Despite the rapid development of effective vaccines and efforts to ramp up production, much of the world’s population has limited – if any – access to vaccines, while high-income countries continue to hoard vaccine doses and refuse to take the necessary steps to ensure equitable global distribution.

As global leaders gathered in New York City for the United Nations General Assembly, PHR took to the streets with Health GAP and other partners in the People’s Vaccine campaign to demand that vaccines reach those who need them most. PHR joined frontline health care workers and leading public health experts like Dr. Oni Blackstock to send a clear message to President Biden and other decision-makers: vaccine equity is not just a matter of health, but also a matter of human rights.

Thank you @oni_blackstock for standing up for global vaccine equity! #VaccineEquityNow pic.twitter.com/y5LOEVkNvm

— Physicians for Human Rights (@P4HR) September 20, 2021

On Monday, September 20, 2021, PHR hosted a virtual press conference with top public health, epidemiology, and human rights experts calling on high-income countries to do much more to scale up vaccine manufacturing and equitable distribution. The event was moderated by PHR COVID-19 senior policy expert Max Hadler.

Participants included:

• Tom Frieden, MD, MPH, President and CEO of Resolve to Save Lives, former U.S. CDC Director
• Salim Abdool Karim, MBChB, PhD, FRS, Director of AIDS Program of Research in South Africa (CAPRISA), PHR Advisory Council member
• Joia Mukherjee, MD, MPH, Chief Medical Officer for Partners In Health
• Soumya Swaminathan, MD, MBBS, Chief Scientist at the World Health Organization

This year marks two decades since the deadly terror attacks on the United States on September 11, 2001. On this occasion, PHR joins the world to remember the thousands who perished on that day and to honor the many first responders – including medics, physicians, nurses, firefighters, police officers, and so many others – who rushed to the front lines in response.  

It is also a moment to look back on the aftermath of the 9/11 attacks, namely the “war on terror,” in which the Bush administration began dismantling longstanding prohibitions against torture in U.S. and international law and implemented systematic policies of psychological and physical torture – policies which continue to cause harm and suffering to this day.

Today, 20 years after the 9/11 attacks, PHR continues its advocacy for transparency and accountability for the U.S. torture program, but also against torture and for the rights of survivors globally.

PHR’s Documentation and Advocacy Against Torture

Since the 2001 attacks, PHR has investigated and exposed the severe health impact of the U.S. government’s illegal and inhumane interrogation and detention practices on national security detainees. In a powerful series of reports and scientific papers, we revealed how the United States’ “enhanced interrogation” program and other torture techniques inflicted profound and long-lasting psychological and physical pain and trauma on the men it targeted. We also showed how it undermined professional ethics and challenged trust in the health professions who participated in the planning and implementation of these cruel and harmful practices.

PHR has brought the full force of our research and advocacy against the torture practices that followed 9/11. Through numerous investigations and reports, we have exposed the profound physical and psychological harms inflicted on U.S. detainees by these torture methods, including waterboarding, sensory and sleep deprivation, years of indefinite detention, solitary confinement, sexual assault and humiliation, and force-feeding.

PHR documentation has also shed light on the role of medical professionals who designed and carried out these horrific abuses. Psychologists designed the “enhanced interrogation” methods that the United States previously recognized as torture and oversaw their use, with other health professionals, at secret CIA “black sites” around the world. Similar techniques were used at military detention facilities in Guantánamo Bay, Afghanistan, and Iraq. Our investigations have shown unequivocally how the post-9/11 torture program also constituted an illegal regime of human subject research on unwilling subjects – one of the gravest breaches of medical ethics in U.S. medical history.

Today, 20 years after the 9/11 attacks, PHR continues its advocacy for transparency and accountability for the U.S. torture program, but also against torture and for the rights of survivors globally, including through our role in the continued development of the groundbreaking Istanbul Protocol.

PHR also takes this occasion to recognize the many health professionals who have worked tirelessly over these decades to document and expose the impact  of torture carried out by the United States: we thank Brigadier General (Ret) Stephen Xenakis, Dr. Scott Allen, Dr. Sondra Crosby, Dr. Vincent Iacopino, Dr. Stephen Soldz, Dr. Steven Reisner, Dr. Allen Keller, and so many others who have worked so persistently with PHR and through their networks to call attention to the violations and to press for transparency and accountability.

“As we reflect on the 20th anniversary of September 11 – the tragic loss of life and the actions of first responders and Flight 93 passengers – we must strive to understand the full scope of that day’s horror, including the tragic mistakes that the U.S. government made in its war on terror, resulting in the needless deaths of thousands of U.S. troops and hundreds of thousands of Iraqi and Afghan civilians, and the incalculable suffering from the systematic torture of thousands of innocent people.

“The pursuit of justice should never undermine the rule of law. To honor the victims and heroes of 9/11, we must recognize the full scope of inhumanity that 9/11 represents and, now more than ever, work together across the lines that divide us, nationally and internationally, to ensure peace, justice, and respect for the dignity of all people.”

Vincent Iacopino, MD, PhD, former medical director of Physicians for Human Rights (PHR, adjunct professor of medicine at the University of Minnesota Medical School, and senior research fellow at the Human Rights Center of the University of California, Berkeley.

PHR Papers and Reports on U.S. Torture

Deprivation and Despair: The Crisis of Medical Care at Guantánamo

The report by Center for Victims of Torture (CVT) and Physicians for Human Rights (PHR) details widespread medical deficiency at the Guantánamo Bay detention center and finds systemic and longstanding deficiencies in care, including the subordination of medical needs to security functions resulting in the denial of care, patient distrust of medical professionals due to a history of medical complicity in torture, patient neglect, rapid rotation of medical professionals in and out of Guantánamo causing discontinuity of care, and denial to detainees of access to their own medical records.

Nuremberg Betrayed: Human Experimentation and the CIA Torture Program

Based on an analysis of thousands of pages of documents and years of research, PHR shows that the CIA’s post-9/11 torture program constituted an illegal, unethical regime of experimental research on unwilling human subjects. In this report, PHR researchers show that CIA contract psychologists James Mitchell and Bruce Jessen created a research program in which health professionals designed and applied torture techniques and collected data on torture’s effects. This constitutes one of the gravest breaches of medical ethics by U.S. health personnel since the Nuremberg Code was developed in the wake of Nazi medical atrocities committed during World War Two.

Truth Matters: Accountability for CIA Psychological Torture

The Senate torture report documents the abuses that followed the development of a comprehensive program of detainee torture by CIA personnel with the help of psychologists James Mitchell and Bruce Jessen. This briefing paper, based on the Senate torture report, analyzes the operational goal of Mitchell and Jessen and its effect in destroying human beings using methods and practices long recognized as torture.

Doing Harm: Health Professionals’ Central Role in the CIA Torture Program

On December 9, 2014, the U.S. Senate Select Committee on Intelligence released the executive summary, findings, and conclusions of its 6,700-page report on the CIA’s post-9/11 torture program. This detailed review of the 500-page executive summary analyzes evidence of medical complicity in torture and shows how health professionals who participated in the CIA torture program violated core ethical principles common to all healing professions.

Experiments in Torture: Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

PHR’s 2010 publication, “Experiments in Torture,” is the first report to reveal evidence indicating that U.S. military and intelligence medical personnel allegedly engaged in illegal experimentation on prisoners captured after 9/11, in addition to the previously disclosed crime of torture. Those experiments observed and analyzed the physical and psychological impact on detainees of the use of “enhanced interrogation techniques.”

Aiding Torture: Health Professionals’ Ethics and Human Rights Violations Revealed in the May 2004 CIA Inspector General’s Report

This white paper, published in August 2009, examines specifics of the May 2004 CIA Inspector General’s Report, which demonstrated that health professionals played a leading role in establishing an unethical medical premise upon which attorneys rationalized an illegal program of torture.

Broken Laws Broken Lives: Medical Evidence of Torture by US Personnel and Its Impact

This 2008 report examines the dangerous consequences of unlawful U.S. interrogation practices. It specifically focuses on the extreme torture and suffering of men, who were never charged of any crimes, in detention facilities in Iraq.

Leave No Marks: Enhanced Interrogation Techniques and the Risk of Criminality

This landmark 2007 report for the first time revealed and documented medical evidence confirming the first-hand accounts of the excruciating pain and continued suffering of men who, never charged with any crime, endured torture at U.S. detention facilities in Afghanistan, Iraq, and Guantánamo Bay. The report demonstrated that the authorization of these techniques, whether practiced alone or in combination, may constitute torture and/or cruel and inhuman treatment, and may place interrogators at serious legal risk of prosecution for war crimes and other violations.

Break Them Down: Systematic Use of Psychological Torture by U.S. Forces

As evidence of U.S. national security interrogation practices emerged, it became clear that psychologically abusive methods of interrogation were at the core of U.S. intelligence gathering. “Break Them Down,” published by PHR in May 2005, was the first comprehensive review of the use of psychological torture by U.S. forces, examining the devastating health consequences of psychological coercion and explaining how a regime of psychological torture was put into place in the U.S. “war on terror”.

Interrogations, Torture and Ill Treatment: Legal Requirements and Health Consequences

In a 2004 statement, PHR calls on the United States government to disclose the involvement of health professionals in making detainees fit for torture/ill treatment. PHR also calls on for an end to the transfer of detainees for interrogation in other countries known to employ torture techniques such as hooding, beatings, soaking water, and deprivation of food, light and medications.

Separation of families. Denial of medication and medical care. Nonconsensual medical procedures. For decades, health and rights advocates have documented abuses against people held in U.S. Immigration and Customs (ICE) detention. However, as COVID-19 began to rage across the United States, pandemic-related inadequacies worsened conditions for detainees and exacerbated the existing threats to their health and safety.

As part of Physicians for Human Rights’ (PHR) webinar series on COVID-19, on June 28, 2021, expert panelists discussed the health and human rights implications of COVID-19 inside ICE detention centers. The conversation included how the public health crisis has been handled throughout the pandemic, how vaccination has been managed for detained populations, and what needs to be done to ensure that the right to health is protected for people in detention.

As COVID-19 began to rage across the United States, pandemic-related inadequacies worsened conditions for detainees and exacerbated the existing threats to their health and safety.

The discussion was moderated by Lee Gelernt, a civil rights lawyer at the American Civil Liberties Union (ACLU) and deputy director of the ACLU’s Immigrant Rights Project. Panelists included: Nilson Barahona-Marriaga, a former ICE detainee at the Irwin County Detention Center in Georgia; Eunice Cho, JD, a senior staff attorney at the ACLU National Prison Project; Josiah Rich, MD, MPH, a professor of medicine and epidemiology at the Warren Alpert Medical School of Brown University, practicing infectious disease and addiction specialist at The Miriam Hospital and the Rhode Island Department of Corrections, and director and co-founder of The Center for Prisoner Health and Human Rights; and Sophie Terp, MD, MPH, an associate professor of clinical emergency medicine at the Keck School of Medicine at the University of Southern California.

Dire Conditions in ICE Detention Exacerbate Risk

People held in ICE detention are awaiting adjudication from immigration authorities; they range from recently arrived asylum seekers fleeing persecution and violence to undocumented people who have long resided inside the United States. On average, 26,000 people per day are detained in more than 200 ICE detention facilities nationwide. Detention can last from a few months to years.

When COVID-19 started to spread in the United States, it wasn’t long before ICE facilities and other carceral systems – where crowding makes protection against the pandemic difficult – were hit hard. Despite widespread calls for the release of ICE detainees – the vast majority of whom are facing civil, not criminal charges – in order to protect their health, these mitigation measures were ignored; instead, detainees endured what quickly became a public health and human rights crisis.

As of June 24, 2021, according to the COVID Prison Project, 831 people in ICE detention were being monitored or under isolation after testing positive for COVID-19. Due to a lack of transparency around conditions in ICE detention facilities, however, the number of positive cases is likely significantly higher. As reported by PHR, these numbers can be attributed to ICE’s failure to follow Centers for Disease Control and Prevention (CDC) guidelines to protect those in its custody when COVID-19 first emerged. Not only did ICE not enforce social distancing among detainees, it did not provide adequate personal protective equipment such as masks, hand soap, or hand sanitizer for those detained.

One of these was Nilson Barahona-Marriaga. As someone formerly detained by ICE, Barahona-Marriaga experienced abuse and neglect by ICE officials firsthand. “We didn’t receive any kind of information about what was happening with COVID-19,” he said. “Everything we knew about it was because of the media. We watched numbers go up and began to hear about health conditions that can put you at a higher risk.”

Along with other detainees, Barahona-Marriaga participated in a desperate appeal by way of a hunger strike. They demanded that ICE follow public health guidelines, provide detainees with protective equipment such as masks and cleaning supplies, and release medically vulnerable people from detention. Their efforts were in vain. In retaliation, Barahona-Marriaga said, ICE officials turned off running water. “These are the kinds of things that made me want to come and tell my story, because people are suffering in detention,” Barahona-Marriaga said.

These and other instances of abuse against hunger strikers in ICE detention were also extensively documented by PHR and the ACLU in the recent investigation, “Behind Closed Doors: Abuse and Retaliation Against Hunger Strikers in US Immigration Detention.”    

U.S. Mass Incarceration Fuels Pandemic Vulnerabilities

Panelists addressed how the pandemic has highlighted the severe vulnerability of the United States to a virus like coronavirus due to the high rates of incarceration in the country. “We are incarceration-crazy,” said Dr. Rich. “We lock up a higher proportion of our citizenry and immigrants than any other civilization in the history of mankind.” While a short-term solution to the extraordinary risk of COVID-19 spreading in congregate settings is to follow recommended public health precautions – such as mask-wearing, testing, quarantining, offering vaccines, and releasing detainees – “Ultimately, the fundamental problem is there are too many people [in detention],” said Dr. Rich.

Dr. Sophie Terp further underscored the challenge of implementing recommended public health precautions in often-crowded detention environments. According to Dr. Terp, people in ICE detention facilities should be given precedence for vaccinations. “Study findings really highlight how immunizations for COVID-19 need to be prioritized – particularly for detained individuals whose age or comorbid conditions place them at increased risk for mortality,” she said.

“Our country will ultimately be judged in this period by not only how we tackled COVID generally, but how we dealt with the most vulnerable people.”

By Lee Gelernt, a civil rights lawyer at the American Civil Liberties Union (ACLU) and deputy director of the ACLU’s Immigrant Rights Project

Today, infection rates in these facilities remain high. According to a recent New York Times study, the infection rate in ICE detention was five times that in prisons and 20 times that in the general public. Frequent transfers of detainees and regular shift changes of ICE officials have also caused the infection rate to surge. Compounded by the Delta variant, slow vaccine rollout, and a lack of personal protective equipment and supplies, the threats to the health of detained people only grow.

ICE’s failure to prioritize the health and well-being of detained people amid an international public health emergency is further proof that change is desperately needed. In addition to calls to improve conditions in detention, including wider access to vaccines, PHR is calling on President Biden to end the U.S. reliance on mass immigration detention and invest in community-based social services as alternatives.

“Our country will ultimately be judged in this period by not only how we tackled COVID generally, but how we dealt with the most vulnerable people,” concluded moderator Lee Gelernt. “Among these is certainly those who have been locked away in ICE detention facilities.” 

Hopes of controlling the COVID-19 pandemic are increasing, with nearly five billion doses of vaccines administered globally. Yet for vulnerable populations such as Rohingya refugees in Bangladesh, there is a long road ahead. As a result of the violent August 2017 crackdown on Rohingya previously living in Myanmar, Bangladesh hosts a population of nearly one million Rohingya refugees who have fled violence and ethnic persecution. Living in crowded refugee camps, the Rohingya population faces the grave risk of contracting COVID-19 amid a major surge of the highly contagious Delta variant. The Bangladeshi government acquired a large stock of vaccines in August, allowing for the start of vaccinations for Rohingya refugees. However, with more than  7,000 daily new confirmed COVID-19 infections in Bangladesh as of August 19, access to vaccinations for Rohingya refugees is critical to the health of a population already ravaged by the trauma of persecution and facing deficient health care.

The provision of reliable access to such information and the building of trust with health care providers is essential for a successful vaccine campaign.

The Status and Access to Health Care of Rohingya Refugees in Bangladesh

The displaced and stateless Rohingya came to Bangladesh’s borders seeking safety and security. However, they are not recognized as refugees by the Bangladeshi government – which considers Rohingya to be “forcibly displaced Myanmar nationals” –  and, as a result, do not have the same protections as other refugees living in the country.

The COVID-19 pandemic opens old wounds for the Rohingya, who have faced numerous challenges in accessing basic health care since arriving in Bangladesh. Rohingya refugees often express hesitancy in trusting health care systems in the refugee camps and in reporting symptoms of COVID-19. COVID-19-related restrictions previously put in place by the government of Bangladesh have limited aid workers’ access to the camps and included internet blackouts and phone restrictions there, further complicating the delivery of aid. Given these challenges, it is unsurprising that Rohingya refugees have not received adequate information on health care and the COVID-19 pandemic. The provision of reliable access to such information and the building of trust with health care providers is essential for a successful vaccine campaign.

COVID-19 Response in Rohingya Camps

The majority of the nearly one million Rohingya refugees in Bangladesh live near Cox’s Bazar, in an area which became host to the world’s largest refugee camp following the 2017 influx. Prior to the COVID-19 pandemic, the dense living conditions in Cox’s Bazar had already resulted in severe health hazards and disease outbreaks.  

However, while the establishment of 14 COVID-19 treatment facilities was expedited in Cox’s Bazar, no vaccines have been provided to some 20,000 Rohingya who were relocated to the remote island of Bhasan Char to ease overcrowding in the refugee camps.

Exacerbating this, the vaccination of Rohingya refugees against COVID-19 was delayed until August 10 due to dramatically inequitable global vaccine distribution that limited supplies to Bangladesh and the deprioritization of refugee populations in Bangladesh and elsewhere, which runs counter to the World Health Organization’s framework for vaccine allocation urging all countries to prioritize high-risk groups, including people over age 65 and those with underlying health conditions, regardless of residency and legal status. The second wave of COVID infections in India resulted in the suspension of vaccines provided to Bangladesh through the COVAX program, halting Bangladesh’s vaccine rollout.

Following efforts by the government to secure vaccines from other sources, the vaccine supply in Bangladesh recently increased, as did vaccination rates. True to its promise to include Rohingya refugees in the national vaccination roll out, the Bangladeshi government has started vaccinating the Rohingya, with the U.N. High Commissioner for Refugees predicting that 65,000 of nearly 900,000 refugees will be vaccinated in the first cohort. However, while the establishment of 14 COVID-19 treatment facilities was expedited in Cox’s Bazar, no vaccines have been provided to some 20,000 Rohingya who were relocated to the remote island of Bhasan Char to ease overcrowding in the refugee camps. No vaccination plans have yet been announced for the Rohingya on Bhasan Char.

Recommendations

For at-risk populations in low-income countries to gain sufficient access to vaccines, the international community must move more quickly to meet the demands of the People’s Vaccine Alliance, of which PHR is a proud member

The Rohingya’s vulnerability during the pandemic has only further demonstrated the urgency of protecting the universal right to health for all people, regardless of legal status. While the renewed vaccine supply to Bangladesh has brought a wave of relief, the near 15-month delay in vaccine access for the Rohingya and the limited reach of the first cohort speaks to the urgent need to address global vaccine supply and inequity, which threaten to prolong the unrelenting spread of COVID-19 worldwide.

For at-risk populations in low-income countries to gain sufficient access to vaccines, the international community must move more quickly to meet the demands of the People’s Vaccine Alliance, of which PHR is a proud member. High-income countries like the United States must make a significantly greater investment in global vaccine manufacturing to have any hope of controlling and ultimately ending the COVID-19 pandemic. Bangladesh should uphold the human rights of refugees by adhering to global public health recommendations to prioritize refugee and displaced populations in their vaccination efforts. The Bangladeshi government must provide legal status to the Rohingya as refugees and ensure their reliable access to health care as well as timely and accurate health information to allow the smooth vaccination of the Rohingya population once the vaccine supply is made available to Bangladesh.

As COVID-19 continues to ravage low- and middle-income countries, Iraq struggles to manage the pandemic within its borders. It continues to have one of the lowest vaccination rates in the Middle East: to date, only about one million people have been fully vaccinated, representing less than two percent of a population of approximately 40 million.

Iraq has secured Pfizer, AstraZeneca, and Sinopharm vaccines in recent months, including 1.25 million doses of the AstraZeneca vaccine through COVAX, the global vaccine distribution effort back by the World Health Organization. However, many of these doses have gone unused and some might have even expired, said an official with the Iraqi Ministry of Health who granted an interview with Physicians for Human Rights (PHR) in July 2021 on the condition of anonymity. Many Iraqis say that they do not trust that the COVID-19 vaccines will be safe or effective, leaving them uninterested in or unwilling to get vaccinated. This COVID-19 vaccine hesitancy stems from a combination of factors, including an immensely traumatized population and the longstanding dysfunctionality of public services.

The Iraqi public’s deep mistrust in their government, coupled with misinformation about the coronavirus and the vaccine, continues to thwart efforts to protect the population against the virus.

This viewpoint has started to shift somewhat now given the Delta variant’s recent deadly surge across the country, but not quickly enough. The Iraqi public’s deep mistrust in their government, coupled with misinformation about the coronavirus and the vaccine, continues to thwart efforts to protect the population against the virus.

The Pandemic Hits a Weakened Health System

For decades, conflicts, internal strife, dictatorship and dysfunctional governments, and a weakened health system have left the Iraqi people vulnerable and without adequate health care.

When COVID-19 first struck Iraq in late February 2020, its impact was devastating. The virus subsequently spread so widely that it seems as if nearly every Iraqi knows someone who has contracted COVID-19. Johns Hopkins University estimates that more than 1.7 million Iraqis have contracted COVID, making Iraq one of the hardest hit in the region. Officially, the government reports more than 19,000 Iraqis have died from COVID-19, though due to limited testing and poor data tracking, the true number of deaths is likely far higher.

This summer, according to the Iraqi Ministry of Health, the number of COVID-19 cases and deaths have significantly increased. It reported that 87 people died on August 6, 2021, making it the deadliest day since the pandemic began in Iraq in February 2020. Due to the increase in deaths, the Ministry also reports that the daily vaccination rate has increased by more than threefold in recent weeks, to approximately 80,000 per day. While this recent uptick is promising, Iraq’s vaccination rates are still far below other countries in the region. According to Dr. Nabeel Ibrahim, an internist in Medical City Hospital in Baghdad, the country’s current vaccination rate is so slow that Iraq will need years to vaccinate 70 percent of its population. At that rate, and in the context of emerging variants, it is unclear whether such a drawn-out effort would be protective.

Deadly Outcomes of Mistrust and Misinformation

Initially, the ubiquity of the disease meant that some Iraqis viewed COVID-19 as minor illness. As vaccines eventually became available, there was a low level of demand. Ahmad Abbas, a military officer from southern Iraq, told me, “In my unit and among my family, no one wants to be vaccinated. It is not worth it; [COVID-19] is not a big deal.”

The initial COVID-19 surge nearly toppled Iraq’s fledgling health services infrastructure and the country has struggled to find enough doctors, beds, or oxygen to help those sickened by the virus.

Government and health officials have struggled to improve upon a lack of educational and promotional information about the value of the COVID-19 vaccines, with limited success. Numerous government authorities have been vaccinated on TV to promote its safety, and public health authorities have outlined the benefits of getting vaccinated. On July 8, the Ministry of Health issued a statement to media outlets and via social media emphasizing that only vaccines can help break the cycle of infections in the country. Prominent Shi’a cleric Muqtada al-Sadr was vaccinated on national television and instructed his thousands of followers to get vaccinated.

Hagob Yakouf, a 50-year-old man from Kurdistan, said, “How can I trust that I will (get) the vaccine I want, one that it is not expired or improperly frozen. I do not have faith in health workers and facilities.” There is no evidence that Iraqi health officials have mishandled any vaccine shipments, but the initial COVID-19 surge nearly toppled Iraq’s fledgling health services infrastructure and the country has struggled to find enough doctors, beds, or oxygen to help those sickened by the virus. Two recent fires in COVID-19 wards have killed scores of Iraqis, most of them patients. This has further cemented doubts about the health system.

“I do not trust any vaccine,” said Mohammed Khalaf, a 72-year-old resident of Baghdad who has diabetes, when asked why he wasn’t vaccinated yet. Seeing that more Iraqis are now opting to get vaccinated, Mr. Khalaf is considering getting the vaccine but remains unsure. He is far from the only one who feels that the vaccine might be harmful. Another Baghdad resident, who is 62 and suffers from asthma and preferred to remain anonymous, remains unconvinced, “I have heard vaccines are not useful.”

Iraqis’ deep distrust of their government extends to a lack of confidence in its ability to properly handle the COVID-19 vaccines.

The official with the Ministry of Health concedes that the government’s efforts to date have not had much impact. “In general,” he said, “people do not much trust any government approach.” Research shows that Iraqis do not believe that the Iraqi government has their interests in mind. Iraqis’ deep distrust of their government extends to a lack of confidence in its ability to properly handle the COVID-19 vaccines.

While some of these efforts have succeeded, they have confronted constant competition from other voices focused on the vaccine’s negative side effects, including some health care workers who have taken to social media to discourage people from getting vaccinated, arguing that any vaccine takes years to be proven safe and effective. Recently, the Iraqi Medical Association rescinded the medical license of a doctor who has repeatedly taken to YouTube and Facebook to advise the public against getting vaccinated. However, these kinds of arguments have continued to circulate widely in a country of 25 million social media users (a figure that increased by 19 percent between 2020 and 2021 as many people turned to social media outlets for information during the pandemic). 

Further complicating matters, some Iraqis who are willing to get the COVID-19 vaccine have strong preferences for specific brands. The AstraZeneca vaccine is the primary type distributed by COVAX, but the AstraZeneca vaccine has been met with concerns over associated blood clots that emerged in March 2021. Demand is high for the Pfizer-BioNTech vaccine, but supply is limited (Iraq signed a contract with Pfizer to purchase 12 million doses, but only 500,000 have been received thus far). Iraq also received about 500,000 doses of the Sinopharm vaccine, but it is less trusted by some people.

Luay Hassan, a 53-year-old from Baghdad, said, “I will not take the Chinese vaccine because I do not trust it, I will wait for Pfizer. This applies to almost all of my family and friends.” In March, Iraq signed an agreement with Russia to import one million doses of the Sputnik V vaccine, but no shipments have arrived yet.

Looking Ahead

In the face of widespread resistance, the government has taken to trying to force its large civil service sector to get vaccinated through employment-based mandates, a potentially risky move given their past heavy-handedness in dealing with positive COVID-19 cases. On June 8, the Iraqi government issued an order that all public sector employees be vaccinated by October 1, 2021 or be prohibited from returning to work. Likewise, the country’s national security advisor recently made COVID-19 vaccination compulsory for all members of the security and armed forces.

As Iraq enters a third COVID-19 surge with the emergence of the Delta variant, the country is in desperate need of a more robust vaccine strategy to fight the pandemic.

At least some companies have also mandated vaccinations for their employees. According to Hassan Auda, a nurse in charge of vaccination in Almshrah, a town in southeastern Iraq, “The people of my town are not interested in getting the vaccine. Most who have been vaccinated are working with Chinese oil companies where it [vaccination] is mandatory.”  

Starting in October 2021, no Iraqi will be able to fly internationally without proof of vaccination status. These government mandates do not seem to include accommodations for those who are unable to get vaccinated for medical or other valid reasons. How the government intends to enforce these edicts – and how effective these measures will be – are open questions.

As Iraq enters a third COVID-19 surge with the emergence of the Delta variant, the country is in desperate need of a more robust vaccine strategy to fight the pandemic, including more active promotion of the benefits of the vaccine and a comprehensive media campaign that better leverages local and religious leaders as trusted voices. Sufficient resources must be allocated to set up localized vaccine drives in residential neighborhoods and to explore effective types of incentives to increase vaccination rates. The Iraqi government must work with COVAX to ensure that the country secures sufficient vaccine supply. These steps will be critical to help Iraq get on the right path and alter its current trajectory.