Omicron arrives in Iraq

BAGHDAD - The number of confirmed coronavirus cases is increasing again in Iraq as the omicron variant spreads and vaccination rates remain low, but the new strain’s milder symptoms are relieving pressure on the healthcare system and oil industry operations, as fewer cases require hospitalization, doctors and oil sector officials say.

The omicron variant first emerged in Iraq in early January, and there has subsequently been a sharp rise in case numbers, in the country’s fourth wave of infections since the pandemic began nearly two years ago.

Iraq recorded 7,693 new coronavirus cases on Jan. 25, a rise from 156 on Dec. 25, 2021, exactly a month earlier, and limited testing means that real infection numbers are likely higher. A third to half of cases are of the omicron variant, a Health Ministry spokesperson said this week.

“The number of cases is increasing, especially among medical personnel, but most cases are mild and do not require hospitalization,” said Dr. Abdul Amir al-Shimmary, a consultant surgeon and former head of the Iraqi Medical Association. “There are cases among both the vaccinated and the unvaccinated, but the cases of the vaccinated are usually mild.”

Most people requiring hospitalization have refused vaccination, according to a doctor at a coronavirus isolation hospital in Baghdad.

“The number of patients in the hospital this morning was 17, and the number is increasing. Most of the patients refused to take the vaccine from the outset,” said a medical worker at the Ibn al-Khatib hospital in Baghdad, where at least 82 people were killed last year after a large fire tore through the building. “Most of the beds are occupied, and there are no pulmonary resuscitation beds left for other patients.”

During previous waves of infection, Iraqi medics reported that hospitals were overflowing with ill patients, and that staff lacked the necessary personal protection equipment (PPE), oxygen and equipment to safely do their jobs.

But omicron’s milder symptoms as well as partial vaccination of the population appear to be sparing the Iraqi health care system – already suffering from decades of conflict, mismanagement and corruption – from similar pressures, according to multiple doctors in Baghdad, Missan, and Dhi Qar.

“I don't expect a crisis,” said a senior health directorate official in Dhi Qar province, citing omicron’s milder symptoms. “There is no remarkable increase in terms of hospital admissions, despite the increase of the omicron infections.”

So far, the latest wave of infections seems to be having little impact on the oil industry. Even before omicron’s arrival, some companies working in the sector had introduced vaccine mandates, to minimize disruption to operations, and Iraqi state oil companies had reduced shift sizes to minimize workplace overcrowding. All section heads are at work, while employee levels have been reduced by half in the state-run Dhi Qar Oil Company (DQOC) and Basra Oil Company (BOC), according to company officials.

The reduced staffing levels are “sufficient” to complete tasks, according to a DQOC official. Low staffing levels at fields and private transportation – reducing social contact and transmission potential – are also protecting the oil sector against the effects of the fourth wave of infections, a second DQOC official said. But infections among administration staff and civil works laborers may delay projects and order deliveries, he added.

In Missan, the Chinese companies PetroChina and CNOOC have tightened precautions since omicron’s emergence, according to two oil sector officials in the province.

At Halfaya field, operator PetroChina has been taking “strict precautionary measures for more than a month,” according to a field official. “They are not allowing anyone to enter the company’s headquarters except for the workers there,” the official said. “The shift system at Halfaya field has also shifted to 15 working days instead of three working days, to reduce coming and going.”

State-run Missan Oil Company (MOC) has responded to the new variant by vaccinating workers, or requiring them to show negative PCR tests on arrival at work, according to Kefaya Hassan Mohammed, head of the company’s health, safety and environment authority.

In the Kurdistan region, industry officials at two oil fields reported vaccination mandate policies that withhold salaries from employees who refuse inoculation.

In October last year, the Kurdistan Regional Government's (KRG) Ministry of Natural Resources (MNR) issued an order making vaccination obligatory for all oil company workers, according to an official at the Taq Taq field.

“According to the order, salaries of unvaccinated people will be withheld for three months,” the official said. “If they insist on rejecting the vaccine, they would be discharged from work after the three-month deadline expires.”

“If you don’t get vaccinated, you will be dismissed,” said another official at Khurmala field, operated by the Iraqi-Kurdish company Kar Group.

Despite relative easing of pressures on hospitals, authorities are relying at least partially on donations to equip medical workers to fight the coronavirus. This week the World Health Organization (WHO) handed over more than 20 tons of what it described as “urgently needed” medical equipment to the Ministry of Health in the Kurdistan Region of Iraq. The goods included intensive care unit beds, PPE, and emergency medical devices.

Despite the milder symptoms presented by omicron, Iraq’s healthcare system remains extremely vulnerable, due to poor compliance with infection control measure and low vaccination rates, the aid organization Doctors Without Borders said this week. Iraq’s total covid-19 death toll stands at 24,309.

Another risk factor is continuing hostility towards medical workers. According to one of the Dhi Qar medical officials, isolation wards are not functioning as intended due to threats received by medics, disincentivizing them to staff the facilities.

“There is a big isolation center in al-Hussein Education Hospital in Nassriya, and all districts and sub-districts also have such centers, yet they are not active and do not have doctors as staff because most of the doctors received threats and suffer problems during their work,” said the official. “Most of the isolation centers are free of doctors right now, and when they receive patients, they give them oxygen and ask them to go home, or refer them to other centers to avoid problems.”

Iraqi medics have reported receiving threats throughout the pandemic, often from families of patients who accuse them of aggravating their relatives’ conditions. That is likely a result of deep distrust in state institutions and a lack of investment in the healthcare system, meaning it is often unable to meet patients’ needs.

Iraqi Kurdistan has also seen a rise in infections since the arrival of the omicron variant. In an attempt to curb infections, from Feb. 1, entrance to public spaces including government offices, businesses, shops and restaurants will be denied to individuals who cannot produce either a recent negative PCR result or a vaccination card, according to a KRG directive issued at the beginning of January.

The KRG has also made vaccination mandatory for civilian and military public servants, although it is unclear how strictly the requirement is being enforced.

In Baghdad, the supreme health and safety council chaired by Prime Minister Mustafa al-Kadhimi issued infection control recommendations on Jan. 12, as cases continued to rise. They include a requirement for all arrivals to Iraq to show a vaccination card and a negative PCR test result, extra efforts to detect forged vaccination certificates, and vaccination awareness campaigns on Iraqi state TV.

An official close to the prime minister said that the recommendations have been “circulated to the relevant authorities and their implementation has been confirmed.”

Despite the issuing of vaccine mandates in some companies, inoculation rates across Iraq remain low. The federal Health Ministry began offering booster shots in November 2021, yet just 15 percent of the population of around 40 million have received the first two doses of a vaccine, according to data gathered by Oxford University’s Oxford Martin School research centre. Around 66,000 people have had a third booster dose, a Health Ministry spokesperson said.

Iraq’s vaccination rate is lower than all its neighbors except Syria: Turkey and Iran have vaccinated 62 and 63 percent of their populations, respectively, and Saudi Arabia 67 percent. Three-quarters of people in Kuwait have been inoculated.

Iraqi medics blame ignorance and false information spread on social media for vaccine hesitancy.

“People fear the side effects of the vaccination,” said one of the Dhi Qar health sector officials. "They think it is useless and causes sterility, and that it is still under development.”

Health workers said they need more support from the Health Ministry to fight misinformation and encourage vaccination.

“The Ministry of Health needs to undertake major awareness and education campaigns," said Shimmary, the consultant surgeon. “They need to hold accountable voices that mislead people, to ensure that more people are vaccinated.”

Lizzie Porter reported from Baghdad. Rawaz Tahir reported from Erbil. Jassim al-Jabiri reported from Basra. Jewdat al-Sai'di reported from Amara. Iraqi staff reporting from Nassiriya are anonymous for their security.