BAGHDAD–— Khalid Jamal had the Americans’ attention, and he was determined to make the most of it.

He hauled the group through the Rusafa District’s Al Fadal medical clinic, pointing out defects large and small. When he came to the immunization center, he barked at a nurse to get a bucket intended to keep the serum cold. She removed the top to the bucket to show the Americans Jamal’s coup de grace: The bucket was empty.

"They call Saddam a criminal, but he built facilities," he said.

The demonstrative gestures and inflammatory words last Monday were intended to illustrate the lack of support that the Shiite government was providing to Rusafa, this Sunni section of Baghdad. Yet the actions just as clearly showcase continuing sectarian suspicions that haunt the Iraqi government whenever it comes up short — an all-too common occurrence for a country just starting to find its footing. As often as not, the Americans are left to patch up the differences.

Jamal, called "KJ" by most U.S. soldiers, is nominally a "Sons of Iraq" leader, but his role is more akin to political boss. He has an outsized personality. During a patrol through Rusafa’s book market Saturday, he disparaged the Iraqi army and boasted that his "Sons of Iraq" group secured the area without its help.

The "Sons of Iraq" movement helped Sunni leaders like Jamal find a renewed political voice that had largely been silenced with the initial invasion. That gave them a much-needed stake in Iraq’s political process, but it also puts them at cross purposes with competing Shiite parties.

Yet Jamal’s observations at the health clinic are indisputable. Cabinets no longer held the medicines their carefully labeled shelves say they should. There was no place where women could have their babies. Refrigerators were empty, though even if they were full, the lack of electrical power means immunizations would quickly spoil. Jamal blamed all this on the government, which he said used insurgent activity as an excuse to pull supplies and doctors from the clinic. Al Fadal needs help from coalition forces, he said, not the Iraqi government.

Jamal’s complaints are only partly true. The government did pull its physicians from the area in 2006 when the violence got too bad for them to stay, said Ali Bustani, a Shiite and the Rusafa district health director. Meanwhile, the lack of supplies is something that all clinics are experiencing.

"You visit any health facility, any hospital, they want a lot of supplies," Bustani said.

To compound the problem, local officials often run up against bureaucratic rules designed to equitably distribute scarce resources. Iraq regulates how many and what type of health-care facilities can exist in a given area. A neighborhood can’t expand a clinic into an emergency center if there is a hospital within a certain distance. Residents are expected to visit the hospital instead.

The government allocates doctors based on the population of the surrounding areas, and it issues medicine and immunizations based on the number of patients. Those numbers are prone to exaggeration. Jamal claimed the clinic, which was empty Monday, averaged 200 to 300 patients daily. One interpreter put that number closer to 50 or 60 a day.

Still, there is a clear shortage of medicine and immunization. Bustani said that reflects a broader problem, not a Shiite conspiracy.

"There is a shortage of immunizations in every facility, not just Al Fadal," he said.

Other rules reflect concerns that any American hospital manager would recognize. Bustani wasn’t comfortable bringing a maternity ward to the Al Fadal clinic because it lacked a hospital’s emergency facilities and a blood bank.

However, some of the rules are utopian ideals that have been shoehorned onto a much messier reality. The mandate that limits the number of hospitals, for example, doesn’t take into account that Sunnis may have to cross through Shiite neighborhoods to visit a hospital. That would once have made any hospital visit a potentially fatal errand.

The situation is better now, but Iraqis still have a hard time losing this mind-set. Many residents delay visits until there is nowhere left to turn but their local clinic, said Maj. Tim Zamora, the executive officer for 3rd Squadron, 89th Cavalry Regiment, the U.S. unit responsible for Rusafa.

Lt. Col. David Ristedt, the 4th Infantry Division surgeon, echoed the concern: "It’s going to take years to get to where they’re comfortable walking alone again. They still haven’t come out of the mind-set ‘it’s dangerous to leave my community.’ "’”

Such complicated relationships between root problems and sectarian perceptions aren’t limited to health care — or even to Iraq’s Muslim majority. One Christian man in Rusafa complained the government neglected him because his religion didn’t have representation in parliament. The U.S. platoon sergeant noted that he’d seen plenty of Shiites living worse than the man was.

This leaves the Americans to build bridges between Iraq’s various sects — and, perhaps most importantly, the strong personalities like Jamal who represent them. That’s something that can only happen slowly.

In this case, Ristedt encouraged Jamal to work with the Ministry of Health. With the Americans turning over so much responsibility to the Iraqis, it’s not as easy to throw U.S. money into making projects happen. He’ll need the Iraqi government’s help.

Ristedt encouraged Bustani to send a team to visit the clinic and examine whether the situation could be improved, and Zamora asked him to consider sending the physicians back to the clinic.

"Things are progressing, and we’d like the clinic to progress as well," Zamora said.