In the Deadly Heat, Iraq’s Hospitals Have Become the Ground-Zero Battlefield in the Country’s Climate Crisis

In Iraq, where the confluence of war, economic turmoil and political instability has ravaged the health sector for decades, climate change is the newest and most formidable enemy.

Al Sadr Hospital, Amarah—It’s 10am on an early August day. The temperature is already 37°C. By noon it will rise to 49°C, turning the city into an inferno, where even a breeze feels like fire.

The emergency room is overflowing. Beds are full, with curtains not always pulled. A doctor holds an X-ray up to the light. Patients in wheelchairs, black-cloaked mothers with small crying children in tow, old men on the verge of collapse, stream in, vying for attention, oblivious to the paint peeling off once-cheerful pink walls and the glass windows opaque with gunge. A uniform-clad security guard stands at the entrance, another mills among the crowd. A faded poster of a woman lying on a gurney, her mouth in a silent scream, imploring against violence and guns, is ignored. 

Hospital corridors are packed with the relatives of patients, walls lined with women sitting, waiting; the young men standing, jangly, alert. It is hot. 

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Dr Muhammed Kareem Muhammed leans over, examining a patient. 

Nurse Mariam Qassim is by his side, a headache from the suffocating bus ride to work after heat robbed her of a good night’s sleep, creeping in at the edges. ”What we are facing in the heat …” She stops abruptly, interrupted by shouting. There is a fight going on in the corridor.  

“It is due to the heat stress,” Muhammed says, tense. “They blame us.” Qassim flinches. “It is frightening when they are being aggressive to us,” she whispers. This wasn’t the job she’d signed up for. 

Heat is the silent killer of climate change, creeping invisibly into every corner of life. 

Its inexorable rise slowly saps water and ultimately life from once-rich land, leaving only desert and shrivelled plants as evidence of generations of families and lives once well lived. A cloud of sadness and memory replaces identity, respect, a sense of community: it settles over the new lives found in the margin of cities, where they clash with those that have long been there. Services, already overburdened, are pushed to breaking point. Children of the climate-displaced flood schools, swelling classes to impossible sizes, as many as 80. Wind blows the loose sand of desertified land into sandstorms that sweep the country, sending gasping hundreds into hospitals. 

As the temperature rises, each year notching up degree by degree, demand for an already inadequate electricity supply grows, air conditioning becomes increasingly essential to life, but the grid fails. Melting wires spark, causing fires, burning people; children faint from the heat in un-air-conditioned schools. Construction workers, traffic police, sanitation workers and soldiers pass out in the streets. A sanitation worker in Sadr city, and a Baghdad paediatrician, both dead from heat, one succumbing in the street, beside the wheels of his rubbish cart; the other alone in his apartment, dead three days before being found, both in late July.  

As the temperature rises, tempers fray. Anger and aggression permeate homes, streets, pharmacies and hospitals, putting the whole country on edge, threatening its already fragile stability. 

Outdoor labour turns deadly under the unrelenting sun. Hospitals, places of succour and healing, have become battlegrounds, forums where urban and rural cultures clash. Doctors and nurses work in fear.

Hospitals are breaking down, not from a lack of will but from a relentless wave of challenges: from mass displacement of populations seeking refuge from drought and failing agriculture, to widespread electricity shortages, melting wires that spark fires, to the soaring mental health issues faced by both healthcare workers and patients. 

Named the fifth-most-vulnerable country to climate change in the world, Iraq has already experienced climatic devastation, with soaring temperatures, diminished and insufficient rainfall, severe drought, dust and sandstorms, and severe water scarcity infiltrating and disrupting every aspect of life and undermining the very stability and security of the country. 

Temperatures have increased by a staggering 2.5°C over the past four decades, surpassing global average increases two to seven times, while the number of extreme hot days has been increasing at a rate of 10.69 per decade, meaning the temperature will now often stay above 50°C for days or weeks on end, turning the country into an inferno, ruining sleep, searing lungs, sapping energy, fraying tempers, and putting the whole country on edge. 

It is bad now, but forecast to get even worse. More frequent heatwaves are expected, the temperature is expected to continue to rise between 1.6°C and 2.4°C by 2030, and a further 1.9°C to 3.2°C over the next two decades. By 2050, Iraq, already one of the hottest countries on the planet, will be the hottest country in the region.   

Already today, Basra, with temperatures of 53°C, is ranked the hottest city in the world by Hot Cities, while Baghdad, the country’s capital, at 51°C, is only marginally cooler. By 2050, Basra will be on the verge of unliveable, forecast to have 148 days of “highly dangerous heat” in the sun and 37 such days in the shade.

At the same time, Iraq is suffering from severe water scarcity. Rainfall has declined 10% in the past two decades and will continue to plummet another 9% by 2050. The famed Tigris and Euphrates rivers, whose waters nurtured the very birth of civilisation and on which Iraq has long depended, are drying up. Today, weeds cover the banks long submerged under glistening waters. By 2030, the Tigris and Euphrates will have lost 50% of their water supply. The ramifications of the water crisis are altogether terrifying. By 2035, in just 10 short years, the World Bank anticipates that the gap between water supply and demand will increase by a staggering six billion cubic metres.

The decline in rainfall coupled with rising temperatures has also led to widespread desertification: 39% of the country — 50% of its agricultural — has now succumbed to it, while an additional staggering 100,000 acres are lost annually.

"When a patient dies, their families are angry — and they’ll break everything, equipment, everything in sight and threaten and assault doctors and staff."

Dr Samar Farooq, a surgeon and assistant to the general manager at the Department of Health in Al-Rusafah, Baghdad

This has made climate displacement and migration a stark reality — and a societal problem. According to the International Organization for Migration, as of October 2023, 130,000 had been forced to migrate to cities due to climate change. It is a rapidly growing problem. By 15 March 2024, the number had already increased by more than 10,000 to 140,184. In cities, however, they form an unwelcome underclass, working menial jobs, straining already stressed services to the breaking point and creating unrest. 

Iraq’s hospitals have become the ultimate convergence point, the ground-zero battlefield, for the country’s climate crisis. Scorching temperatures, widespread electricity shortages, crumbling infrastructure, and mass displacement all collide within their walls. Every consequence of climate change finds its harshest expression here, pushing the healthcare system to the brink as it struggles to absorb the full brunt of this spiralling disaster.

“Climate change is a global challenge,” says Professor Hussein Fadhil Aljawadi, head of the health directorate in the Maysan Governorate. “But in Iraq, we feel it early and deeply.” 

Weight of history and an uncertain future

Dr Ali Abdulwahid (54) is in the eye of the storm. He has managed the overcrowded Al Sadr Hospital in Amarah for eight years, after a 26-year career as a general surgeon. 

Amarah, once part of Mesopotamia’s famed Fertile Crescent, is now an arid landscape, devastated by climate change. Here, the weight of history hangs heavily, where the origins of mankind collide with the challenges of an uncertain future.

Thousands of displaced people from the drying Al Hawizeh marshes have flooded Amarah, swelling its population from 420,000 in 2005 to 1.1 million by 2020. This demographic explosion has overwhelmed the hospital’s capacity.

At the same time, patient loads skyrocket as extreme temperatures and increasing frequency of sandstorms exacerbate existing health problems and drive an upsurge in patients suffering from heat-related illnesses, respiratory conditions and other climate-induced ailments to its doors. 

“With the hot temperatures, there are more patients, twice as many as before,” Abdulwahid says, throwing his hands up in despair. “Way too many patients.” 

Grossly underresourced, the hospital can’t cope.

The ER has 24 beds, far short of the number needed for the 750 to 800 people who will arrive daily in the summer, never mind the additional 200 who will come in when there is a sandstorm or other extreme climatic event. 

Yet as patient numbers continue to grow year after year, funding effectively shrinks, forcing Abdulwahid to run a hospital with ever-increasing needs on a shoestring budget that doesn’t even cover the minimum.  

“This year, they gave me only 700 dinars for electricity. In my home I spend more!” he says.

As if on cue, the lights flicker off.

His shoulders slump in frustration.

As temperatures rise and the urban populations grow, the need for cooling increases and the deficit between supply and demand grows catastrophically.  

Displacement swells patient numbers, power failures stifle cooling, and rising temperatures inflame tempers, creating a perfect storm where each problem fuels the next.

On 21 June 2024, a sunny day where temperatures reached 48°C in Basra and 47°C in Baghdad — temperatures that are typical these days — demand reached a record 48GW, fully 23GW above available capacity. Frequent and prolonged outages ensue from the deficit.  

“This year, the electricity situation is worse than ever,” Abdulwahid explains, exasperated. “The hotter it is, the less reliable the generator is. Sometimes we’re left to work in the dark, with only a flashlight or a phone for light.”

When the national electricity stops, the hospital switches to two gas-powered generators. Both are very large, supplying 1.25MW each, but they do not generate enough power to cover every area of the hospital. The critical areas — operating room, ICU units, incubators and ventilators — are prioritized.

The air conditioning is not. It stops. When the electricity is shut down for hours, the temperature in the hospital can rise to 40°C.

As the hospital heats up, so do tempers. 

It is a vicious cycle. Displacement swells patient numbers, power failures stifle cooling, and rising temperatures inflame tempers, creating a perfect storm where each problem fuels the next.

“When it gets so hot in here when electricity fails, it is very stressful for our staff and patients,” Abdulwahid explains. “Patients arrive with their loved ones, they are hot, it is hot in here and it is very difficult. They become angry in the heat, angry and anxious. They put the problem on us and that is very stressful for the staff who are also hot.”

“Heat makes the staff tense and angry, more tense than usual,” admits Dr Muhammad Joseph, an internal medicine specialist at Baghdad’s St Raphael Hospital. “We come to work in the heat, it makes us tense and the patients are also tense. So, there is fighting all the time.”  

While the lack of electricity threatens patient care, the heat inflames violence, fuelling conflict between the medical staff and the displaced rural tribal families who crowd the corridors. 

“Fighting is definitely the biggest change I’ve seen over the 14 years I’ve been working as a doctor,” says Dr Samar Farooq (37), a surgeon and assistant to the general manager at the Department of Health in Al-Rusafah, Baghdad. “The relatives of patients are attacking doctors. When a patient dies, their families are angry — and they’ll break everything, equipment, everything in sight and threaten and assault doctors and staff.”

The frequency and severity of the aggression and violence has reached alarming levels.

“Violence has become our daily reality; it will happen three or four times a day,” explains Dr Bassim, president of the Baghdad Medical Syndicate and manager of Al Sadr Hospital in Baghdad. “Every 24 hours, someone hits the staff. We’re at a point where we expect it to happen.”

It’s not just wires sparking fire. Transformers, subjected to extreme heat, are exploding … recently, an oxygen cylinder exploded in the punishing heat of the sun.

“It’s not just physical attacks we worry about,” Dr Ahmed Saleh (31), chief of resident doctors at Al Sadr Hospital in Amarah, confides. “There are threats of kidnapping, of revenge against our families. Some doctors have been forced to pay ‘blood money’ to families of deceased patients. How can we focus on saving lives when we’re constantly looking over our shoulders?”

The situation has become so dire that hospitals have had to dramatically increase security measures. “We now have 60 armed security personnel on duty 24 hours a day,” Bassim admits. 

It hasn’t ended the problem — a doctor had been injured a few days earlier.

Consumed with worry

The heat is also perilous for hospital infrastructure. 

Adnan Ajum (48) has been in charge of the hospital’s firefighting department for five years. “Safety is my job,” he says from his small office in the hospital’s basement. As temperatures rise, his job has become fraught with danger. “Fires are happening more and more because it is getting hotter and hotter. The rubber insulation on the wires is melting in today’s extreme temperatures, igniting fires as the bare wires touch and spark.”

He recounts recent incidents: “Two fires within the past 18 months, both caused by electric shorts precipitated by melted wire covers. One was in the operating room — luckily, minutes before the patient and doctors entered. The other was in the doctors’ apartment on site and not so lucky: it resulted in serious burns.”

It’s not just wires sparking fire. Transformers outside, subjected to the extreme heat of the sun, are exploding: Two recently. Likewise, recently, an oxygen cylinder exploded in the punishing heat of the sun.

And then there are 12 elevators to think about. When constantly working in high temperatures, they become dangerously hot and need portable AC units to cool them down, siphoning energy from other needs, and compounding the strain on the fragile grid.

Ajum is now consumed with worry every day on the job. “I worry about myself and the others — I am responsible for everyone. I worry as every day it gets hotter, I worry there will be more fires as it gets hotter and hotter. Even today with the strong wind I worry. I worry that the bolts will come loose, and the transformer will fall and cause a fire.”

“Maybe I will tell you and you will laugh, but whenever I come to work now I do recite ayas for saving me and pray to allah no fires.”

Temperatures this high coupled with electricity failure can be dangerous and are routinely sending surges of people suffering the consequences of the extreme heat to hospitals, or sometimes, especially for those lacking cooling, to morgues.

Fainting students are arriving in overcrowded emergency rooms, adding to the burden on hospital staff.

"When people can’t pay for the generator, it makes them aggressive and angry, which sometimes results in people fighting or even killing each other."

Muhsen Al Ali, retired public servant

“The air conditioning in classrooms is zero. We have rising temperatures, extremely high temperatures inside classrooms and no air conditioning,” says Muhammed Jassim, a nurse at the Number 2 Health Centre in Sadr City, Baghdad, where he is in charge of 26 schools.   

He pulls out a thick register. “These are records of students losing consciousness, fainting in class from the heat,” he says, flipping through the pages. “Each month there are about 100 cases. They had to postpone the final exams this year because of the fainting. It happened this year but it has been happening often.”

The health centre has also had to set up a special unit for abused women, since domestic violence has skyrocketed – a fact Jassim attributes to the stress of sweltering conditions.

“The heat has aggravated family problems,” Muhsen Al Ali, a 50-year-old retired public servant, agrees. “There’s so much anger – the heat robs husbands of sleep and makes them angry at his wife and kids. And women are all one second away from suffering – stuck in a hot house with children who can’t go outside as it is too hot. It all makes people aggressive, tired and dizzy.” 

An estimated 4.5 million private generator operators are relied on in homes to fill the gaps caused by the frequent national grid outages. They become more and more crucial to life with every degree increase in temperature. But they come at a cost many can ill afford – a cost that increases in summer as the need increases.  

“All these problems make people behave worse and sever the bonds in communities and families,” Muhsen notes sadly from his home in Sadr City. “When people can’t pay for the generator, it makes them aggressive and angry, which sometimes results in people fighting or even killing each other.”

With electricity crucial to survival in the extreme temperatures, customers are at the mercy of the generator operators, who have been known to exploit their plight and operate with mafia-like impunity.  

Muhsen’s friend, Mohammed, has experienced this first-hand. 

“One day, the operator of the generator claimed he had a problem and turned off the generator, telling us it was broken,” he recalls, his voice low. “I went to his house to ask him what the problem was.” His eyes darken. “Later that night, three men came to my house with guns,” he says grimly. “That’s the reality of it,” he sighs. 

The electricity has cut out at Amarah’s Al Sadr Hospital. The temperature is rising in the darkened building. A blood-curdling scream echoes up the dark stairwell. A black-cloaked woman flies up the stairs, trailed by a dozen other women. Screams turn to loud sobbing, mingling with thunderous shouting in the hall above. An angry mob descends the staircase, pushing anyone in their path out of the way. 

The challenging environment, heat, overcrowding, threats and violence are driving doctors away in droves, leaving hospitals severely understaffed and staff turnover high.

“Many doctors are leaving to migrate to other countries,” explains Dr Hadi Suleiman Hassan, vice-president of Iraq’s medical association. “The difficult and threatening atmosphere contributes to migration.”

At Al Sadr Hospital, Abdulwahid throws up his hands in despair as he describes his staffing problems. Already grappling with a shortage and high turnover, he has no specialists.

On top of this, among the staff who remain, many are taking days off, a result of the heat, stress and threats, he explains, as well as the extra work created by the staffing shortage.

It is a problem echoed throughout the country. Dr Ahmed Saleh is struggling to make the hospital work with half the number of doctors needed. “Doctors leave because of the problems and despite the need,” he notes wryly. “The resources are less but the patients increase — this is not logical.”

“For me it is disgusting. We can’t do the necessary work within the allocated time and resources,” fumed Bassim.  

"If the water situation stays the same, we could see seven million more people displaced in Iraq over the next five years due to climate impacts."

Yusif Muayed Yusif, senior official at Iraq’s Ministry of Environment

The vicious cycle of heat, violence, and exodus threatens to unravel Iraq’s healthcare system.

“The situation is just becoming more and more difficult,” explains Dr Joseph of Baghdad’s St Raphael Hospital. “As it does, more and more doctors leave. Some people can’t survive these issues.”

“This is not sustainable,” Abdulwahid says, sighing wearily. “There are so many challenges. There’s too much standing behind this door right now.

“This is the job of a head manager,” he suddenly blurts. “It’s miserable, it’s stressful. I want to leave. I’m tired, so tired.”

Iraqi officials increasingly view climate change not just as an environmental or public health issue, but as a fundamental threat to national security.

“When we are talking about climate change, we are talking about the increase in temperature. We’re talking about the supply of the electricity. We’re talking about displacement of many thousands of people. We’re talking about many, many fears about the health sector, about education, about the economy. We’re talking about the economic sector, agriculture sector, social sector, care sector – food security, social security, health security, economic security,” says Yusif Muayed Yusif, a senior official at Iraq’s Ministry of Environment who has worked on climate issues for two decades. “It affects every sector across the country.

“But if the water situation stays the same, we could see seven million more people displaced in Iraq over the next five years due to climate impacts,” he warns. “That would be catastrophic for our health system and society as a whole.”

As Iraq continues to warm, the future of its healthcare system — and the country as a whole — remains uncertain. Without major upgrades to infrastructure and increased funding, hospitals will struggle to cope with ever-rising demand.

The challenges are immense. Corruption and political instability are huge obstacles. “We [the government] are thinking only of today,” says Dr Ahmed Saleh, laughing darkly. “Every plan being told to you by the government is just showbusiness.”

Yusif is optimistic, noting that “there is now a good political understanding about the severe impact of climate change.” Plans to work across sectors to build resilience are under way. The Ministry of Health has just established a section devoted to health and climate change. Progress is happening.

But time is running out. The existential threat posed by climate change in Iraq is not just a distant possibility: it is already unfolding. The stakes are high. “We are talking about Mesopotamia, our history, our civilisation, and the future of the next generation,” acknowledges Yusif. He pauses to let the words sink in.