UMM QASR, Iraq - The hospital is mobbed. Mothers press inside the concrete structure with sons and daughters suffering from diarrhea, malnutrition, coughs and fevers. Men hobble about the lobby with crude crutches that Americans might recognize from Civil War photos. Outside, children who are thirsty and threadbare beg foreigners for water and dinars, the devalued Iraqi currency.
The three doctors at this port city's only hospital have been working day and night to treat the daily influx of 800 to 1,000 people since war began three weeks ago. That is about triple the usual volume, and the doctors are weary from overwork, frustrated that they have had to turn some people away.
But yesterday, help arrived. A clean white bus pulled up, and out poured six Kuwaiti doctors and a paramedic offering to treat the sick and provide medicine and equipment to restore this broken-down place.
Years of neglect
"This hospital has been neglected for 10 or 13 years," said Dr. Mubarek Ali Al-Kandari, the general surgeon who came from Kuwait with a gynecologist, an anesthesiologist, three internists and a paramedic. "It is time now to rectify things."
The hospital is dirty with desert sand and pieces of broken equipment. Entire rooms are empty - no examination tables, no medical carts.
An emergency room has several beds behind plastic partitions. But the sheets look sand-yellow, like everything else. The operating room hasn't functioned in six months. Doctors say the place has been deteriorating for years, but war halted shipments of medicine and supplies.
Al-Kandari, a 33-year-old with a curly beard and the traces of an Irish brogue from his medical training in Dublin, boarded the bus at dawn yesterday after performing an appendectomy in Kuwait City on a woman who was 36 weeks pregnant.
After the 90-minute drive to Umm Qasr, the medical personnel began seeing patients, but mainly drew up inventories of needed supplies. They planned to stay all day, then return three times a week until they are satisfied that they can stay home with clear consciences.
In neat English script, Al-Kandari wrote up a list of 40 needed medicines that, he said, the Kuwaiti government and medical societies will provide: antibiotics, steroids, painkillers, asthma inhalers and others.
He also listed supplies to restore the operating room so that surgeons can perform hernia repairs, Caesarean sections and other basic procedures. The hospital also needs a ventilator, sterilization equipment and modern instruments.
Kuwait, an oil-rich country with modern health care, can afford to help Iraq. But Al-Kandari and others said the medical problems are daunting and will require Western help if any lasting improvements are to be made.
It is a common refrain in these parts: The United States and Britain started this war, and it will be up to them to put the country back together again.
"I think it should be maintained by the British," said Al-Kandari. "They are taking care of the area. They should pay salaries for doctors and pay staff for cleaning and provide a continual supply of medicine."
The health problems of Umm Qasr cannot be solved by doctors and equipment alone. Azzedire Zeroual, an Algerian-born physician with UNICEF who is assessing health needs in southern Iraq, said an estimated 1 million children younger than age 5 suffer from varying degrees of malnutrition.
Although there is little outright starvation, he said, three wars in 20 years, along with U.S. sanctions, have created food shortages that make it hard for the poor to get the protein and vitamins they need.
Although the United Nations oil-for-food program helped, Zeroual said, the privations caused by this war threaten to make the problem worse.
He predicted a 25 percent increase in malnutrition over the next year. UNICEF helps by providing high-protein biscuits for children with moderate malnutrition and therapeutic milk for the severely malnourished.
Malnourished children appear pale and lethargic, he said, and are at high risk for cholera, typhoid and other infections.
Poor sanitation and a shortage of clean drinking water have led to an increase in diarrhea in the past three weeks. Yesterday, the hospital treated 50 children with diarrhea, giving them salt solutions supplied by UNICEF to prevent youngsters from becoming dehydrated.
"Some of these children were showing the first signs of malnutrition," said Zeroual, explaining how he can tell by pulling down a child's lower eyelid and checking to see whether the normally red tissue has turned white. "In Iraq, most of the pregnant women are suffering from iron deficiencies and anemia, and 25 percent have low-birth-weight babies."
Typically, May brings outbreaks of cholera and typhoid in southern Iraq, and Zeroual worries that food and water shortages will make this a particularly difficult year.
Another concern is the shortage of vaccines. The Iraqi government did a decent job of providing childhood immunizations that flowed in through the United Nations' oil-for-food program, he said.
But the war disrupted the vaccine program, and doctors in Umm Qasr can protect only against tetanus, whooping cough and diphtheria. Dr. Akram Alshoulyh, the hospital director, said he has seen three cases of measles in the past three weeks, far from an epidemic but a sign that one could erupt.
But when he talks about his main worries, one rises above the rest.
"The major problem is water supply - deliveries of water and sewage disposal," he said. Before the war, clean water came through a pipeline from Basra. Water flows intermittently now, but the chlorination and filtration plant has broken down, making the water suitable only for washing.
Trucks arrive with clean water from Kuwait, which helps but is inadequate to quench thirsts in a country where temperatures reach 100 degrees in spring and surpass 120 degrees in summer.
With medicine in short supply and the hospital overwhelmed, many families are left to wonder what will happen to children who are sick.
This week, a mother brought her hydrocephalic baby to the hospital to see whether doctors could relieve the pressure on the child's brain. The physicians could do little because they lacked a shunt, a tube that could drain fluid from the infant's head.
Riza Jassn, who worked for an iron and steel company before the war shut it down, said Tuesday that he might be forced to take his 12-year-old son Ahmed by taxi to a hospital in Basra. The boy has been sick for several days, and Jassn said the hospital has been too busy to take care of him.
"I think it is typhoid. Or it could be influenza. He always has a headache, and he is very warm. He does not eat. The hospital was most busy. The doctor also is busy, many women and many men standing in his room."
Outside the hospital, two women dressed in black robes sat dejected on the steps. Nada Abdullah, 30, had brought her mother, Sabiha Salim, to see whether doctors could do something for the paralysis that has rendered her right arm and leg useless and made her face droop. But they, like many others yesterday, would have to come another day.
'I can't move'
"I can't move, and I am very tired," said Salim, who said she is 50 but looked a generation older. "Nobody asks about me." She sat crumpled as if dropped like a puppet. "My head hurts me. My right eye, I can't see with it."
Abdul Redha Abbas, the Kuwaiti paramedic who arrived with yesterday's contingent, said the scene was heartbreaking.
"Most of these people are sick," he said. "They need medicine. They need food. They need water." Noting that Kuwait and Iraq were enemies under the previous Iraqi government, Abbas said he never harbored ill feelings toward the Iraqi people.
"We came to help our people here," he said. "Kuwait and Iraq are one society. We are brothers."