July 6, 2020 | Insight

UPDATE: COVID-19 In Iraq

July 6, 2020 Insight

UPDATE: COVID-19 In Iraq

Iraq’s luck with the coronavirus appears to have run out. Though it weathered the pandemic’s first two months better than anticipated, in recent weeks the virus has spread at an alarming rate. As Iraq’s dilapidated health system works to avoid collapse, the dramatic spike in cases places significant additional pressure on a new government already struggling with an unprecedented economic crisis and an escalating challenge from Iran-backed Shiite militias.

Situation Overview

Given Iraq’s deep ties and proximity to Iran, the pandemic’s original epicenter in the Middle East, there was legitimate concern that Iraq would suffer a dangerous spike in cases early on. But thanks to decisive action in mid-March to impose sweeping lockdown measures, the worst was largely avoided. A 24-hour curfew was put in place. Travel within the country was restricted. Borders, airports, schools, and businesses were shut down. By the time the government began relaxing the curfew in late April before the holy month of Ramadan, Iraq appeared to have dodged a bullet. Total cases on May 1 stood at just over 2,000. Deaths numbered less than 100.

By the middle of May, however, it was clear that any sense of success in getting the virus under control was premature. On May 13, the number of new daily cases topped 100 for the first time. By June 5, the 1,000-case threshold was crossed. During the seven-day period from June 30 to July 6, the average number of daily cases exceeded 2,100. Altogether, over the past six weeks, Iraq’s total cases have increased more than 17-fold, from just over 3,400 to 62,275.

Iraq’s fatalities from the virus have experienced a similarly dramatic increase. May 30 was the first time that Iraq had more than 10 deaths in a single day. Since June 25, more than 100 have been dying on average per day. From March 2, when Iraq reported its first deaths from COVID-19, to May 30, fewer than 200 people in total lost their lives. Just over a month later, as of July 6, the number of fatalities from the virus had jumped to 2,567.

Among health experts, a consensus seems to have developed that the main cause of the spike in cases has been the Iraqi population’s failure to observe social distancing guidelines since the curfew’s relaxation during Ramadan. In a June 17 interview, Dr. Adham Rashad Ismail, the representative of the World Health Organization (WHO) to Iraq, alleged that because infection rates in Iraq had been contained in the pandemic’s first months, many people concluded “it was a hoax.” As a result, he complained, “In the last few weeks and during Eid [the celebration marking the end of Ramadan], we saw funerals and celebrations of hundreds of people gathering – that wasn’t commendable by the public.”

More charitably, it was also the case that an increasing number of Iraqis, already suffering from severe economic hardship and a lack of state support, chose to return to work and risk getting the virus rather than continue staying at home and watch their families go hungry. Finally, it is also true that the major increase in cases has coincided with a major increase in the number of tests, from about 3,000 per day in mid-May to over 12,000 per day by late June. That said, the ratio of positive cases to tested samples appears to be accelerating rapidly, going from 0.6 percent on April 16 to 14.5 percent on June 19.

COVID-19 in the Greater Middle East

Country Cases Deaths
Iran 243,051 11,731
Pakistan 231,818 4,762
Saudi Arabi 209,509 1,916
Turkey 205,758 5,225
Qatar 100,345 133
Egypt 75,253 3,343
Iraq 62,275 2,567
UAE 51,540 323
Kuwait 50,644 373
Oman 47,735 218
Afghanistan 33,190 898
Israel 30,162 332
Bahrain 29,367 98
Algeria 15,941 952
Morocco 14,329 235
Sudan 9,767 608
West Bank & Gaza 4,339 17
Somalia 2,997 92
Lebanon 1,873 36
Yemen 1,265 338
Tunisia 1,188 50
Jordan 1,164 10
Libya 1,046 32
Syria 372 14

Source: JHU Coronavirus Resource Center
Data current as of 10:00 AM, July 6, 2020.

Implications

While the spike in the virus’ spread is indisputable, determining how dire the situation will become is more difficult. Though an imperfect metric, Iraq’s fatality rate – though steadily rising in recent weeks – of just over 4 percent remains lower for now than that of many industrialized democracies, including France, the United Kingdom, and Italy, whose rates exceed 14 percent. In his interview last month, Ismail reported that the number of very severe cases in Iraq requiring intensive-care unit beds was relatively low, with a large number of beds still available. This is explained at least in part by the fact that as many as 90 percent of those hospitalized were reportedly less than 60 years old and at significantly lower risk of catastrophic outcomes.

The real risk for Iraq from the troubling surge in cases arises from the pre-existing fragility of its healthcare system. Decades of conflict, corruption, and under-funding have left the sector woefully unprepared for this crisis. In recent weeks, there have been multiple press stories about extreme shortages of both oxygen for patients and protective gear for healthcare workers. Iraqi doctors, nurses, and other health workers are reportedly contracting the virus at a higher rate than in other countries, which is a potentially major problem given that Iraq already has fewer health workers than those countries. Even worse, many workers that test positive are allegedly being forced to keep working by administrators, turning hospitals into major nodes for spreading the virus rather than blocking it.

The governor of Erbil province in Iraq’s Kurdistan region has warned of “catastrophe” if more stringent measures are not taken to rein in the virus quickly. Ismail has said that if the population’s behavior does not change, the outright collapse of the Iraqi healthcare system remains a distinct possibility, and that “if [it] breaks … I doubt it can be brought back.”

While the economic freefall triggered by COVID-19 led to a collapse in world oil prices that has been devastating to Iraq’s finances, there are few signs yet that infections among workers have impacted oil production. Nor have cases within Iraq’s security forces had a noticeable effect yet on their ability to conduct counterterror operations against the Islamic State.

What to Watch for

One recent study suggested that at the current rate of growth, the number of infected Iraqis could approach 2.8 million by the end of August. Subjecting Iraq’s precarious healthcare system to that kind of stress clearly would carry enormous risk. It remains to be seen whether the government is capable of leveraging a combination of further restrictions, public messaging, and enforcement to get the public to return to a much higher level of compliance with social distancing that would slow the spread.

This will be a tall order for the new prime minister, Mustafa al-Kadhimi, who has been in office for barely two months and is already overloaded trying to deal with multiple other crises. The collapse in oil prices has left his government with a massive budget deficit, barely able to cover more than half of its monthly payroll. He is also struggling to assert the state’s authority over a group of powerful Iran-backed militias that threaten to bring the government down if pressed too hard. Managing these high-priority challenges while simultaneously trying to tame an escalating epidemic – all without fatally destabilizing the country – will be a supreme test of Kadhimi’s political skill and mettle.

John Hannah is senior counselor at the Foundation for Defense of Democracies (FDD), where he also contributes to FDD’s Center on Military and Political Power (CMPP). For more analysis from John and CMPP, please subscribe HERE. Follow FDD on Twitter @FDD and @FDD_CMPP. FDD is a Washington, DC-based, nonpartisan research institute focusing on national security and foreign policy.

Issues:

COVID-19 Iran Iran Global Threat Network Military and Political Power