Like many others in the world, Iraqis are facing unprecedented quarantine measures to control the spread of the coronavirus. In a country still recovering from decades of war, sanctions, and extremism, experts fear that Iraq would be unable to adequately respond if there is a widespread outbreak of COVID-19. Moreover, Iraqis who have been stricken with the novel coronavirus are also facing deep discrimination within their neighborhoods and communities. This current of stigmatization is driving those infected, particularly women, to deny that they have the virus and avoid potentially life-saving medical interventions.
In Iraq, people suspected of having contracted COVID-19 are quarantined for 24-48 hours in a medical facility to await test results; there is no policy for in-home quarantines. If the result is positive, the infected person is quarantined for 14 days at a hospital focused on treating COVID-19 patients. However, many Iraqis are hiding their symptoms and refusing to be tested. According to Dr. Ali al-Bayati, a practicing psychiatrist and commissioner at the Iraqi High Commission of Human Rights, this is happening, in part, because “those infected are becoming (social) outcasts. The public is panicking, and due to lack of general health awareness, people do not understand the pandemic” or how to respond to it.
This current of stigmatization is driving those infected, particularly women, to deny that they have the virus and avoid potentially life-saving medical interventions.
The resistance has grown so intense that, increasingly, the Iraqi government is sending armed security forces with medical professionals to apprehend people infected with coronavirus and hospitalize them. These measures appear to criminalize the infected person and their family – and echo darker days in Iraq, when security forces would seize suspects from their neighborhood streets to imprison them. Dr. Saif Erzooqi, an internal medicine doctor in Baghdad, noted, “many patients refuse to be quarantined; for them it is considered an accusation.”
In fact, this intense opposition to medical evaluation and government intervention might help explain why Iraq has reported exponentially fewer cases than neighboring Iran, one of the countries hardest hit by COVID-19. As of April 22, 2020, Iraq’s Ministry of Health reported 1,631 cases across a total population of approximately 38 million. By comparison, Iran’s official count exceeds 85,000 in a population roughly twice that of Iraq. In a recent New York Times article on resistance to coronavirus testing in Iraq, Dr. Hazim al-Jumaili, a deputy health minister, agreed that this makes his job guiding the country’s response challenging. “It is true we have cases that are hidden,” he said, “and that is because people don’t want to come forward and they are afraid of the quarantine and isolation.”
Exactly why this is happening is likely a combination of lack of confidence in Iraq’s anemic health care system and deeply ingrained social norms. Iraq’s health care system is one of the weakest in the region, debilitated by decades of conflict and comprehensive international sanctions, as well as corruption. According to the World Bank, there are 1.4 hospital beds and 0.8 physicians for every 1,000 Iraqis. The World Health Organization notes that, over the last decade, Iraq has spent only $161 per capita on average each year on health (compared to neighboring Lebanon’s $649 and Jordan’s $304).
Medical professionals and human rights groups are increasingly expressing concerns that many families would not send their daughters, even if symptomatic, to hospitals, where they would be unprotected and isolated from family.
Women might be most deeply impacted by the intense stigmatization surrounding the virus. Dr. al-Bayati says this is preventing women even from seeking medical treatment. This is likely due to deeply ingrained social norms and government policies that do not take these norms into account. In many conservative families, for example, there is resistance to wives and daughters being taken out of the family home. A video recently posted on social media showed a man threatening the government if they take his wife to quarantine. Dr Erzooqi noted that when he referred one woman to temporary quarantine, her family tried to convince him that their mother did not have the virus, with no basis in medicine. It was “an attempt to avoid the quarantine,” he added. One doctor working in a health center on the outskirts of Baghdad told PHR about a number of cases where women visited his office against the will of their husbands or brothers.
Medical professionals and human rights groups are increasingly expressing concerns that many families would not send their daughters, even if symptomatic, to hospitals, where they would be unprotected and isolated from family. Since the government’s response to COVID-19 doesn’t adequately take social distinctions between men and women into account, this might in practice further deprive women of equal access to health care. In many medical settings, men and women awaiting the results of a coronavirus test are forced to share the same room during the 24-48-hour quarantine. According to a doctor at one of Baghdad’s main hospitals, forcing individuals of different genders to share the temporary quarantine rooms can exacerbate families’ concerns about the safety of their female family members.
Although medical authorities in Iraq are overwhelmed and face a fundamental lack of resources and staff to respond to COVID-19, the Iraqi government needs to improve its policies in response to the pandemic and must actively consider a gender lens when it is reforming its response. The Iraqi government and all community leaders should advocate for awareness among the public to respect the rights and confidentiality of patients, especially women.