The Fallujah Educational Hospital for Women and Children has one of the most sought-after maternity facilities in Iraq’s Anbar province.

The lack of quality maternity care in the region means the hospital is overloaded, with patients coming from as far afield as Karbala, 85km to the south, to make use of its already stretched facilities.

Amid the country’s numerous conflicts, Fallujah itself has changed hands numerous times – in January 2014, the city was captured by Islamic State (IS), prior even to the group’s capture of Mosul in northern Iraq.

While the city was taken back from IS in June 2016, the recovery process has been slow, and there has been little improvement in local services.

Lack of investment from central government has left the maternity hospital reliant on foreign donors for equipment.

The exterior of the Fallujah Educational Hospital for Women and Children (MEE/Alex MacDonald)

To make matters worse, for years now, babies born in Fallujah have suffered disproportionately high levels of birth defects, including congenital heart disease, gastroschisis (where the digestive system is found outside the baby’s body) and spina bifida.

Paediatrician Sameera Alani says that she generally sees around 30 cases a month of children suffering from birth defects.

Since 2009, Alani has been the leading force in documenting the cases.

On Facebook and Twitter, she and others run the the Fallujah Birth Defects group, which posts imagery of the shocking array of problems that foetuses in the region develop in the womb.

“Environmental pollution is an important cause, but we can’t say which case is related to what cause,” she told Middle East Eye

Alani explained that a lack of facilities in the hospital meant that it was difficult to determine the direct cause.

The last time a team came to Fallujah to examine the levels of environmental pollution in the local area had been in 2011, when a team of analysts from London had documented pollution in the “trees, soil and water”.

“Since then, the subject has been totally neglected and forgotten – by chance or intentionally, I don’t know,” Alani said.

Uranium exposure

Although the causes are numerous, one of the most documented reasons has been the lingering impact of uranium in the local environment, a remnant of the brutal bombardment of the town by US-led forces in 2004, as well as previous conflicts, including the 1991 Gulf War.

A 2011 report produced by Alani and British doctor Christopher Busby found that “enriched uranium exposure is either a primary cause or related to the cause of the congenital anomaly and cancer increases” in Fallujah.

Alani said that the lack of a clear registration system meant that there were no official statistics before 2003 on the number of birth defects emerging in Fallujah, and so she could only go by her own experience.

“We noticed that there are many, many cases that we didn’t see before. I have been working in this hospital since 1997 –  I used to see maybe one or two cases per month,” she explained.

In the last month, Alani said she had documented around 33 cases of birth defects and 35 the month before.

One recent case she had seen involved a woman giving birth to premature twins.

“Out of the two babies, one was born with mermaid-like legs, a condition called sirenomelia, and the other baby was born with gastroschisis, spina bifida and congenital heart disease,” she said.

She said the parents had been “hysterical and nervous” at the time of the birth.

“The father started shouting,” she said.

Despite the serious problems her department has to manage, there is little in the way of cash flow from the government’s coffers.

“The government has no budget,” she said.

“We have two important pieces of equipment in this department – one is the ultra-sound machine, which was donated from a French organisation, and an echocardiogram machine, which was a donation from a group of activists [from Japan and Sweden].”

Alani said an upcoming conference in the northern city of Erbil had been set to take place in June to encourage donations but had been postponed indefinitely.

“Nothing here is from the government – maybe only the tables and chairs!” she said, adding that the problems were not unique to Fallujah.

“Why would the protests be happening if it’s different in other areas? It’s all the same.”

Sunnis stay indoors

The inability of the government to provide basic services has sparked widespread anger across Iraq and led to more than a month of mass demonstrations.

The problems afflicting the maternity hospital at Fallujah are reproduced across the country – with activists accusing the political classes of pocketing the profits from Iraq’s vast oil reserves and allowing the country’s infrastructure to crumble.

But while corruption, poverty, unemployment and lack of services has seen protesters in Baghdad, Karbala, Basra, Nasiriyah and other provinces of Iraq take to the streets, the residents of Fallujah – like most of the Sunni-majority regions of Iraq – have stayed in doors.

At least 330 people have been killed so far in the clashes between security forces and protesters, with thousands more wounded.

Activists have also been kidnapped, tortured and repeatedly threatened for their involvement.

But while the largely Shia protesters have all these obstacles to face, for Sunnis there are even bigger concerns.

Sitting outside a garage in Fallujah, a group of men discussed their concerns about the protest movement with MEE.

“Protests are not good for the people,” said Yasser, the owner of the garage.

“They hinder economic life and many people die or become kidnapped because of these protests.”

He added that the last major protests in Anbar, beginning in 2012, had preceded the rise of IS, which no-one wanted to see again.

During the war on IS, Yassir said, his shop had been hit by an explosive barrel, destroying it. He had applied to the government for compensation, but received nothing.

‘We suffered so much when we last protested’

As Yassir was speaking, another man interceded saying people in Fallujah had “learned the lesson” from the 2012 protests, which had begun as demonstrations against unemployment and anti-Sunni discrimination by the government of then Prime Minister Nouri al-Maliki, but were later hijacked by militant groups.

“People have the right to go protest, they have a good motive, but the politicians, they don’t care. They have the post, they don’t care,” he said.

“We want to go out and protest because the people are suffering – but we cannot go out and protest because we suffered so much when we last protested… so we’re not going to do any protests here.”

Human Rights Watch has documented incidents of Anbaris being targeted simply for voicing support for the latest protest movement online.

One case documented by the US-based rights group saw a young man putting a frame around a profile picture on Facebook, showing support for demonstrators, on 26 October.

According to a relative, four police cars soon turned up at his door, beat him, accused him of “inciting protests” and then handcuffed him and took him away.

He was held incommunicado until 31 October when he was released without charge.

On 24 October, just a day before the beginning of major planned protests, a statement from Anbar Police Command warned residents against joining demonstrations.

“Anbar governorate calls upon its citizens to head to work and continue with construction, preserving security, supporting security forces, and benefitting from past lessons, from which the province has only gotten destruction, killings and displacement,” it read.

‘The rivers are also poisoned’

Fallujah has suffered greatly in a relatively short period of time and, despite promises of investment for reconstruction, the city’s ongoing health crisis is still being left unaddressed.

Yassir’s brother, Nader, said there were serious medical issues in Fallujah as a result of the white phosphorous that the US had used during the war, but said that health facilities had degraded in the city.

“Before IS came, just outside Fallujah there was a Jordanian hospital providing some very good care, but now they are closed down,” he said.

“The rivers are also poisoned – about a year or two ago, many fish suddenly surfaced dead. I was suspicious it was sabotage.”

However, so far, despite the major problems, there has been little evidence that Iraq’s Sunnis are willing to risk further violence and demonisation by publicly backing the protests.

Having barely recovered from IS’s rule, their position is still too precarious.

“If we go out protesting, they will give us terrorism charges, they will say ‘you are with IS’,” said Nader.

“We in the Sunni areas, we suffer most.”

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Featured image: Paediatrician Sameera Alani, right, in the Fallujah Educational Hospital for Women and Children (MEE/Alex MacDonald)