Forced to choose who to treat in an overwhelmed hospital in Baghdad: COVID-19 in Iraq

Dr Aurelie Godard
Dr Aurelie Godard
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Iraq’s delayed vaccination efforts are forcing frontline medical staff to decide who to dedicate life-saving resources to.

We are choosing who to take from the emergency room now. We permanently have between six and ten people on continuous positive airway pressure (CPAP) - a form of non-invasive ventilation – in the emergency room waiting for a bed in our unit. It is always full while patients wait for a bed and we have nowhere else to send them.

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And so we’re forced to choose. It’s not a nice experience, but that’s what we are doing. You have families at the side of the bed of their loved one that see you taking another patient to the unit who arrived after them. They understand very well that if we don’t take their relatives or friends, perhaps it is because we do not believe they will survive whether treatment is given or not. I do not have a choice. Do I take an old woman who is 77 years old and leave a 40-year-old man on a stretcher?

I do not always know who to take, though. This week we had a 33-year old pregnant woman admitted. The baby was dead when she arrived because she was too hypoxic. The woman died less than 24 hours later, passing away despite the fact she only waited five minutes in the emergency room.

In contrast there’s another woman who has been waiting for seven days in the emergency room, who I finally admitted today because she is starting to do better. There were others who were admitted before her because she is 62 years old. I thought she would be dead a few days ago. She had two oxygen lines connected to her mask, and was on CPAP 24 hours a day. You think she is not going to survive the night. The next morning, she is still there, and doing a bit better. After a day she’s doing even better. Now, she’s not well, but I think she will survive.

During that time there were people aged 19, 21 and 33 that died. At the moment, the youngest person in the unit is 17 years old, and she is on CPAP.

A man who has recovered from the coronavirus disease (COVID-19) donates his plasma to help critically ill patients at National Blood Transfusion Center in Baghdad, Iraq June 18, 2020. (File photo: Reuters)
A man who has recovered from the coronavirus disease (COVID-19) donates his plasma to help critically ill patients at National Blood Transfusion Center in Baghdad, Iraq June 18, 2020. (File photo: Reuters)

It is hard to not choose the patient that has the greatest chance of surviving. How do we know who really has a chance of getting through this and living? What patient should I give my time and energy to?

During the first wave of coronavirus in Iraq the youngest patient we saw was 38. He got better and left the hospital after a few days. The others, they were all around 60, which is not old by any means, but they were not 17, 19, 21 or 33 and pregnant. It is not normal.

The patients fight to breathe. It’s similar to you swallowing water when you’re in the swimming pool. Imagine living that for a whole week – more, for some people. The families sitting at bedsides are hypnotised by the figure of their loved one’s oxygen saturation. You look at it and know that when it goes down, it’s not going well. Yet in their eyes there is simultaneously so much anxiety and so much hope when they show you a photo they took during the night when the oxygen saturation reached 95 or 97 percent and they are so happy, and you know that sometimes it’s a false signal.

Each of the patients are consuming 40 liters of oxygen per minute, on average, which is a huge amount. We are refilling the hospital’s tanks of 4,000 liters of liquid oxygen every day.

And we are one hospital. We are the tip of the iceberg and I have no idea what is going on in people’s homes, in the community.

It is really dramatic, and the people dying now are those who we could have prevented from dying through vaccination. So, it becomes more revolting to see young people dying of something that should have been at least partially controlled by vaccination.

The vaccination effort has slowly started while it is already many long weeks that Iraq saw the second wave hit. It isn’t waves we’re experiencing in Iraq. Instead it’s a terrible plateau that has covered many months. So, with a vaccination effort in its infancy we must ramp of the program across the country urgently.

I am not saying that everyone could already have been vaccinated, but the deaths we’re seeing now are preventable. That, on top of everything else I see here, makes me despair even more.

The Iraq ministry of health was contacted but had not responded by time of publication.

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