BAGHDAD — A fire sparked by an exploding oxygen cylinder killed at least 82 people, most of them COVID-19 patients and their relatives, at a Baghdad hospital late Saturday, a devastating example of the pandemic’s impact on a country riddled with corruption, mismanagement and a legacy of decrepit infrastructure.
The Interior Ministry said that 110 more people were hurt and that the death toll was expected to rise as more patients who suffered severe burns succumbed to their injuries.
The hospital, located in one of Baghdad’s poorer neighborhoods and dedicated to treating severe COVID-19 cases, had no smoke detectors, sprinkler system or fire hoses, said Maj. Gen. Khadhim Bohan, head of Iraq’s civil defense forces. And the fire spread even more quickly because of flammable material used in false ceilings in the intensive care ward, Bohan said.
“If there had been smoke detectors, the situation would have been totally different,” he told the state-run Iraqiya TV.
Bohan said that civil defense had inspected the hospital last year as part of 18,500 technical inspections but that its recommendations for safety measures had been ignored.
Doctors and rescuers described a chaotic scene at the hospital, which was crowded with relatives of patients. Officially, there is a ban on most visitors to avoid the spread of infection. Because of a lack of nursing staff, Iraqi hospitals, even in COVID-19 wards, depend on relatives to help look after patients.
The fire struck as the world struggled with the biggest new weekly coronavirus case total yet, in a pandemic that has stretched well into its second year. Even as wealthier countries are rapidly rolling out vaccines, more countries than ever are struggling with overwhelming caseloads and mounting death tolls.
Iraq is battling an intense new wave of coronavirus infections. On Sunday, the country reported 6,034 new coronavirus cases and 40 deaths, a figure that excludes those who died in the fire. Last week, the country of almost 40 million topped more than 1 million cases since the start of the pandemic.
Despite being one of the world’s biggest oil producers, Iraq is also suffering a financial crisis that economists attribute to decades of mismanagement and dysfunctional institutions.
The country’s health care system was devastated by more than a decade of international sanctions against Saddam Hussein starting in the 1990s. After the U.S.-led 2003 invasion and widespread looting, the country descended into a devastating civil war. In 2014, it faced the collapse of entire army divisions when the Islamic State group, now territorially defeated, took control of one-third of the country.
The government has spent billions of dollars to try to restore the health care infrastructure, but the system remains dysfunctional. Relatives must provide oxygen and medication in many hospitals that public health experts say lack proper management or basic maintenance. The country is dotted with hospitals where construction started years ago but was never finished because of corruption.
“There is a systemic failure of the entire health care system,” said Dr. Aizen Marrogi, a former liaison to the U.S. surgeon general in Iraq.
“If you walk through a hospital, a lot of the material is a fire hazard,” he said, noting the flammability of alcohol-based antiseptics and anesthesia compounds as well as oxygen.
Strained by huge patient counts and heavy energy use amid a need for more oxygen supplies and ventilators, hospitals around the world have been struck by an increasing number of fires like the one in Baghdad.
A European Commission report early this year warned of the dangers of hospital fires because of increased oxygen use. It reported almost 70 people were killed in hospital fires around the world tied to supplemental oxygen last year, including 10 in Romania. A more recent fire in April in Romania, where intensive care units have also been overwhelmed, killed three patients.
An Iraqi health ministry spokesperson said the Ibn al-Khatib hospital, where the fire broke out, had been renovated last year to refit it for treating COVID patients. He declined to comment on why the renovation did not include smoke detectors or a sprinkler system, saying that was now under investigation. Also under investigation is whether oxygen cylinders in the hospital were improperly stored.
Medical personnel at Iban al-Khatib said the fire started when a cylinder filled with oxygen caught fire and then exploded, setting off a chain reaction of exploding canisters that quickly ripped through the intensive care ward, where patients were crowded four to a room. Without a central sprinkler system or fire hoses, relatives and staff used small fire extinguishers in a futile attempt to put out the fires.
As everything from hospital bedding to ceiling tiles started to burn, filling the ward with choking smoke, staff and patients’ relatives started breaking windows to try to jump down to safety from the second floor.
Among the dead were many older patients, including some on ventilators, who could not move from their beds when the fire started, officials said. Some of the bodies were so badly charred, they will need DNA tests to be identified.
“It was a horrible scene,” said Dr. Waad Adnan, a hospital resident who was in the physicians’ quarters next to the hospital when the fire started. “There was the sound of explosions and then huge balls of fire. The hospital staff did their best to turn off the central oxygen, but the canisters began exploding.”
Without oxygen, some of the sickest patients lived for only minutes. Others either died from smoke inhalation or burned to death.
Adnan said one of the reasons the death toll was so high was that the overcrowded hospital ignored restrictions on visitors to what were supposed to be isolation wards.
One Facebook notice listed five members of one family who died in the fire: a tribal sheikh being treated for COVID-19, his wife and their three sons. With the most seriously ill patients on ventilators, many of the relatives died when they refused to leave their loved ones.
Adnan, in a phone interview, said that from outside the hospital, he had seen patients and their relatives breaking windows and throwing themselves from windows to escape the fire.
Before firefighters arrived at the hospital, on the outskirts of Baghdad, hundreds of neighborhood volunteers rushed to the scene to try to rescue the wounded.
A neighborhood tuk-tuk driver who lives near the hospital, Ahmed Hassan, said that he and other drivers rushed to the hospital to try to help a friend’s aunt who was being treated for COVID but that when they arrived, they found she had already died.
“I couldn’t see anything but heavy smoke and people running and shouting and charred bodies,” said Hassan, 19. “I heard screaming and saw smoke and people cursing the hospital staff for not helping the patients.”
He said he and other young men spent an hour running in and out of the hospital trying to rescue patients while the fire burned. Some were able to walk, while others, he said, he pulled from their beds.
“I found one of the people who was not able to move, and I yelled, ‘This man is still alive; we can save him!’” he said.
The older man clung to him and asked him not to leave him. He said, “‘Please, this is my phone. If I die, tell my family I forgive them for everything.’”
The man died Sunday.
Nizar Jabar al-Lami, a policeman, said his wife, Marwa, 29, had gone to the hospital to take care of her mother. They both died in the fire. Al-Lami, in tears, said they had buried his mother-in-law, 75, but were still trying to identify his wife.
“Until now I cannot recognize her to be able to bury her because she is among the charred bodies,” he said.
Prime Minister Mustafa al-Khadimi called the fire a crime and ordered an investigation. He also ordered the health minister suspended and the detention for questioning of the health director for the Rasfah area of Baghdad, where the hospital is. The hospital’s director and its head of engineering and maintenance were also ordered detained.
Kadhimi came to power promising reform after the previous prime minister was forced to resign after widespread protests two years ago against government corruption and lack of public services. But the system that fosters both by assigning government ministries to specific political parties has remained in place.
The health ministry has traditionally been controlled by the Sadr bloc, followers of Shiite cleric Muqtada al-Sadr, who on Sunday tweeted that if the health minister was at fault, he should step down.
President Barham Salih said the tragedy was a “result of the accumulated destruction of state institutions due to corruption and mismanagement,” in a post on Twitter. “Showing pain and sympathy with our martyrs and injured sons is not enough without strenuous accountability for the negligent.”