The Islamic State's recent takeover of the western Iraqi city of Ramadi has left Anbar province, geographically the country's largest, without a functioning hospital.
A witness to the takeover of Ramadi said Islamic State looted the main hospital and detained some of the medical staff, who asked to be allowed to keep the hospital open.
"The hospital is closed. The fourth floor was destroyed by mortars and missiles. The clinics were destroyed," the witness said, asking for anonymity in order to avoid reprisals from IS. "They even stole the MRI machine."
Some of the medical staff who fled Ramadi have opened a primary clinic in Amariyat al-Falluja, a government-controlled town about 50 miles southeast of Ramadi, where tens of thousands of displaced Anbar residents have pooled in open-air andtent camps and in the open air as they attempt to cross a nearby pontoon bridge that connects Anbar to Baghdad province. The other roads are controlled by IS.
Hundreds of thousands of people are displaced within the province, and many are being prevented from leaving Anbar by government security forces who fear IS fighters will covertly enter other provinces along with the refugees.
Those who have made it out are facing difficulty with finding medical care in Baghdad as well.
Numaan Hospital in northwest Baghdad is being overrun by refugees from other parts of the country, and before the fall of the city of Ramadi in May the hospital had already seen a 30 percent increase in patients. At the same time, there are shortages of some basic supplies to the extent that doctors are buying some supplies themselves.
"Initially, for the first week, we didn't leave. The Islamic State wouldn't let us," said Shatha Maarouf, who fled Ramadi in March, after IS took over the part of the city in which she lived. "They were everywhere, on the roads and at the entrance (to the city). We were afraid if we left, they would take the house, or destroy it."
"One of my children spent 19 days on a feeding machine. He was [77 pounds], now he's [46 pounds]," Maarouf said.
The Iraqi Ministry of Health's budget for this year is lower than the previous year as oil prices have slumped and the Iraqi government diverts resources to the war against the Islamic State. The group's advance has further damaged health care, with residents of IS-controlled territory reporting that hospitals in those areas have largely shut down.
It comes at a time when the country is in need of more hospital beds.
"The number of beds in this recovery room are not enough, even the space between the beds is not enough, but what can we do about it? It's the same in all hospitals," said Wissam Karam Ali, a doctor at Imam Ali Hospital in Sadr City, one of Baghdad's most crowded neighborhoods and the site of frequent car bombings for the last 12 years. "When there are explosions and similar things, we don't know what to do. We need more hospitals, especially in Sadr City."
Even worse than the lack of care, Karam Ali said, is the psychological toll the violence takes.
"People can't be comfortable when a bomb can explode at any given moment," Karam Ali said.
The doctors deal with the country's everyday violence even as they become targets of it themselves.
More than 2,000 Iraqi doctors have been killed since 2003. Others have been the victims of kidnapping and robbery, or extortion and revenge by bereaved families whose loved ones they couldn't cure.
"We do not have godly powers. There is only so much I can do. If someone dies, things go crazy. They take it out on the doctors. This happens in all hospitals in Iraq," Karam Ali said.
It has prompted many of them to simply flee to countries where the salaries are higher and there is less risk. Karam Ali tried to leave in 2007 but was deported back to Iraq after being arrested in Greece. A cousin he had fled with made it to Sweden and remains there.
Karam Ali said he plans to leave again, possibly with one of his colleagues.
"We talk about it," he said. "We don't know if we're leaving or not."
Follow David Enders on Twitter: @davidjenders
Watch the VICE News Documentary "A Dangerous Occupation: Doctors in Baghdad."
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