NASIRIYA, Iraq — The provincial civil defense chief, Brig. Gen. Salah Jabar, had warned for months about the problems in local hospitals before a fire in a coronavirus ward in this southern city killed at least 60 people this week. He flagged the flammable construction materials, a lack of fire detectors and improperly stored oxygen canisters.
But his repeated warnings to the regional health ministry were ignored, he said. Then he heard from his mother.
A week ago, she was being treated for Covid-19 in the same hospital hit by the lethal blaze in the southern city of Nasiriya, and while she was recovering in a different isolation ward, two small fires broke out there.
“My mother told me about it and said: ‘It’s better if you get me out of here. This place scares me,’” General Jabar said on Wednesday. Although she was still ill, he said, he had her discharged and took her home, just days before the deadly fire at the Imam Hussein Teaching Hospital.
It was the second catastrophic fire in three months in an Iraqi coronavirus ward — a tragic symptom of years of chronic mismanagement and corruption that have left millions of Iraqis without proper health care, reliable electricity or clean water. In Nasiriya, the capital of Dhi Qar Province, that misery is compounded by a power struggle involving powerful tribes and Iran-backed militias that outgun the government’s official security forces.
In Iraq’s once-celebrated health care system, there is so little nursing or orderly support that even in an infectious disease ward, patients each have a relative or two staying with them to bring food and medicine.
“The wards are unsupervised. People go in and out, and they bring electric hot plates and fans and food,” said General Jabar, who has 16 years of experience with Iraq’s civil defense forces, which work to ensure that buildings adhere to safety standards, among other responsibilities.
“We should not be saying these things to foreign press because these are national secrets. But what is painful to us are the victims,” General Jabar said. The next day, he said he had received orders not to give any more interviews.
In one of his inspection reports sent to the provincial health ministry, General Jabar said he had pointed out a leak in the central oxygen system at the Imam Hussein hospital. But the hospital told him it did not have money for repairs.
The ward destroyed by the fire had been in operation for only a few days before it burned, and officials said investigators had not yet determined the cause of the blaze.
In the wreckage, Iraqis looking for traces of family members or friends sifted through blackened metal and charred blankets with their glimpses of pink roses or tiger print patterns, the only spots of color amid the ashes.
Hussein Shaheid, 19, a high school student, said he had found some bones and a hand. But he did not find any trace of the friend he was looking for, Murtazha Hamid, who was 16.
“He rescued his mother and sister,” Mr. Shaheid said. “He tried to help other people, but he went missing in the fire.”
On his upper arm, Mr. Shaheid has a small blue tattoo of an airplane. He said he dreamed of flying away from Iraq — far from the poverty, the everyday violence and the unrelenting despair.
Nasiriya is known for its persistent antigovernment protests, which have largely been crushed by militias and security forces in other cities. The killing of dozens of unarmed protesters in November 2019 helped bring down Iraq’s prime minister, Adel Abdul Mahdi. Iranian-backed militias, many of them now part of official Iraqi security forces, are blamed for most of the killings of protesters.
After the latest fire, Prime Minister Mustafa al-Kadhimi ordered the dismissal of a hospital director and the provincial health chief. A provincial court issued warrants for their arrests.
Saadi al-Majed, a consulting surgeon who was appointed the new provincial health chief after the fire, said all of the dead were either patients or their relatives who were caring for them. All of the patients in the ward were receiving oxygen, and many were unable to move when the blaze broke out.
Dr. al-Majed, who has been brought in twice before to head the health directorate during crises, said his first task was to try to stop enraged relatives from attacking the hospitals and health care centers.
“They are fighting with us,” he said in an empty office at the new al-Nasiriya Teaching Hospital across town from the hospital that caught fire. “They attack some of our staff. So the first thing was to calm the situation as much as we can.”
Despite a decade of construction, the al-Nasiriya hospital still had not opened until the past week. It is the province’s first new public general hospital in 40 years.
Hours after he was appointed, Dr. al-Majed was supervising surgeries in the new hospital and had begun moving patients there from other facilities.
“This is a difficult country,” he said. “There is no management. There is only crisis management.”
Dr. al-Majed blames years of corruption for the dysfunction of government ministries.
But the roots of the health care problems go deeper than that. Saddam Hussein’s invasion of Kuwait in 1990 led to more than a decade of sweeping U.S. trade sanctions and a severe decline in Iraqi infrastructure. After 2003, governments divvied up ministries among political parties, with posts given to party loyalists.
“They don’t want to change because they want to put money in their pockets. Sorry, but it’s as simple as that,” Dr. al-Majed said. “People die every day because there are not enough hospitals, not enough health care centers in the province.”
Ahmed al-Khafaji, the governor of Dhi Qar Province, who is also a cardiologist, was appointed in April after his predecessor was dismissed for failing to prevent the killings of unarmed demonstrators during a protest in February.
He said investigators were looking into whether the fire was caused by a technical failure, negligence or arson.
Dr. al-Khafaji said the hospital’s isolation wards, built from flammable sandwich panels, were constructed on an emergency basis as hospitals became overwhelmed with Covid-19 patients. He said he had instructed the health director to remedy the shortfalls soon after he received a report about the problems a month ago.
“I want to make peace in the city and to build up security, and then we want to build up the city infrastructure and provide basic services for the people,” he said.
But the governor’s simple agenda could prove difficult to achieve in Iraq. He identified corruption in the province and the country as the biggest obstacle to change.
With summer heat often above 120 degrees, electricity shortages in Iraq have left residents of Nasiriya without power for hours at a time. Those who can afford it rely on private generators to fill in the gaps.
But many of the city’s 2.4 million people cannot. There are few jobs here even though Iraq is rich in resources, and some of the world’s biggest oil fields are nearby.
“I depend on the private sector to create jobs, but, you know, the private sector needs good security to start projects,” Dr. al-Khafaji said.
In the village of al-Ibrahim, about an hour’s drive from Nasiriya, the road was lined with mourners of an extended family killed in the hospital fire. Black funeral banners near a tribal flag hoisted in front of a mosque listed the names of multiple victims from one family. Another member of the family is believed to be among 21 charred bodies that were sent to a morgue in Baghdad to be identified.
The victims were cousins of an antigovernment activist, Alaa al-Rikabi, who is running in national parliamentary elections scheduled for October as part of a new opposition party that will demand basic services.
“Almost everywhere in my country, you can see the oil fields, you can smell the oil smoke,” Mr. al-Rikabi said. “But you cannot see the benefits that should be obvious for my people.”
Falih Hassan and Awadh al-Taiee contributed reporting.