Watching Children Starve to Death

By NINA BURLEIGH/BAGHDAD

In a dingy pediatric ward at Baghdad's Qadissiya Hospital, Fadhia, 19, stands vigil over a crib where her five-month-old daughter lies dying of malnutrition. She has been here before: a month earlier she watched as her three-year-old son succumbed to starvation and diarrhea. Now she watches as her little daughter, her face all shriveled and her body bony, grows smaller every day. The hospital is crammed with such children. But it has no food to save them, and scant medicine.

Even sheets and diapers are lacking, so the famished babies lie naked on plastic mattresses. Each day the hospital admits another 10 cases of marasmus -- an advanced state of malnutrition that causes the child's face and body to become as shriveled and haggard as those of a wizened old man. Other children have grotesquely swollen bellies -- a symptom of the starvation syndrome known as kwashiorkor. Before the war, says the hospital's director, there was barely one such case a year.

While America has celebrated a swift, efficient victory in the Persian Gulf, a tour of hospitals inside Iraq tells the story of a different war. This one is still being fought, against epidemic disease and starvation, the conflict's sorry legacies. Its principal victims are children. The tour, sponsored by the Arab-American Medical Association for doctors of Iraqi extraction, afforded unprecedented access to the country's ravaged medical system and desperate doctors and patients. But even on the street, the hunger and suffering were palpable. "I was shocked by the look on people's faces," Cleveland physician Nadia al-Kaisi told TIME, the only U.S. publication represented on the tour. "They are all emotionless, desperate faces without smiles."

Hospital administrators and doctors, who give interviews in rooms invariably decorated with a portrait of Saddam Hussein smiling benevolently, are often reluctant to admit the extent of the health disaster they are witnessing. But signs of distress are everywhere. Many hospitals were damaged by allied bombing, including three in Baghdad and two in Basra. Completely destroyed was the only hospital in the country that performed kidney transplants and advanced heart surgery. In other cases, physical damage to medical facilities was caused by the civilian uprisings that followed the war.

But most widespread problems are traceable to the allied devastation of power plants and to the continuing trade embargo. Without electricity, hospitals cannot operate even such basic equipment as incubators or refrigerators needed to store blood and medicine, much less the more sophisticated machinery of operating rooms and intensive-care units. In the northern city of Arbil, all premature infants are dying: there are no working incubators. In the southern city of Karbala, a hospital without refrigeration relies on a makeshift method to acquire blood for transfusions: the staff sends a young man running out of the hospital to fetch a person with the proper blood type, who will give blood as the operation progresses.

While economic sanctions were not meant to include food and medicine, they have effectively done so, according to health professionals in Iraq. In hospitals where children lie dying of malnutrition, mothers hovering over cribs hold out a hand when they see a foreign visitor and beg, "Haleeb, haleeb," (Milk, milk). Because the cash-starved government can no longer afford to subsidize the cost of imported baby formula and other staples, prices have skyrocketed. A can of Similac cost half a dinar ($1.50) before the war; now it costs 20 dinars.

One day's worth of formula for Fadhia's dying five-month-old daughter would cost more than her husband makes in a week. Qadissiya Hospital ran out two months ago, and the mothers are unable to breast-feed because they cannot find enough food for themselves. Fadhia and thousands of other indigents who live in the Baghdad slum known as Saddam City have taken to foraging alongside dogs and sheep, searching for food in the mounting piles of garbage that line every street. There has been no refuse pickup in the neighborhood in five months. Nor is there clean water. Sewage has backed up into the streets in greenish, foul-smelling pools.

Because of such conditions, the threat from dysentery, typhoid fever, cholera and other diseases brought on by consuming contaminated food and water is even greater than the threat of starvation. "Dysentery is the No. 1 killer in Iraq right now," says Arfan al-Hani, a suburban-Chicago cardiologist who led the Arab-American medical delegation. Hospitals across the country are admitting two to five times as many patients with gastroenteritis caused by waterborne infections as they did before the war. Some other infections, including salmonella and shigellosis, could be treated with simple antibiotics. But all the doctors can offer are sugar-water solutions, and so patients are dying.

Children are faring the worst. According to the Iraqi Red Crescent, 80% of all deaths since the cease-fire have been youngsters. A Harvard medical team that visited Iraq in late April estimated that 170,000 children will die of gastrointestinal disease complicated by malnutrition as a result of the war. Allied bombing of power stations caused the breakdown of the water- purification system.

Though the greatest suffering is among the poor, visiting doctors were shocked to see the reduced state of their own, mostly middle-class relatives, who must also scrounge for clean water and make do with rationed flour that is often cut with sawdust. "The children looked thinner," noted Chicago urologist Emil Totonchi, who also judged his brother, a Baghdad physician, to be "clinically depressed." Said Totonchi: "When I looked into the faces of my relatives, I saw there was something major lacking. I didn't see much of life or hope -- just bare existence projected so strongly."

Demoralization is a serious problem among medical workers. Many doctors and nurses fled during the war and have not returned. Those who stayed are overworked and still shell-shocked from their wartime experiences. At Baghdad's Yarmouk hospital, chief surgeon Boghos Boghossian remembers when more than 300 bodies were delivered from the Amiriyah bomb shelter, many charred beyond recognition. There were only 20 burn beds to receive them. Candlelight replaced electricity throughout the hospital, except in the operating theaters, to which all electricity from the generator was diverted. "It was like being thrown back into the Middle Ages," says Boghossian.

In southern cities, where fierce fighting erupted between Shi'ite rebels and the government, healthworkers were caught in the cross fire. Three floors of Karbala's Husaini hospital were destroyed, and blood and bullet holes are still visible on walls and doors. One doctor there tells of walking down a hallway where dead and wounded lined every inch of the floor and of being unable to tell which stray limb belonged to which body. For weeks, dogs feasted on decomposing remains in the courtyard between the wards.

Across Iraq, doctors and officials say they are relying almost entirely on relief aid to keep going. The government has been unable to purchase equipment because the country's funds remain frozen. Supplies stockpiled before the war were lost in the ensuing chaos and civil uprisings.

While the total amount of aid reaching the country is impossible to calibrate, a massive mobilization by UNICEF and the International Committee of the Red Cross is under way. However, the situation for the summer remains grim. Iraqi health officials and Western observers say that without an immediate lifting of sanctions, at least as they affect the country's ability to import food and medicine, tens of thousands of children will die, the victims of a war that, for them, is still being waged.