Table 1.

- Main challenges and obstacles faced by the Iraqi health system during the pandemic.

Obstacles	Reasons
Sudden flare up in number of patients beyond hospitals capacity	Poor adherence to health instructions and delayed closure of borders with neighboring countries
Rapid turnover of decision makers in	Inexperience, panic, overwork, pressure from other governmental unprofessional parties
Discredit the role of epidemiologists in controlling the pandemic
Uncertainty in decision making
Miss management due to lack of knowledge about the virus	Lack scientific approach in the treatment (no randomized trials)
Depending on passive rather than active surveillance	Overload on HCWs and burden on health system
Lack of periodic medical examination for frontline HCWs	Poor planning and deficient experience
Weak implementation of vaccination campaigns especially house to house	Poor planning and limited amounts of vaccine
Poor public cooperation	Panic, listening to rumors and negative effect of some religious and community leaders
Challenges
Shortage of HCWs	Migration of doctors due to the unfavorable security condition
Deficient supply of medicines	Domination of certain companies over the governmental supply
Problems in maintaining PPE	Lack of national budget
Limited bed capacity	old buildings of hospitals with no extension/renovation
Insufficient oxygen supply	Depending on oxygen cylinders
Inadequate training of HCWs	Lack of continuing medical education
Insufficient amount of PCR	Restricted to the Central Laboratory of Ministry of Health
Delayed supply of vaccination	Logistic problems

HCWs: healhtcare workers, PPE: personal protective equipment, PCR: polymerase chain reaction