Siham, Noor, and Maryam: three nurses talk about their merciless work in hospitals, including the related social conditions and stigmas, and low wages. This is enabling specific conditions in a profession that many practitioners are now considering leaving. On the life of nurses in Iraq.

At the end of March 2024, the Ministry of Health published the official job referral form for graduates of nursing colleges, institutes and preparatory schools in Iraq. It stated that the form would remain active on the Ministry’s website for thirty days from the date of its launch. 

But who would want a job that a person who spent years working at would just leave for another specialty? Nursing is an unappreciated profession. Nursing staff do not receive adequate compensation in their salaries for their work and are not treated with the respect required that would make them stick to a role known to some as “Angel of Mercy.” Several nurses that Jummar interviewed said, “It is work without mercy.” 

Six months prior, in September 2023, the Ministry of Finance announced the completed a new system of job rankings for appointing people in the medical, health, and nursing professions under the Ministry of Health. The number of these professionals exceeded 45,000 as defined by the amended Medical Graduation Law No. 6 of 2000. 

For Noor, a nurse, these ministerial decisions will not change her opinion, as she believes that “nurses get no appreciation.” She added, “There are not even public or private places for us to take breaks, and these are our most basic rights at work.” For that reason, she has decided to leave nursing. She plans to study another medical specialty, one where she will not have to face the daily pressures of work in a hospital in Karbala. 

“At least the pressure on them (other specialties) is less than that of a nurse in hospitals. More importantly, other specialties have greater job benefits than nursing.” Noor started on her new study path in 2020. 

A specialty that brings neither money nor recognition 

Although they are in direct contact with patients, and they experience high risk of exposure to injury and infection, and the daily effort is great, especially in central health facilities that are crowded with patients, a nurse is always viewed – in health institutions and society as a whole – as someone who failed to be a doctor. They are popularly called “the bandage” which is shorthand for their specialty and function in merely dressing and stitching wounds, although this requires great skill. 

Nurses are also deprived of the privileges of a senior position, as they do not advance to senior positions in the departments and institutions of the Ministry of Health. That is, they do not receive what they deserve in return for their effort. This is true for the nurse, Nabaa, who works in a hospital in Karbala. Something prompted her to look for a different specialty, which she found by becoming a pharmacist. “I am going back for a new degree again, despite the difficulty of the subject, to gain what I deserve. These are things I did not get from nursing,” she said in her interview with Jummar. 

Siham, a nurse who has been working for two years, works in the internal medicine department. This department is usually crowded with visitors and patients which requires the nurse to work with breaks and at the same pace throughout working hours. 

Despite this, for Siham, the nurse is the weakest point in the Ministry of Health, “We are exposed to many risks in the course of our work … over the course of my time there, I found that there is no authority that defends nurses and that nurses take the blame and face other problems.” She too, after serious reflection on her job and its difficulties, is thinking of working towards obtaining a specialism in a different field. 

Insufficient allocations 

For years, in addition to the lack of appreciation, Siham, Noor, and others who work in nursing have received lower wages than other health sector workers. This is also true when it comes to risk allowances, which are an addition to a salary given as an incentive for working in a hazardous profession. Although they are considered the most at risk, nurses were the least likely to receive fair and representative allowances. 

Until a few years ago, the risk allowances granted to nursing professions were at 50 percent. After many requests, and following pressure on the authorities, the allowances were raised to 80 percent at the beginning of 2019. Iraq’s Council of Ministers then agreed to raise the paygrade level (which disables job promotion and financial privileges once nurses have reached the fourth level) for those in health and nursing professions as well as raising their risk allowances for by 30 percent, in accordance with Resolution No. (61) of 2019. 

According to the World Health Organisation, the COVID-19 pandemic caused great harm to the health sector, as the latest figures show that an estimated 50 percent of health and care workers, who were already experiencing increased workloads and underappreciation before COVID, were suffering from exhaustion due to the significant additional burdens placed on their shoulders. 

Despite the COVID pandemic and the dangerous working conditions it created, nurses continued making demands and, on several occasions, holding sit-ins. One of the demands was that nurses working in critical departments be given higher risk allowances. After demonstrations and strikes, the government finally agreed to raise the job placement for the nursing staff and increased risk allowances to 100 percent. This was a small victory, achieved with patience and effort, which followed hardship that had lasted years. However, this was still not sufficient to do justice to those in the nursing profession, especially with continued issues related to pay scales and nurses being viewed as inferior, both within health institutions and by society at large. 

Before these shifts in government policy, and because of continued marginalisation, nurses such as Noor and Siham, along with the rest of their fellow nursing staff, were deprived of their monthly risk allowances which, according to the nurses, are a right that was taken away from them. 

Through a simple calculation made on nurses’ final monthly salary before and after the decisions to raise the risk allowance, it appears that the monthly salary difference is approximately 500 thousand dinars (just over 380 USD), which is a significant amount, and which nurses need to improve their living conditions. 

The Nursing Syndicate considers the increase of risk allowances as an important step towards enhancing fair labor opportunities and ensuring a safe working environment for nursing staff, midwives and health personnel. Some nurses believe the increase will help improve nursing work by securing similar entitlements to other medical personnel who receive higher risk allowances. However, other nurses believe that the increase is insufficient relative to the nature of their work and are demanding that their benefits be raised to 100 percent of their salaries, in line with other medical specialties. 

Regardless of this range in opinion, the increase has not been implemented yet. There is concern amongst nurses that the increase might be cancelled, due to Iraq’s economic situation and the large increase in employment planned for other sectors. Many nurses fear that the planned increase will stall before official approval. This may prevent disbursing the increase, under the pretext of lack of available funds, which is a legal argument that can be used to avoid implementing policy. 

Studying alternative specialisations 

Before the increase in the job placement quota, an employee in this profession working in the Ministry of Health would remain in at the fourth pay grade and would not be promoted to the subsequent ranking i.e., second and third, as occurs in other ministries with employees who are educated to degree level. Even after a long service in health institutions, their salary would be capped. They would not be entitled to promotion, whereas their peers in other ministries enjoy such rights as approved by law in 2013. 

Due to this uneven job evaluation, thousands of nurses have experienced exclusion and marginalisation over the years. Some nurses remain at the fourth pay grade throughout their period of service, under the pretext of not having a job description. As a result, many nurses continue to struggle with balancing the high cost of living and low salaries. 

The constant feeling of injustice for Noor, Siham, and the rest of their fellow nurses led many of them to pursue study in other medical specialties in private universities, such as dentistry, pharmacy, and anesthesia, aspiring to obtain higher salaries and more lucrative risk allowances. 

After two years in a hospital in Karbala, working in the neonatal unit, Maryam spoke with Jummar about her work, “In my opinion, nursing as a profession is a very beautiful and extremely humane specialty. In addition, it has taught me many things, including patience, love, support, and using this with my patients.” 

A nurse’s work goes beyond medical work to include a sensitive, humane approach with patients. Maryam pointed out her effort to remain a smiling and kind person for the person she cares for, considering their difficult circumstances. 

According to Maryam, whatever the psychological state of the nurse, priority must be given to the patient, and attention must be paid to patients on their return visits. 

She wonders, does the health sector consider these issues? Then she answers her own question, “Frankly, I do not see adequate appreciation in terms of how they treat us. They do not consider all aspects including salary, management, and the risk of always being in direct contact with the patient.” 

Although nursing personnel constitute an important part of the Ministry of Health – reports indicate that their number is about 90,000 nurses, out of 625,000 health personnel in Iraq- medical institutions are suffering from a shortage in nursing staff, according to Majid Shankali, Chairman of the Health and Environment Committee in Parliament. 

According to a report by the US-based CEO WORLD magazine, Iraq ranks 72nd out of a total of 193 countries, on the list of countries most in need of nurses and midwives, while ranking 11th [on that scale] in the Arab world. 

Although successive governments have opened the door to employment in the nursing profession, the idea of leaving these nursing jobs may continue to resonate with those working in them if the working conditions and stipends continue to be unacceptable.