BAGHDAD, Iraq—Shakir al Ainachi's first threat came when a man barged into his office at the Iraqi health ministry and pulled a grenade out of his pocket. A few weeks later, gunmen fired six shots at the physician's car as he drove to his clinic.
It was only after the latest threat, a letter received this month telling al Ainachi he would be "cut into pieces," that the orthopedic surgeon added a new tool to the blue doctor's kit he keeps in a desk drawer: a shiny pistol.
"What can we do? It's come to this," al Ainachi said with a sigh.
Money-hungry kidnappers and politically motivated terrorists are killing off Iraq's top doctors or driving them out of the country just when their war-ravaged patients need them most. Iraqi doctors accustomed to saving lives are now enrolling in self-defense courses that teach them how to kill.
In the past six months, at least six doctors, including the dean of Baghdad's medical college, were shot to death. Nearly 30 other doctors or their children were abducted and released for exorbitant ransoms. At least 40 physicians, including a pioneer in kidney transplants and Iraq's top dermatologist, have fled the country for safer grounds.
"If this continues, patients will have to go to Jordan for a simple tonsillectomy," said a gynecologist in the flashpoint city of Fallujah who wouldn't give her name for security reasons.
The crisis has deprived ailing Iraqis of specialists in several fields, delayed crucial surgeries and shut down clinics across the country. Last month, Iraqi doctors planned a weeklong strike to draw attention to the issue, but ended the walkout after a day because they couldn't bear to turn away the bombing victims that flood into Iraq's overcrowded, understaffed hospitals with each fresh wave of violence.
Though lawyers, professors and bankers are also targets, the Iraqi medical community has been hardest hit by attacks on the country's relatively affluent middle class. The new Iraqi government that assumes power next week is already issuing weapons permits to physicians and is considering a special security force to escort doctors to and from hospitals. There are also plans for a rewards program to encourage tips on assailants.
"We'll take care of the problem," Interior Minister Falah al Nakib vowed Friday. "We've already arrested many gangsters. This is an organized-crime issue."
Mafia-like crime rings see doctors, who make vastly more money than the country's blue-collar workers, as easy targets for fast cash from ransoms. But guerrilla groups also are increasingly threatening doctors as part of their large-scale campaign to derail American-led reconstruction efforts.
So far, the threats are working. Iraq's best neurosurgeon, who is also president of the Cancer Council, is scouting for jobs in the United Arab Emirates. Others, such as a top surgeon undergoing physical therapy after kidnappers broke his forearm and shoulder, have shuttered their clinics in Baghdad.
Muawaffaq al Bayati, an eye doctor, made $3 a month under Saddam Hussein's regime. The U.S.-led coalition's improvements to health care bumped his salary to $300 a month, but the raise hasn't stopped him from looking for work outside what he called "the most dangerous place in the world for doctors."
At night, al Bayati practices out of a private clinic he's watching for a colleague who fled to Egypt after his son was abducted. During the day, he no longer leaves the public hospital where he's stationed. Bored two weeks ago, he ventured out to a market and was immediately attacked by a knife-wielding man who took his wallet, but spared his life.
"We are losing our experts and we need them now more than ever," al Bayati said. "People tell me I should carry a weapon. But how can I have a gun on my hip while I'm examining patients?"
Thana Nassir, a head and neck surgeon, stopped driving herself to work after she was followed one rainy day by a car with black-tinted windows. She parked and ran inside the hospital before her potential attackers could get out.
She now travels with three bodyguards and even deflated the tires on her young son's bicycle to prevent him from being snatched while riding around their well-to-do neighborhood in Baghdad.
Like other besieged doctors, Nassir said she stays in Iraq only out of commitment to her patients and to rebuilding the country's dilapidated health-care system.
"I walked downstairs from my clinic one day and found all my patients waiting by my car to follow me home," she said this week. "My own patients now have to protect me."
(c) 2004, Knight Ridder/Tribune Information Services.
PHOTOS (from KRT Photo Service, 202-383-6099): usiraq+doctors