Query response on Iraq: heart surgeries, heart transplants [a-11760]

2. Dezember 2021

This document was prepared after researching publicly accessible information currently available to ACCORD as well as information provided by experts within time constraints and in accordance with ACCORD’s methodological standards and the Common EU Guidelines for processing Country of Origin Information (COI).

This document is not, and does not purport to be, conclusive as to the merit of any particular claim to refugee status, asylum or other form of international protection.

Please read in full all documents referred to.

Non-English language information is summarised in English. Original language quotations are provided for reference in the document or upon request.

Heart Surgeries in Iraq

The Norwegian Country of Origin Information Centre Landinfo, an independent body within the Norwegian immigration authorities, which provides COI services to the Norwegian immigration authorities provided the following information on cardiovascular diseases, based on various sources from 2017 and 2019: According to the Iraqi Deputy Minister of Health Iraq has good treatment options for people with heart diseases. One of the foremost centres in the country is said to be located in Nasseriya. Open heart surgery is performed in Iraq in public hospitals. In Central and Southern Iraq, such operations are carried out only in Baghdad, Basra, Nasseriya and Najaf. According to MedCOI from 2017, there is only one public cardiac surgery hospital in Baghdad, Ibn al-Bitar Hospital for Cardiac Surgery. All treatment is said to be for free, which leads to long waiting lists.

According to the same source, there are private heart surgery hospitals in Baghdad, but they do not perform open heart surgery.

Heart surgery on children is a challenge, and some of the patients are sent to Turkey for treatment at the state's expense. This applies especially to newborns with congenital heart disease and children with genetic defects. The medications required in such instances are not always available in Iraq.

According to a representative of Kurdistan Save the Children (KSC) in Erbil (meeting with Landinfo in April 2019), heart surgery is not completely free in the Kurdistan Region of Iraq (KRI). He called it "semi-private." Patients have to pay around 2.5 million Iraqi Dinars (2,000 USD at the time of the report, or currently 1,511 Euros[1]) for an operation. KSC assists some children with funding. If the patient cannot be operated on in KRI, they assist the patient in being transported to India. According to Landinfo this costs 4,000 USD (3,535 Euros). According to Landinfo, the claim that children have to pay for heart surgery is contrary to the information from the Deputy Minister of Health according to whom all medical treatment of children should be for free. There may be a difference between the KRI and the rest of Iraq, but Landinfo was unable to verify that. According to the Deputy Minister of Health, children were sent abroad at the expense of the state, but this may, for reasons of capacity, only apply to some children.

KSC pointed out to Landinfo that they can only assist in certain cases, and that the need exceeds the capacity. (Landinfo, 14 October 2019, p. 23-24) [2]

Treatment options in Iraq

The UK Home Office, the United Kingdom’s department responsible for interior affairs, published the following information on heart conditions in its country policy and information note on medical and healthcare provision in Iraq from January 2021:

“4. Cardiology (heart conditions)

4.1.1 In December 2020 the WHO published data on causes of death across the WHO member states covering 2019. The data stated that in 2019 there were 36,600 deaths caused by Ischaemic heart disease, 2500 deaths caused by hypertensive heart disease and 300 deaths caused by rheumatic heart disease in Iraq. According to the WHO data, heart disease was the leading cause of death in Iraq in 2019.

4.1.2 Some examples of hospitals/clinics that treat heart conditions and pharmacies/clinics that can provide appropriate medication were found on the MedCOI website and are listed below:

Inpatient treatment by a cardiologist

- Baghdad Medical City Hospital, Bab El Moazzam, Baghdad (public facility)

- Mosul Cardiac Center, Hay Al-Wahda, Mosul (public facility)

- Baghdad General Teaching Hospital, Bab Al Moatham Bridge, Baghdad (public facility)

- Hawler Teaching Hospital, Safeen Street, Erbil (public facility)

- Azady Teaching Hospital, Barzan Street, Dohuk (public facility)

- Royal Hospital, Tuy Malik neighbourhood near Kawa Street, Sulaymaniyah (private facility)

Outpatient treatment and follow up by a cardiologist

- Baghdad Medical City Hospital, Bab El Moazzam, Baghdad (public facility)

- Mosul Cardiac Center, Hay Al-Wahda, Mosul (public facility)

- Baghdad General Teaching Hospital, Bab Al Moatham Bridge, Baghdad (public facility)

- Ibn Al Nafees Hospital, Al Nidal Street, Al Andalous Square, Baghdad (private facility)

- Life Support Team, Building 809, Italian Village, Gulan Street, Erbil (Private Facility)

- Private Practice in Shilan Private Hospital, Mohabad Road, Dohuk (private facility)

- Life Support Team Clinic, 60 Meter Street, opposite to Shar Hospital, Sulaymaniyah (private facility)

Inpatient treatment by a cardiac surgeon

- Mosul Cardiac Center, Hay Al-Wahda, Mosul (public facility)

- Baghdad General Teaching Hospital, Bab Al Moatham Bridge, Baghdad (public facility)

Outpatient treatment and follow up by a cardiac surgeon

- Mosul Cardiac Center, Hay Al-Wahda, Mosul (public facility)

- Baghdad General Teaching Hospital, Bab Al Moatham Bridge, Baghdad (public facility)

Cardiology, procedure with electrical cardioversion

- Baghdad Medical City Hospital, Bab El Moazzam, Baghdad (public facility)

Placement of Implantable Cardioverter Defibrillator (ICD) and follow up of ICD by Cardiologist

- Ibn Al Nafees Hospital, Al Nidal Street, Al Andalous Square, Baghdad (private facility)

Cardiac Surgery: catheter ablation; procedure to remove a faulty electrical pathway of the heart

- Baghdad Medical City Hospital, Bab El Moazzam, Baghdad (public facility)

Cardiac Surgery; cardiac catheterization

- Mosul Cardiac Center, Hay Al-Wahda, Mosul (public facility)

- Baghdad General Teaching Hospital, Bab Al Moatham Bridge, Baghdad (public facility)

Cardiac Surgery; PTCA/PCI; coronary angioplasty including follow up

- Baghdad General Teaching Hospital, Bab Al Moatham Bridge, Baghdad (public facility)

Cardiac Surgery; Coronary artery bypass grafting (CABG), Bypass

- Baghdad Medical City Hospital, Bab El Moazzam, Baghdad (public facility)

Cardiac Surgery; heart valve surgery

- Vajeen Private Hospital, Silav Road, Dohuk (private facility)

Diagnostic imaging: ECG (electro cardio gram; cardiology)

- Baghdad Medical City Hospital, Bab El Moazzam, Baghdad (public facility)

- Mosul Cardiac Center, Hay Al-Wahda, Mosul (public facility)

- Baghdad General Teaching Hospital, Bab Al Moatham Bridge, Baghdad (public facility)

- Ibn Al Nafees Hospital, Al Nidal Street, Al Andalous Square, Baghdad (private facility)

Diagnostic imaging by means of Holter monitor / ambulatory ECG device

- Baghdad Medical City Hospital, Bab El Moazzam, Baghdad (public facility)

- Ibn Al Nafees Hospital, Al Nidal Street, Al Andalous Square, Baghdad (private facility)

Diagnostic imaging by means of cardiac stress test

- Baghdad Medical City Hospital, Bab El Moazzam, Baghdad (public facility)

Diagnostic imaging by means of ultrasound of the heart (echocardiography – echocardiogram)

- Baghdad Medical City Hospital, Bab El Moazzam, Baghdad (public facility)

- Mosul Cardiac Center, Hay Al-Wahda, Mosul (public facility)

- Baghdad General Teaching Hospital, Bab Al Moatham Bridge, Baghdad (public facility)

Diagnostic imaging by means or coronarography

- Mosul Cardiac Center, Hay Al-Wahda, Mosul (public facility)

- Baghdad General Teaching Hospital, Bab Al Moatham Bridge, Baghdad (public facility)

Inpatient treatment by an internal specialist (internist)

- Baghdad Medical City Hospital, Bab El Moazzam, Baghdad (public facility)

- Royal Hospital, Tuy Malik neighbourhood near Kawa Street, Sulaymaniyah (private facility)

Outpatient treatment and follow up by an internal specialist (internist)

- Baghdad Medical City Hospital, Bab El Moazzam, Baghdad (public facility)

- Life Support Team Clinic, 60 Meter Street, opposite to Shar Hospital, Sulaymaniyah (private facility)

Laboratory research for cardiac biomarker, troponin

- Mosul Cardiac Center, Hay Al-Wahda, Mosul (public facility)

- Baghdad General Teaching Hospital, Bab Al Moatham Bridge, Baghdad (public facility)

Long-term cardiac rehabilitation

- Mosul Cardiac Center, Hay Al-Wahda, Mosul (public facility)

- Baghdad General Teaching Hospital, Bab Al Moatham Bridge, Baghdad (public facility)“ (UK Home Office, January 2021, p. 13-17)

Pages 17 to 23 of the above Home Office information note provide examples of available medications for heart conditions in Iraq (UK Home Office, January 2021, p. 17-23).

Faruk Medical City, a private hospital in the city of Sulaimaniyah, Kurdistan Region, offers, according to its website, coronary artery bypass grafting (CABG) surgeries including high-risk and urgent surgeries, heart valve surgeries: aortic and aortic valve surgeries, mitral valve repair and replacement, tricuspid valve surgery, infectious endocarditis surgery, aortic surgery, hypertrophic cardiomyopathy surgery, surgery for congenital heart disease in children and adults, tricuspid valve regurgitation and cardiac surgeries for children over one year of age. (Faruk Medical City, undated)

Foreign assistance with heart operations

Al-Monitor, an online news platform for news coverage on the Middle East, described in an article from 2015 the practice of many Iraqis to seek medical treatment abroad, with a doctor describing open heart surgeries as difficult to treat in Iraq:

“In the midst of a medical crisis forcing Iraqis to travel to various countries, most frequently India, to receive treatment, Iraqis have lost faith in the country’s medical services, which they see as lacking adequate technologies and thus proper care. They are therefore seeking treatment abroad in neighboring countries, including Jordan, Iran and Turkey. Indian hospitals, however, are the big winners in the competition to woo patients, due to their lower cost, followed by facilities in eastern European countries. […]

Yet, the state is encouraging these practices by allocating funds to finance the treatment abroad of cases lacking adequate local avenues for care. After medical consultations to determine whether a case is particularly difficult, a committee decides whether the afflicted person should receive state funding for treatment elsewhere.

Baghdad International Airport employee Abbas al-Sultani told Al-Monitor, ‘Flights to India in particular are in great demand by people seeking treatment there. There is one flight that departs Baghdad daily to India, and most passengers on that flight are seeking medical treatment.’ [..]

Shaker cited ‘kidney failure, organ transplant, cancer, open heart surgeries, tumors, coronary artery transplant surgery and spinal deviations’ as among the diseases considered difficult to treat in Iraq.“ (Al-Monitor, 5 February 2015)

Al-Kafeel Super Speciality Hospital in Karbala, a private hospital in the city of Karbala, wrote on its home page about 289 successful heart operations, which were conducted at the hospital by a team of Turkish doctors during a two and a half year timeframe, from 2017 to the summer of 2019 (Al-Kafeel Super Speciality Hospital in Karbala, 31 August 2019).

Daily Sabah, a government-affiliated English-language daily newspaper in Turkey, wrote in January 2021 that Turkish doctors travelled to Iraq to treat infants with heart conditions:

“Seven infants with various heart conditions in Iraq found aid from beyond the borders of their country. A delegation of Turkish doctors travelled to Iraq to help children who cannot travel abroad due to restrictions related to the coronavirus pandemic. For a week, eight doctors who travelled to Baghdad from Istanbul, performed surgeries on infants who were born with heart defects.“ (Daily Sabah, 5 January 2021)

New developments

PUKmedia, the media outlet of the Kurdish political party, Patriotic Union of Kurdistan (PUK), reported on a new type of procedure available in the Kurdistan Region as of October 2021:

“A doctor at Shar Hospital performs heart surgery without opening the chest and says people do not need to go abroad for such surgery.

‘We have succeeded in performing four heart surgeries without opening the chest, which is the first time that such surgery will be performed at the Kurdistan Region and Iraq in general,’ said Hemin Abdulrahman, a surgeon who performed the surgery with his staff at a press conference.

‘All four surgeries have been successful, and the patients are stable,’ he said.

‘Most patients with heart diseases are afraid of opening the chest, and they do not allow the surgery,’ he said.

‘The cost of this surgery is not significantly different from chest surgery, so the patient will not be concerned about the cost,’ Dr. Hemin Abdulrahman said.“ (PUKmedia, 18 October 2021)

The public health office of the governorate of Thi Qar announced in December 2020 that Nasiriyah Heart Centre had opened the first intensive care unit for paediatric cardiac surgery in Iraq (Thi Qar Health, 11 December 2020).

The United Nations Development Programme for Iraq (UNDP Iraq) wrote in August 2021 that it had assisted the opening of a centre for heart surgery at the Salam hospital in Mosul. The centre comprises of two patient wards with eight beds each, an administrative office, two operating rooms, a recovery room, and an intensive care unit. The centre has six physicians, four surgeons and two anaesthesiologists serving 30,000 Iraqis in Nineveh, performing open and closed heart surgeries. (UNDP Iraq, 18 August 2021)

Al-Rafidain, an Iraqi news website, which publishes news from a variety of news channels, published an article in October 2021 reporting that Maysan governorate opened a new center for open heart surgery including two operating theaters, the first of its kind in the governorate (Al-Rafidain, October 2021).

Al-Sabaah, the official newspaper of Iraq, reported in September 2021 that Iraq and South Korea have agreed to establish the first specialized centre for paediatric cardiac surgery and research in the governorate of Thi Qar (Al-Sabaah, 25 September 2021)

Costs

The Health Directorate of Al-Najaf published information on its website, last updated in 2014, about the centre for heat surgery and catheter procedure at Sadr City Medical Centre in the city of Al-Najaf. According to the website, the catheter procedure costs 500 Iraqi Dinars (0.30 Euros) at the public ward of the public hospital, and at the private ward of the same public hospital the procedures using a diagnostic catheter cost between 300,000 (180 Euros) and 350,000 (210 Euros) Iraqi Dinars, and a therapeutic catheter costs between 400,000 (240 Euros) and 450,000 (270 Euros) Iraqi Dinars. (Al-Najaf Health Directorate, 15 September 2014)

NAS News, an Iraqi news portal, wrote in an article from July 2021 that the cost of performing a diagnostic cardiac catheterization at the Imam Zain Al-Abidin Specialist Hospital in the city of Karbala is 750,000 Iraqi Dinars (451 Euros), while the cost of performing treatment operations is 3 million Iraqi Dinars (1,802 Euros). The article describes that 25 patients were treated for free for the occasion of Eid Al-Ghadeer [an Islamic commemorative holiday] (NAS News, 31 July 2021).

ACCORD tried to contact private and public hospitals in Iraq via phone to confirm the types and costs of heart surgeries conducted but was unable to receive the required information. ACCORD consequently talked to a 70-year-old pensioner with heart problems from Baghdad, who had informed himself about the possibilities and process of a diagnostic cardiac catheterization for personal use in September 2021. He approached a public hospital in the Medical City Baghdad, as well as a private hospital in the Kurdistan Region of Iraq. Both hospitals informed him that they could provide the diagnostic catheterization. In the public hospital, he was told that it is possible to have the procedure done in a public or a private ward of the same state hospital. The public ward is said to charge only a minimal amount for the procedure, but the patient did not consider having the procedure done at the public ward, because of the surrounding conditions. In the private ward of the public hospital, he was informed that the procedure costs approximately one million Iraqi Dinars (601 Euros). The private hospital in the Kurdistan Region equally told him that they charge approximately one million Iraqi Dinars for the procedure, but according to the informant, tests and doctor appointments needed before and after the procedure are more expensive at the private hospital than at the private ward of the public hospital. (Pensioner from Baghdad, 27 November 2021)

The costs for other types of heart operations could not be found.

Heart Transplants in Iraq

Among the sources consulted by ACCORD within time constraints no information could be found on the subject and availability of heart transplants in Iraq.

References: (all links accessed 2 December 2021)

·      Al-Kafeel Super Speciality Hospital in Karbala: Turkish doctors at Al-Kafeel Hospital: Our success in heart operations has exceeded (99%), and their techniques are available in the hospital [أطباء أتراك بمستشفى الكفيل: نجاحنا بعمليات القلب تجاوز الـ(99%) وتقنياتها متوفرة بالمستشفى], 31 August 2019
https://kh.iq/news/details/465

·      Al-Monitor: Iraqi government spends millions on medical treatment abroad, 5 February 2015
https://www.al-monitor.com/originals/2015/02/iraq-health-sector-corruption-treatment-india.html#ixzz7DKII6rU8

·      Al-Najaf Health Directorate: Centre for Cardiac Surgery and Interventional Catheterization [مركز جراحة القلب والتداخل القسطاري], 15 September 2014
http://alnajafhealth.gov.iq/%D9%85%D8%B1%D9%83%D8%B2-%D8%AC%D8%B1%D8%A7%D8%AD%D8%A9-%D8%A7%D9%84%D9%82%D9%84%D8%A8-%D9%88%D8%A7%D9%84%D8%AA%D8%AF%D8%A7%D8%AE%D9%84-%D8%A7%D9%84%D9%82%D8%B3%D8%B7%D8%A7%D8%B1%D9%8A

·      Al-Rafidain News: Opening of a heart surgery centre in Maysan
[
افتتاح مركز لجراحة القلب في ميسان], October 2021
http://alrafidain.news/News/8199060/%D8%A7%D9%81%D8%AA%D8%AA%D8%A7%D8%AD-%D9%85%D8%B1%D9%83%D8%B2-%D9%84%D8%AC%D8%B1%D8%A7%D8%AD%D8%A9-%D8%A7%D9%84%D9%82%D9%84%D8%A8-%D9%81%D9%8A-%D9%85%D9%8A%D8%B3%D8%A7%D9%86

·      Al-Sabaah: Iraq agrees with South Korea to establish the largest center for heart surgery [العراق يتفق مع كوريا الجنوبيَّة على إنشاء أكبر مركز لجراحة القلب], 25 September 2021
https://alsabaah.iq/55011/%D8%A7%D9%84%D8%B9%D8%B1%D8%A7%D9%82-%D9%8A%D8%AA%D9%81%D9%82-%D9%85%D8%B9-%D9%83%D9%88%D8%B1%D9%8A%D8%A7-%D8%A7%D9%84%D8%AC%D9%86%D9%88%D8%A8%D9%8A-%D8%A9-%D8%B9%D9%84%D9%89-%D8%A5%D9%86%D8%B4%D8%A7%D8%A1-%D8%A3%D9%83%D8%A8%D8%B1-%D9%85%D8%B1%D9%83%D8%B2-%D9%84%D8%AC%D8%B1%D8%A7%D8%AD%D8%A9-%D8%A7%D9%84%D9%82%D9%84%D8%A8

·      Daily Sabah: Turkish doctors bring healing aid to Iraqi infants with heart defects, 5 January 2021
https://www.dailysabah.com/turkey/turkish-doctors-bring-healing-aid-to-iraqi-infantswith-heart-defects/news

·      Faruk Medical City: Department of Cardio Thoracic and Vascular Surgery
[
قسم جراحة القلب والصدر و الأوعية الدموية], undated
http://www.farukmedicalcity.com/ar/outpatient_service/cardio-vascular-thoracic-surgery/

·      Landinfo – Norwegian Country of Origin Information Centre: Irak: Helsetjenester, 14 October 2019
https://www.ecoi.net/en/file/local/2019866/Irak-temanotat-Helsetjenester-14102019.pdf

·      NAS News: Al-Hussainiya Shrine performs 25 “catheterization” operations for heart patients [العتبة الحسينية تجري 25 عملية ’قسطرة’ لمرضى قلب], 31 July 2021
https://www.nasnews.com/view.php?cat=66379

·      Pensioner from Baghdad: Interview ACCORD, 27 November 2021

·      PUKmedia: For first time, Kurdish surgeon performs heart surgery without opening chest, 18 October 2021
https://www.pukmedia.com/EN/Details/69719

·      Thi Qar Health: Nasiriyah Heart Center opens the first pediatric cardiac surgery center in Iraq [مركز الناصرية للقلب يفتتح اول عناية مركزة لجراحة قلب الاطفال في العراق], 11 December 2020
http://thiqarhealth.gov.iq/ar/index.php?option=com_content&view=article&id=10193:2020-12-11-09-52-43&catid=41:2012-07-31-07-33-06&Itemid=137

·      UK Home Office: Country Policy and Information Note Iraq: Medical and healthcare provision, January 2021
https://www.ecoi.net/en/file/local/2043929/Iraq_-_Medical_and_healthcare_provision_-_v2.0_-_January_2021_-_ext.pdf

·      UNDP Iraq – United Nations Development Programme Iraq: New Cardiac Surgery Center at Al Salam Hospital Gives Hope to Thousands
[
يمنح مركز جراحة القلب الجديد بمستشفى السلام الأمل للآلاف], 18 August 2021
https://www.iq.undp.org/content/iraq/ar/home/stories/2021-stories/08/new-cardiac-surgery-centre-at-al-salam-hospital-gives-hope-to-th.html



[1] All currency conversions were performed using https://www1.oanda.com/currency/converter/ in November 2021.

[2] Please note that the translation contained in this query response was created from Norwegian using technical translation aids. There is therefore an increased risk that this working translation will contain inaccuracies.