Patrick Cockburn: Hospitals now a battleground in the bloody civil war

Iraqi hospitals are dangerous places. Policemen and soldiers carry their wounded comrades into operating theatres and demand immediate treatment, forcing doctors at gunpoint to abandon operations on civilians before they are completed. The hospital system is not a haven from the war. The Health Ministry is controlled by the supporters of the nationalist cleric Muqtada al-Sadr who did well in the elections in December.

Intelligence officers claim hospitals are now being used by al-Sadr's Mehdi Army militia as its headquarters and hospital basements are used as prisons.

Sunni Arabs are nervous of even going to the central Baghdad morgue to look for their dead because they fear they may be targeted by Shia gunmen. One Sunni who took his brother to the morgue was asked: "Do you know who killed him?" When he answered: "Yes" he was immediately shot dead. Many people with bullet wounds fear entering a hospital on the grounds that they will be accused of being an insurgent.

Once I saw several badly wounded police commandos carried into Yarmouk hospital in west Baghdad. Even those bleeding badly refused to be parted from their machine-guns and would not allow doctors to take off their black face masks.

The Iraqi health system is breaking down. Thirty years ago, it was one of the best in the Middle East. But ever since 1980, the country's oil revenues have all been devoted to buying military equipment. Almost no new hospitals were built. From the start of UN economic sanctions against Iraq in 1990, medical care plummeted further.

Old medical equipment broke down and was not replaced. Once, when travelling north of Baghdad, I was besieged by local farmers who thought I was a foreign doctor and demanded I look at their children. Many of them were carrying dusty old X-rays taken years earlier. The local medical centre had closed.

At another old hospital on the outskirts of Baghdad, the hospital forecourt was packed with vehicles - ambulances and trucks - that no longer moved. Many were without wheels or tyres. The doctors were desperate to obtain an oxygen tank but they had no vehicle to pick it up from another part of the capital.

Doctors were paid very little and only kept going buy opening private clinics. Their pay went up after the overthrow of Saddam Hussein in 2003. But the facilities in which they worked were dilapidated. It was only possible to reach the front door of one of the main children's hospitals in Baghdad by jumping over a stream of raw sewage. Iraqis who were well off increasingly went to Jordan for treatment.

Doctors faced another threat. They were prime targets for kidnappers because they were known to have some money. They had to operate more or less openly even if the doors of their clinics were heavily barred. They were also targets for assassination. Many clinics were closed as doctors fled abroad. By this summer, 220 doctors had been killed and more than 1,000 had fled Iraq.

One friend who had a toothache rang dentist after dentist to ask for an appointment. Either the phone was not answered or he was told that the dentist had left the country.

It is not just the decline in the medical system that has hit Iraqi health. It is the rise in general impoverishment. The Ministry of Labour says that the level of poverty is up by 35 per cent since 2003 and 5.6 million Iraqis live below the poverty line: "At least 40 per cent of this number is living in absolutely desperate conditions."

Three years ago, half the country's population had access to drinkable water. The figure now has dropped to 32 per cent.