If Iraqi medics fail to save the lives of victims, they may be required to pay compensation to the person's clan or face violent retribution, as police say it is none of their business.
Tribes extort blood money from Iraqi doctors when patients die
BAGHDAD // When the two severely injured men were rushed into Basra Hospital's emergency room last summer, Dr Basim al Sudani did what he had been trained to do: he tried to save their lives.
Both patients, victims of a car accident with extensive damage to their chests, hearts and lungs, died shortly after being admitted. Dr al Sudani and his staff had done their best but, he recalls, it would have taken a miracle for the men to survive.
That fact, however, did nothing to deter their tribe from insisting that Dr al Sudani was personally responsible for the deaths and, therefore, should give them US$150,000 (Dh550,000) in blood money, a tribal custom whereby the killer of a member of the tribe must pay up or face violent retribution.
"Of course I took the matter straight to the police but they told me that it was none of their business, and that a tribal claim had been made against me so I must settle it in the tribal way," he said.
Without a strong clan of his own to provide support, Dr al Sudani eventually felt he had no other option than to pay. "The tribes are uneducated and, in a blood money case, if you don't pay, they will come and take revenge against you or your family," he said. Rather than take such a risk in the face of increasing threats, the physician sold his house and paid off the tribe.
Although the sum of money in Dr al Sudani's case is extreme, his experience is far from unusual. Hundreds of doctors across the country have found themselves facing similar threats. The Iraq Doctors' Syndicate, the national union for physicians, recorded 320 cases of tribal blood money demands against its members in 2009 and 2010.
The tribes insist they should be paid compensation, according to their customs, but medical professionals and politicians say the claims amount to nothing more than extortion.
Feras al Kerbasi, an official with the Doctors' Syndicate in Baghdad, said: "We are seeing increasing numbers of cases where doctors are threatened by tribes after people died in hospital, either following accidents or during surgical procedures. Most of the doctors have no choice and end up paying, usually about $8,000 but sometimes much more than that. Tribes have come to see this as a simple way of earning some extra money."
The situation is now so serious that some doctors are refusing to treat patients who are at risk of dying. Especially in emergency rooms, experienced staff are increasingly reluctant to get involved with serious injuries.
Dr al Sudani, head of the emergency ward in Basra, has taken just such a step. "I have done no surgery since last summer" when the tribal claim was made, he said. "I now limit myself to offering consultations and advice, health checks and that kind of thing, but I do nothing more than that."
Medical professionals, including the Doctors' Syndicate, have called on the government to take urgent action. The cabinet has given initial approval to new legislation that would outlaw tribal claims against doctors, as well as allowing medical staff to carry pistols for personal protection.
However, with a long political impasse following last year's elections - Iraq's government has still not been fully formed, almost 12 months after voters cast their ballots - the proposed law has joined the backlog of pending legislation.
"Unless something is done quickly, more doctors will stop trying to save lives through surgical intervention, even when they think that is what is necessary," Mr al Kerbasi said.
"Many of our members are talking about stopping working and if parliament does not take action soon, we will protest and perhaps go on strike."
Baghdad's Khadamiya Hospital, a major centre for surgery in Iraq, has witnessed a rash of tribal claims.
One such case affected Dr Mohei Mohammad, a cardiac surgeon who lost an elderly patient during a risky but necessary heart bypass operation last year. Hospital authorities investigated the death, as is routine, and concluded that there had been no malpractice by its staff.
That did nothing to satisfy the man's clan, from the strongly tribal area of Maysan, in southern Iraq, a place with a reputation for violently adhering to old customs.
"They blamed me for the death," Dr Mohammad said. "We ended up going through the tribal settlement system and I had to pay them $30,000.
"If you don't pay the money, they'll come for your family, so you have no choice."
A senior surgeon, Dr Mohammad said that in years of practice he had never before faced a tribal claim.
"Under the old regime of Saddam Hussein, the government was strong, it protected doctors and there was no way a tribe could harass you," he said. "Now we have a weak government and weak law enforcement so the tribes have stepped in."
In Maysan, Balasim al Kadi, a social scientist, said the tribes had grown in power since 2003, when Saddam was toppled by a US-led invasion, and were now enforcing their rules in a way that they were not traditionally used for.
"The weak government has given the tribes an opportunity to make trouble and corrupt tribal laws," he said. "For the doctors the situation has been getting worse and worse. If you go into Maysan Hospital, many doctors hesitate before helping someone with severe injuries.
"It's a serious problem and the central government needs to do something about it."