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Mismanaged US Contracts Affect Iraqi Health System, say Democrats

Senate Democrats are investigating a series of U.S.-funded health projects in Iraq that have been plagued by cost overruns, delays and cancellations.

The Senate Democratic Policy Committee held its hearing Friday as The New York Times newspaper reported that the U.S. government is dropping Bechtel, the American construction giant, from a project to build a high-tech children's hospital in the southern Iraqi city of Basra. The project is nearly a year behind schedule and has exceeded its estimated cost by as much as 150 percent.

It is the latest in a series of mismanaged U.S. contracts involving the Iraqi health care system. The U.S. Army Corps of Engineers earlier this year canceled more than $300 million in contracts held by the U.S. contractor Parsons to build and repair hospitals in Iraq.

The chairman of the Democratic Policy Committee, Senator Byron Dorgan of North Dakota, expressed exasperation

"In a wide range of areas, the American taxpayer has been taking a bath [paying excessively] and has been fleeced (has been losing money), in my judgment by waste, fraud and abuse, not by the millions or tens-of-millions, but by the hundreds of millions and billions of dollars," he said.

The New York Times quoted U.S. and Iraqi officials giving different reasons for the move to drop Bechtel. U.S. officials say Bechtel did the best it could, but that the worsening security situation took a toll on the project. The Iraqis blame mismanagement by Bechtel.

Among the witnesses appearing at the hearing was Richard Garfield, clinical professor of international nursing at Columbia University, who worked with UNICEF and the World Health Organization (WHO) in Iraq, in conjunction with the U.S.-led Coalition Provisional Authority (CPA) and the Iraqi Health Ministry.

Part of the problem, he said, was that there was little oversight over how U.S. funds were spent.

"The CPA office had a very small staff that had never been in charge of these kinds of programs, and was inundated with information they could not review, and so was unable, both technically and in terms of time in the day, to review the projects they were sending for contract," he said. "Contractors knew there was little accountability to those who were funding them."

Another problem, Garfield said, was that the CPA was more interested in lavish projects for their public relations value, like the children's hospital with its sophisticated equipment for treating childhood cancer, than with the more pressing need of promoting the most basic education in health care.

"We should have been involved in health education, health promotion. We should be addressing diarrhea, before we are trying to diagnose rare and difficult to treat cancer cases, but that does not give you a showy project," he explained.

Mary Paterson, an associate professor in nursing at Catholic University, who worked as a consultant for the U.S. Agency for International Development on restoring health care services in Iraq, agrees.

"We found that relatively inexpensive solutions would have markedly improved the situation for many primary health care clinics, maternity hospitals and emergency rooms, I would like to emphasize that," she noted.

Paterson criticizes what she says was the CPA's unwillingness to work with the Iraqi Health Ministry.

"If we had engaged with them, understood the situation in the ministry and started working, I think we could have been far, far more effective," she added.

Other witnesses said U.S. contractors often used subcontractors to oversee the work of local Iraqi construction companies, rather than working with them directly.

Ali Fadhil, an Iraqi doctor who visited hospitals and clinics throughout Iraq last January to assess the status of reconstruction projects says much of what he saw was poor quality.

He made his comments in an exchange with Senator Dorgan.

DORGAN: "You actually saw raw sewage bubbling up in operating rooms?"

FADHIL: "Yes."

DORGAN: "And these were operating rooms in hospitals that American taxpayers had paid to refurbish?"

FADHIL: "Yes, these were operating rooms that were about to start working in two weeks."

Senator Dorgan says he hopes representatives from the U.S. contracting firms will appear before his committee to respond to the testimony.

He says his Democratic Policy Committee had to hold the hearing because Senate Republican leaders refused to do so.