Baghdad, Iraq – Maxime Pirard, responsible for nursing activities, is visibly tired. The young medical professional works tirelessly in one of Baghdad’s COVID-19 intensive care units, as the country sinks further under the weight of a second wave of the coronavirus.
The clinic, run by the medical organization Médecins Sans Frontières (MSF) in cooperation with the Iraqi Ministry of Health, increased its capacity from 36 to 51 beds early last month, as reported daily cases soared through the country from about 800 in February to over 5,000 in March. As of March 25, the country recorded 6,513 infections.
“The biggest challenge is that the patient flow is very high and the staff are really tired,” nurse Pirard told Al Jazeera. “We also have a lot of staff who get sick, so a lot of colleagues are doing extra chores.”
Pirard is part of a team of 102 local and international nurses and doctors working in the MSF clinic, a brand new structure inside the Al Kindi public hospital, a quiet complex near the bustling Palestinian street of Baghdad .
Tired and overworked, the calm murmur of health workers making their daily rounds inside the clinic belied the gravity of the situation. Not a single room in the long hallway was empty at the end of March, with patients hooked up to breathing machines stretching silently under blankets.
By early February, bed occupancy was below 50 percent, Pirard said, but there’s only room for a “one in, one out” policy.
“The center is full, we have three patients waiting in the emergency room and we know that as soon as we take someone out the bed will be filled with a new critical patient,” Pirard said.
Unlike the country’s first wave last year, most of the people seeking medical help at the MSF clinic need intensive care. “In the past, it was more severe to moderate for patients to have mild symptoms. Today there are more patients with respiratory distress who need a lot of oxygen, ”Pirard said.
According to the Ministry of Health, since the start of the pandemic, Iraq has increased the number of beds in intensive care units (ICUs) equipped with ventilators from 700 to 10,000. As of Wednesday, 468 of them were in use. Health ministry spokesman Dr Sayf al-Badr told Al Jazeera.
But some medical workers are not convinced by these numbers. “The number of genuine intensive care beds in the country is nowhere near this figure,” said a medical source who asked to remain anonymous. “All the hospitals I speak to in Baghdad report a bed occupancy rate of 95% or more.”
On Tuesday, the British charity Save the Children warned that an increasing number of infections were being reported in infants and children. Figures from the Ministry of Health show that the number of children under 10 diagnosed with COVID-19 rose from 11,699 to 13,546 in just two weeks in March.
The ministry says more than half of recent cases in the country are from the highly contagious British variant, first reported in Iraq in February. Dr Abdulameer Mohsin Hussein, president of the Iraqi Medical Association, explains that this could explain why more young people are contracting the virus.
In a country where more than 60% of the population is under 25, according to the UN, the increase in cases among young people is particularly worrying.
“This wave is more aggressive, but I hope we are prepared for it,” said Saif Khalid Abdulrahman, an Iraqi resident doctor. “The first wave was old [patients], this wave, there are more young patients.
Dr Abdulrahman said his youngest patient to die from COVID-19 was only 23 years old and died within 10 days of being admitted to hospital.
Unlike older patients, younger patients tend to wait longer to seek medical help, explained Pedro Miguel Conde Coelho Da Silva, MSF nurse.
“Because you end up tolerating more… when they come, sometimes it’s a little too late.” You try to put all your efforts on this person and the result is most of the time not very good, ”said the Portuguese nurse. That evening, four patients were pronounced dead.
Vaccines on the way
On Tuesday, the health minister warned that cases across the country would continue to rise and the country would soon receive more vaccines.
The inoculation program started in early March with the arrival of the first 50,000 doses of vaccine from Sinopharm, a Chinese state-owned company, followed by 336,000 doses of the Oxford-AstraZeneca vaccine. All Iraqis can sign up for the vaccine through an online portal, although the elderly and frontline workers are given priority.
The health minister said on Tuesday that 200,000 additional doses of Sinopharm were expected in the next 14 days and three million Pfizer over the next few months.
But even with the ongoing vaccination campaign, there are growing concerns among healthcare professionals.
“It is very difficult and possibly impossible to stop the spread of COVID-19 in Iraq at the moment,” said Dr Abdulameer Mohsin Hussein. “Most people, even some health workers, neglect the preventive measures related to the prevention of COVID-19 infection.”
Widespread skepticism about vaccines and lack of confidence in the Iraqi health system are additional hurdles in the country’s fight against the virus. Years of sanctions, conflict and mismanagement have left a once advanced public health system and doctor-patient relationships in tatters.
“Confidence is everything in managing a pandemic,” Mac Skelton, a medical sociologist at the American University of Iraq in Sulaimaniyah, told Al Jazeera. “If you don’t have it, what little fixes, what is it really for?”
Iraq had surpassed 851,000 reported cases as of Thursday. But the real number, Dr Hussein said, is likely to be much higher “because a lot of people, a lot of patients, refuse to go to the hospital”.
And with the start of Ramadan in less than two weeks, healthcare workers expect another increase in reported numbers.
“We have to prevent more people from gathering, asking people to wear masks,” Dr Abdulrahman said. “If we continue like this every year or every six months, we’ll have a big wave like this.”
But many Iraqis still ignore social distancing and wearing masks. Inside the emergency room at Al Kindi public hospital, Ahmed watched over his sick sister, her white mask resting on her chin.
“Iraq doesn’t have the structure or know how to deal with this, so people get infected and die,” said Ahmed, who asked that his full name not be used. “This place is busy, the doctors – they’re doing their best but they can’t keep up with the number of patients.”
The bleak hallways and bustle in Al Kindi’s emergency building are worlds away from the nearby MSF clinic, a relative sanctuary amid Iraq’s dilapidated hospitals and overworked staff.
“In the order of things [Iraqis] have faced so many problems in the past 15 years and therefore a lot of “ blasphemy ” you see is fair against all the challenges they face in their life, ”Skelton said.
“I think they’ll be resilient there, but it won’t end quickly. It will probably be a longer route than in many places.