Ninevah
Basrah
Thi-Qar
Babylon
Diala
Anbar
Salah Al-Din
Najaf
Wasit
Qadisiya
Tameem
Maysan
Kerbala
Muthana
Suleimaniyah
Erbil
Dohuk
Personnel
The doctor to population ratio increased from 1977 to 1998 but was still low at 4.7 per
10,000 compared to most other countries in the region with ratios above 10 per 10,000.
Nurses per population was always low, and fell off precipitously after foreign workers left in 1990. There are 5.2 nursing staff per 10,000 people, meaning that there is about one nurse per physician. In most countries there are 3 – 6 nursing personnel per physician. More than a third of the physicians are specialists, while less than a third of the nurses were trained in post-high school programs.
Nurses and Doctors per 100,000 Population, 2000
Specialists General
Practitioners
Baghdad 16.4 44.8
Total
Doctors
61.2
Nurses
14.3
Nursing
Auxiliaries
15.9
Total
Nursing
Staff
30.2
9.0
11.5
28.4
36.0
37.4
47.5
6.8
9.8
19.7
32.6
26.5
42.4
7.1
13.9
11.5
13.5
15.0
14.8
14.3
10.8
17.8
8.3
14.6
11.8
27.7
7.3
5.8
15.8
36.7
23.6
32.3
27.9
33.0
21.9
30.4
31.4
15.2
35.4
23.4
44.2
37.5
48.6
22.9
50.6
35.1
45.8
42.9
47.8
36.2
41.2
49.2
23.5
50.0
35.2
71.9
44.8
54.4
10.4
13.5
16.8
9.1
1.6
8.3
2.0
4.8
6.7
9.0
10.9
.2
62.2
32.6
7.6
24.2
24.6
18.3
22.1
15.6
23.4
5.1
29.3
20.2
27.2
48.2
12.1
141.8
110.5
88.2
34.6
38.1
35.1
31.2
17.2
31.7
7.1
34.1
26.9
36.2
59.1
12.3
204.0
143.1
95.7

Total Iraq 13.5 32.2 47.7 14.0 38.1 52.1
With 12 beds per 10,000 population but only 4.8 physicians per 10,000 population, Iraq is relatively short of physicians per bed. Especially in light of the low level of support staff per phyician, the beds must be seriously underutilized.
Medical education
Training doctors is the responsibility medical colleges. They receive direction from the
Ministry of Higher Education. Enrollment decisions are made by this Ministry based on student choice, exam results, and school capacity. The system has been heavily politicized in the past.
Basic medical education
The number of medical colleges has been expanded rapidly. Baghdad Medical College was first to be established in 1927. There were only four medical colleges in 1974 but 14 by 2000, including three in the northern governorates. In the last two years three more medical colleges were established but teaching at them has not begun.
Basic medical education is a six-year course. Graduates receive a Bachelor of Medicine and Bachelor of Surgery (MB, ChB). Graduates then complete a two-year internship and provide one year of rural service. The language of instruction is English. More than 8000 students are enrolled in these colleges and there are around 1200 faculty members recruited. Each college consists of eleven departments covering basic and clinical medical sciences, but many colleges lack faculty for some departments.
Postgraduate medical education since 1986 has been directed mainly by the Iraqi
Commission of Medical Specialties. This body provides post-graduate training in most of clinical specialties and some subspecialties. Candidates can also train under the direction of the Arab Board of Medical Specializations, which is a joint programme of postgraduate training programme in Arab countries.
Most doctors specialized in postgraduate training programs in UK or US in the 1970s.
This option declined in the 1980s and nearly ceased in the 1990s. Postgraduate academic studies are also run by the medical colleges. These studies would lead to Master of
Science and Doctoral degrees in basic medical sciences.
There was a considerable brain drain among physicians through the 1990s. While less dramatic than the exodus of foreign nurses, the emigration of Iraqi physicians included many of the leading clinicians in the country. Iraq thus has a relatively young body of physicians with limited skills and great needs for upgrading of education.

There are no university hospitals. Training sites are dependencies of the Ministry of
Health.
Continuing Medical Education
CME units in medical colleges lead Journal Clubs, seminars, symposia and scientific conferences. The Ministry of Health also has a system of CME, allocating units or credit hours for each type of activity. Each doctor should accumulate a certain number of these units over the year but in practice there has never been a system to monitor or judge compliance. Since 1990 travel by health professionals for scientific activities and fellowships were very limited.
Problems with medical education
There are few qualified teachers and scientists in Iraqi medical colleges. Such senior clinicians can earn far more in private practice. The problem is especially acute in recently established medical colleges. Emigration by senior faculty has been very problematic.
Curriculum and teaching methods have been strictly controlled by the Ministry of Higher
Education. Only traditional didactic teaching was permitted (with the exception of the
Tikrit Medical College). Opportunities for self-directed or participatory learning are very limited. The curriculum is crowded with theoretical teaching; information technologies and audiovisual material access has been very limited.
The Tikrit Medical College follows problem-based teaching methods. Since the departure of the founding Dean of that school, it has been in decline with shortage of staff and poor performance by students on the national examinations.
Lab oratory facilities are usually poorly equipped and outmoded. Most college buildings are usually not purpose-built. Lecture halls and classrooms are frequently in poor condition.
During sanctions, the intellectual isolation of the country was extensive. Few books or journals from the last 10 years are in Iraq and telecommunication facilities were discouraged. Severe limitations on permission to participate in regional and international scientific activities compounded this problem.
Short Term Recommendations:
There is a need for physical rehabilitation of most of medical colleges. This would include renovation, expansion by addition of new sites, air conditioning and other engineering work.

Curriculum Review Committees should be established, curriculum decisions should be decentralized, and innovative methods of teaching and learning should be tried. Although several workshops were carried out since the inception of the Integration of Medical
Education and Health Services Programme (implemented by both Ministries of Health and Higher Education and sponsored by WHO), little progress occurred to date.
Twinning programmes with medical colleges abroad are needed. WHO and WFME can facilitate these school-to-school arrangements, scholarships, and fellowships.
The revolution in information technologies must now reach Iraq in electronic and paper formats. Internet access and use for problem solving must be fostered.
A national accreditation system should be developed, incorporate quality assurance mechanisms for institutions and CME requirements for clinicians.