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Iraqi health minister works to reform, restore neglected system. Interview by Rebecca Voelker.

THE WAIL OF AN AMBULANCE SIREN pierces the relative quiet of a downtown Chicago hotel dining room. Iraq’s Minister of Health, Salih Al Hasnawi, MD, stops in mid-sentence until the siren passes. “It’s like Iraq,” he says, injecting ironic humor into a somber conversation. During a trip to the United States last May, Al Hasnawi stopped in Chicago to speak with a group of experts who are investigating ways to use communications technologies and telemedicine to improve access to health care in Iraq. Al Hasnawi, a psychiatrist who became health minister in October 2007, spoke with JAMA about how health professionals and civilians are coping with war and the prospects for rebuilding and reforming the country’s health system. An edited version of that conversation follows. JAMA: What are the major health care challenges that physicians of Iraq face right now? Dr Al Hasnawi: There are problems of security and chaos. There is the destruction of infrastructure and looting. The Iraqi physician fears the problem of security. Some were killed. Some of them were kidnapped. Gradually, there are improvements in security. In 2008, we report only 1 case of murdering a doctor, in Basra. And there were 2 cases of kidnapping for criminal acts, for compensation. This is a very important improvement in security. The second [problem] is economical. Iraqi physicians’ salaries, and all health professionals’, [have been] less than [in neighboring countries]. But in 2008, the prime minister is supportive to promote the status of physicians and all health professionals. We have increased the salaries of Iraqi physicians by more than 2-fold. The third challenge is how to promote clinical skills. We have training courses—one is in the United Kingdom. Also we have training with the World Health Organization (WHO). [During this trip to the United States] I talked with [Department of Health and Human Services] Secretary Michael