What They Asked For, They Did Not Get

The convoy of flatbed trucks picked up its cargo at Baghdad International Airport last spring and sped northwest, stacked high with crates of expensive medical equipment. From bilirubin meters and hematology analyzers to infant incubators and dental appliances, the equipment had been ordered to help Iraq shore up a disintegrating health care system.

But instead of being delivered to 150 brand-new Primary Health Care centers (PHCs) as originally planned, the Eagle Global Logistics vehicles were directed to drop them off at a storage warehouse in Abu Ghraib.

Not only did some of the equipment arrive damaged at the warehouse, owned by PWC of Kuwait, one in 14 crates was missing, according to the delivery documents. The shipment was fairly typical: Military auditors would later calculate that roughly 46 percent of some 70 million dollars in medical equipment deliveries made to the Abu Ghraib warehouse last spring had missing or damaged crates or contained boxes that were mislabeled or not labeled at all.

Not that it really mattered. Just over three weeks before the Apr. 27 delivery, the US Army Corps of Engineers had canceled the construction of 130 of the 150 PHCs for which the materiel was intended. As a result, the equipment that could help diagnose and treat Iraqi illness (and escalating bomb or gun injuries) now sits idle waiting for someone to figure out what to do with it.

Even if the equipment finally makes it through the bureaucratic logjam, lack of trained personnel to operate it, especially outside major cities, will severely limit its utility. The Army Corps had written a 15-day training plan into the contract, but over time, this had been whittled down to 10 and then to just three days. Iraqi Ministry of Health officials have given up hope that any training at all will accompany the sophisticated equipment.

But if Iraqis have failed to benefit from the idle PHCs, the 70-million-dollar contract to supply them has been a shot in the arm for Parsons Global. The Pasadena, California-based engineering company reaped a 3.3-million-dollar profit according to an audit report issued by the Special Inspector General for Iraq Reconstruction (SIGIR), an independent US government agency. And that is in addition to the 186 million dollars that US taxpayers shelled out to Parsons to build dozens of clinics that have yet to dispense a single aspirin.

While the new buildings remain uncompleted and millions of dollars worth of expensive equipment are stored under lock and key, a dwindling number of doctors at existing hospitals perform operations without basic supplies of disinfectant and anaesthesia. A severe shortage of nurses further imperils patient care.

This failed planning and wasted money has been a hallmark of the last three years of healthcare in Iraq. Today the country faces a medical crisis that many say exceeds conditions under sanctions. Compounding this crisis is the violence that creates a steady flow of seriously injured victims.

Days before the equipment arrived in Abu Ghraib, Dr. Lezgin Ahmed, general director of planning at the Kurdish health ministry offices, just below the ancient hilltop city of Irbil, northern Iraq, proclaimed his frustration with the US plan to fix the Iraqi healthcare system to this reporter.

"They told us that they had money for seven PHCs in Irbil, three in Dohuk. We were asked where they should build them, that’s all," said Dr. Ahmed. "We didn’t approve it but we accepted it without interference because it was part of the plan for all of Iraq. They simply asked us for the numbers and locations. What we asked for, we did not get," he said, noting that the ministry would have preferred repair of existing facilities.

Six of the 150 PHCs were slated for the western Kurdish region of northern Iraq. In the Brayati neighborhood of Irbil, just five miles from Ahmed’s office, a partially constructed gray building topped with red water tanks appeared abandoned. The windows and doors were sealed with cinder blocks to prevent intruders after work halted in late March. No construction workers or security guards were to be found.

In other cities across northern Iraq, such as Koya and Sulamanya, the story was the same: buildings, most lacking even paint, stood abandoned. In Halabja Taza, close to the eastern border with Iran, a security guard at an empty Parsons PHC agreed to talk. Nawshin Shakir Qasim explained that the contractors did a really bad job and the roof was leaking. "The American soldiers fired the contractor. Now there is no more money so all the work has stopped," he said.

Indeed, just two months before this reporter’s visit, SIGIR inspectors traveled to five PHCs in Kirkuk, northern Iraq, and came to similar conclusions about the quality of the work. The auditors snapped pictures of poorly placed roof beams, honeycombed concrete, walls made of brick fragments held together with plaster, and staircases crumbling into dust even before they were finished.

The SIGIR auditors also questioned Parsons’ progress reports. One building, declared 56 percent complete, was a shell of uneven bricks. Another floor that was balanced on wooden sticks was listed as half complete, according to the SIGIR report.

If health care is in short supply, blame is plentiful. The SIGIR report concludes that a wide range of factors contributed to the failures, ranging from disputes among Iraqi construction companies, poor quality of local materials, and lax oversight by the Army Corps, which conducted "windshield surveys" – hasty drive-by inspections.

The Army Corps blames Parsons. "They failed to adequately plan project schedules to include known issues, resulting in unrealistic, risky construction and purchasing schedules," wrote the division’ commander, Brigadier General William H. McCoy Jr. "They failed to exercise adequate due diligence to control costs."

And predictably, Parsons blames the Army Corps. In a written reply to the military, the company says that it estimated the job would take two years, but the Army Corps ordered it to finish the clinics in one year. (The contract was canceled after Parsons failed to complete the job in 25 months.) The company also says that it informed the military that did not have enough supervisory staff to oversee all 150 clinics simultaneously as the military demanded.

In a reply, included as an appendix to the SIGIR report, McCoy counters that Parsons "ignored, or failed to respond adequately to, numerous expressions of concern by the government over these issues, and in some cases failed or refused to provide the government with information that would have allowed the government to make decisions to assist Parsons in regaining control over subcontractor performance and cost," he added.

By the time the contract was canceled on Apr. 3, 2006, Parsons had completed only six clinics. Project managers estimated that another 14 could eventually be completed and equipped.

Meanwhile, some 130 sets of medical equipment, partially damaged, are warehoused at Abu Ghraib, in the hope that someday the project might be completed.

Last September, four months after the contract was canceled, Congressman Chris Van Hollen, a Maryland Democrat, questioned Ernest Robbins, the manager of Parson’s Iraq project: "What is the recourse for the taxpayer under these circumstances? Don’t you think that Parsons, given what has turned out to be a very shoddy job, should return some of its profits to the taxpayer"?

Robbins told the Congressional hearing: "No, sir, I will not."

Pratap Chatterjee is the managing editor of CorpWatch. This article is the first in a three-part series on Iraq’s struggling healthcare system.