have endured so many calamities in recent decades, including wars, political violence and sanctions, that COVID-19 “may not be considered a major problem,” he said.
In addition, government pandemic policies, centered on hospitals, do not match the way Iraqis deal with illnesses, Skelton said. In the midst of years of instability, Iraqis had to come up with their own strategies, because either medical assistance was not available or they did not trust hospitals, which at the height of sectarian strife became dangerous places to go.
For this reason, they seek pharmacists, nurses, help from neighbors or even cross borders to treat diseases.
“Most doctors are not surprised, they know that patients would refuse to go to the hospital unless they were short of breath and had no choice,” said Skelton, director of the university’s Institute for Regional and International Studies.
This also suggests that the Ministry of Health statistics, based on tests in government laboratories, are underestimated, as many Iraqis may forgo testing and choose to recover at home.
Iraq’s centralized health care system, largely unchanged since the 1970s, has been crushed by decades of wars, sanctions and protracted riots since the United States’ invasion in 2003. Successive governments have invested little in the sector.
The mix of virus patients with others also exacerbated the number of cases, doctors said. Shahada’s hospital has already been reserved only for patients with viruses; but no more, and patients at COVID-19 and others share rooms where CT scans, MRIs and X-rays are taken, Shahada said.
So far, Iraq has not faced a shortage of medical supplies or ICU capacity. But that could change if cases increase, doctors said.
The Ministry of Health said it plans to start administering the vaccines by the end of March. The government has allocated funds to guarantee 1.5 million vaccines from Pzifer and signed a contract for another 2 million from AstraZeneca. Little has been announced about how inoculation will occur.
Now more than ever, government officials fear it will be difficult to change ingrained habits.
As restrictions eased after September, life returned to Iraq. In Baghdad, restaurants are crowded and masks are rarely seen. Further south, in Basra, residents spend the day as if the pandemic had never hit the south coast, sharing meals in crowded cafes and shaking hands.
“Changing public awareness is the only way to prevent another lethal virus outbreak,” Health Minister Hasan al-Tamimi told the AP during a recent news conference.
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Associated Press writer Samya Kullab in Baghdad contributed to this report.