The Transition Has Begun

Robert Alt

March 29, 2004

Baghdad, Iraq—Much debate has swirled from Washington to Baghdad over the June 30, 2004, Coalition-pullout deadline: Will it be too soon to formally transfer power over key governmental operations from Coalition authority to the Iraqi people? At least one agency has demonstrated that June 30 is not soon enough: In a formal ceremony on Sunday, Ambassador Paul Bremer, surrounded by Iraqi doctors, announced that authority over the Ministry of Health is now officially in the hands of the Iraqi people.

That the Ministry of Health should be the first of the 26 public ministries to return to Iraqi control is quite an accomplishment, especially when you consider its dilapidated status just one year ago. Years of neglect had taken their toll. Maintenance was unheard of under Saddam, leaving only 35 percent of the equipment in hospitals operable. Doctors and medical students were unable to view medical journals online because of government policies that made owning a satellite dish a crime punishable by the state. And to add insult to injury, when Jim Haveman, the senior Coalition adviser, and Dr. Kudair Abbas, the Iraqi minister of health, arrived last year, the ministry building itself was completely looted. It is therefore not surprising to learn that Iraqis had come to expect little in the way of medical care.

What a difference a year makes! Saddam only provided $16 million for health care in his 2002 budget, a wretchedly low sum that should again prompt questions about how the Oil-for-United-Nations-Cronies — I mean, Oil-for-Food — program was operated. In FY 2004, however, the health budget received an enormous 60-fold increase, providing $948 million for 26 million Iraqis. At the end of the war, Iraq possessed only 300 tons of pharmaceuticals on hand. Compare this to the 35,000 tons of drugs distributed this year alone, a total that notably includes 30 million doses of children’s vaccinations.

In order to qualify for transfer of authority, the Ministry of Health had to meet a number of criteria, including developing short and long-term strategic plans, establishing a budget, demonstrating a sound management system, and implementing a system of checks and balances to prevent corruption. Given the state of the ministry he inherited, these are accomplishments for which Minister of Health Abbas should be proud. And clearly he is. On Sunday, Dr. Abbas emphasized his belief that the Coalition would not have transferred power unless he and his staff had demonstrated that they were ready to exercise it. This approval clearly meant a great deal to him. But the transition was also important to him because it meant that the Coalition had not only kept its word regarding the transition of power, but had actually delivered early on its promise. Given how the press often portrays Coalition occupation, it may surprise some to hear Dr. Abbas describing his time working with Jim Haveman and the Americans as “[o]ne of the nicest things in [his] life.” He summed up his feelings by saying that he now has good friends in America.

Notwithstanding these accomplishments, there is still much left to be done. Dr. Abbas readily admits that the medical knowledge of Iraqi health-care personnel lags behind the West by decades. But the ministry, aided by the Coalition, is taking steps to remedy this. The ministry is negotiating to receive expatriate Iraqi doctors from Britain to Iraq to provide expert services and to train local doctors. New textbooks and CD-ROMs have been distributed for training. Access to the Internet at hospitals and medical schools has opened journals previously unavailable. Japan and Egypt are providing grants for post-graduate training, and the U.S. has provided $17 million earmarked for medical training, with another $25 million in USAID funds for programs that include training. The doctors are soaking up the new information as fast as they can. “That ten years of isolation will be made up very quickly,” explained Jim Haveman.

While the ministry now has the authority to run day-to-day operations, Dr. Abbas has not been abandoned. The Coalition has made clear that it will be available to provide advice and assistance as well as funding, but only when asked for them. The transfer of authority is, therefore, real, and is a real first step toward an independent Iraq.

Robert Alt is a Fellow in Legal and International Affairs at the Ashbrook Center for Public Affairs at Ashland University and is currently reporting from Iraq. You can follow his daily progress at