KIRKUK, Iraq — Parents sit on the floor cradling sick infants in the jammed hallways of Kirkuk province’s only pediatric hospital. Half-disrobed patients are examined in front of open doors in rooms with no curtains, privacy a luxury reserved for expensive private hospitals. Some children must wait days for treatment, depending on the severity of their illness, one of the hospital’s harried pediatricians explains to members of the Kirkuk Provincial Reconstruction Team.

In another corner of town, while walking the hallways of a rehabilitation hospital for disabled Iraqis, hospital administrators tell the PRT members their doctors are swamped, seeing patients nonstop all day. They need more money and a near tripling of their staff.

The rehabilitation rooms, however, are nearly vacant, as is the hospital’s large cafeteria, and many pieces of equipment, which the administrators said were bought with U.S. aid money, are still in unopened plastic wrappers. During the unannounced visit, reconstruction team members found only two patients.

Asked where all the patients had gone, the hospital’s assistant director, Faldhil Salih said, "They come in the morning and then go."

A twin epidemic of scant resources and lack of accountability has left the health-care system in Kirkuk province, and much of Iraq, in shambles, and a group of soldiers and civilians from the reconstruction team have been working for nearly a year to improve access and treatment.

"It is frustrating," said Capt. Philip Schaub, after seeing the wasted resources at the rehabilitation hospital.

Schaub, a health-care administrator and a reservist attached to the Missouri-based 418th Civil Affairs Battalion, is part of the PRT’s medical section. PRTs are made up of civilians and troops and are placed throughout Iraq and Afghanistan with the goal of building up civil society and local government.

Back to basics

Kirkuk faces many of the same issues that, according to a March report from the International Committee of the Red Cross, plague the rest of the country, such as insufficient access to clean water and sanitation. Iraq has less than 40 percent of the hospital beds needed to serve its population and more than half the country’s doctors have fled since 1990, according to the report.

Safety for medical workers in Kirkuk has been tenuous, causing many doctors to leave the province, said Staff Sgt. Keith Schaefer, 26, an emergency medical technician and reservist with the 418th. Sabah Amin, the director general of health for the province, survived a recent car bombing and a doctor working with the PRT received death threats. In the past two years several doctors have been murdered in the province.

"The knowledge base has left," said Schaefer, of Springfield, Mo.

In a province where some people go from birth to death without seeing a doctor, the team has focused on providing basic care and immunizations to rural residents by helping to start a mobile clinic system, vans with doctors offering vaccinations, physical exams, basic prenatal checks, and prescription medication.

Because of Iraq’s decades of isolation, many of the country’s doctors have not had the chance to travel abroad to medical conferences and learn about new techniques. The PRT has helped some local doctors set up teleconferencing, so that they can meet with other health-care professionals without prohibitive travel costs.

During a cholera epidemic last year, doctors in Kirkuk used the system to confer with Bangladeshi colleagues who had dealt with a similar epidemic.

The team has shied away from going after flashy new medical equipment. Some Iraqi hospitals are littered with new, high tech, completely unused machines donated by well-meaning organizations, Schaefer said. Iraqi medical workers often lack the training or expertise to use some of the equipment they receive and the same hospitals still grapple with lack of sanitation, clean water and medical supplies.

"You can give a million pieces of equipment but unless you fix these root problems ... the equipment’s not going to mean a hill of beans," Schaefer said.

Navigating bureaucracy

Health care in Iraq is highly politicized, and provincial administrators must navigate a complex bureaucracy to get what they need from the central government, said Stacy Lamon, chief of the PRT’s health care team. The province’s director general must get every project approved and funded by the Ministry of Health, which makes it difficult to meet urgent local needs quickly.

Saddam Hussein’s system, aiming to keep people from forming alliances, is still in place, which means provincial health systems have one set of rules and one source of money, while local districts have a completely different structure.

"It’s a nifty way to be a dictator, it’s a lousy way run a health-care system," said Lamon, the former senior director of program development for the New York City Department of Health.

It’s also nearly impossible to fire public employees, meaning some health-care professionals running nearly vacant hospitals like the rehabilitation center, Lamon said. They see a negligible number of patients while pulling a government salary and devote most of their time to more lucrative private practices.

Saddam’s hospital inspection regime is also still being used, meaning facilities are rarely held accountable for keeping even minimum standards of cleanliness or patient care. Lamon’s long-term goal is convince the Minister of Health to implement more stringent standards and inspections, though Lamon admits it’s a lofty goal.

Aside from the official bureaucracy, there are also the unofficial decision-makers, the local fixers, sheiks and militia leaders, who must be placated to keep projects on track. The mistake many Americans make, Lamon said, is not meeting what they deem the more unsavory power wielders and not taking local customs seriously.

"You need to drink tea with them, you need to stand up when they’re standing, you need to shake hands with them, even if there’s 20 people at the table," he said.