Approximately 5 billion people, or two-thirds of the world’s population, lack access to safe, affordable surgical and anesthesia care; and of
the 313 million procedures that are performed globally each year, only 6 percent are done in the poorest
countries. 1 These staggering statistics speak volumes
to the need for intensive capacity building in many
parts of the world.
After decades of oppression, the people of Kurdistan,
Republic of Iraq, have sought to build an independent
nation—one with a self-sustaining health care system.
This article describes how several Fellows of the American College of Surgeons (ACS) provided care to the
victims of the malevolent regime led by Saddam Hussein and assisted in the establishment of a sustainable
health care system.
Background on Kurdistan
The Republic of Iraq borders six countries in the Middle
East—Jordan, Syria, Turkey, Iran, Kuwait, and Saudi
Arabia. Iraq encompasses approximately 168,753 square
miles (437,072 square kilometers), which is three-fifths
the size of Texas. In 2015, the population was 36,575,000,
making it the fourth-most populated country in the
Middle East. 2
Iraq’s current borders were drawn in 1920 under the
Treaty of Sèvres, which allowed the League of Nations
to partition the collapsed Ottoman Empire. 3 For Iraq,
the treaty had essentially amalgamated three different
groups of people—the Arab Shi’ites and Sunnis and the
non-Arab Kurds—into one nation. A plethora of other
minority groups, such as the Assyrians, Turks, and
Kurdish Yazidis, also inhabit the country. The Yazidi
Kurds practice their ancient religion, Zoroastrianism,
and have been persecuted by the Islamic State in Iraq
and Syria (ISIS), also known as the Islamic State in Iraq
and the Levant (ISIL), since June 2014.
The Kurds are descendants of the Indo-European
tribes who resided in Iraq (Ararat Mountains of
Mesopotamia) in the fourth century BC. An estimated
45 million Kurds live in Kurdistan, an area that is spread
throughout the bordering states. Approximately 6. 5
to 7 million Kurds reside in northern Iraq (Kurdistan
of Iraq), comprising about 17 percent of the popula-
tion of Iraq. 4 The Kurds have their own culture and
language; very few self-identify as Arabs. In fact, their
history demonstrated fierce resistance against Arab
expansion in the sixth century. The Kurds may be the
largest ethnic group in the world that does not have
its own nation.
In June 1992, Kurdistan formed its own parliament
for the first time in its history. Members of parliament
are freely elected, and the government has an appointed
cabinet and functions under a ratified regional constitution. From our multiple trips to Kurdistan, we have
found the Kurds to be extremely gracious people. They
were quick to embrace and thank the U.S. for liberating them from Saddam Hussein’s regime.
Early trips to Kurdistan
Dr. Zibari, a co-author of this article, was one of the
fortunate Kurds who survived Mr. Hussein’s atrocities;
more than 50 percent of his high school classmates
were murdered during the Iraq/Iran war and the Iraqi/
Kurdish war. On May 1, 1976, Dr. Zibari immigrated to
the U.S. after graduating from high school in an Iraqi
Kurdish refugee camp in Kurdistan of Iran.
Like many other exiled Kurds, Dr. Zibari was forbidden from returning to Iraq, with a threat of immediate
execution by Mr. Hussein. However, after 16 years in
absentia and immediately after the first Gulf War, he
returned to his native land in June 1992 after completing a solid abdominal organ transplant fellowship at
the Johns Hopkins University School of Medicine, Baltimore, MD. His return was possible due to the no-fly
zone over Kurdistan, which the North Atlantic Treaty
Organization (NATO) established to protect the mass
exodus of Kurdish refugees who had fled Mr. Hussein’s
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OUTREACH IN KURDISTAN, IRAQ
HIGHLIGHTS
• Describes the health care issues that
affected the people of Kurdistan after
decades of Iraqi dictatorship
• Illustrates the role ACS Fellows played in developing
a sustainable health care system in Kurdistan
• Offers advice to surgeons who are interested
in leading similar efforts in war-torn nations
