Abstract
Background: Since the 2003 United States–British coalition military invasion, Iraq has been in a state of continuous deterioration at all levels, including the health sector. This study aimed to elicit the viewpoints of the Iraqi people on the current health system, focusing on many provided health services and assessing whether the public prefers the current health system or that was provided before the invasion.
 Methods: A cross-sectional survey designed to explore the Iraqi people’s opinions on their health system. A self-administered questionnaire using a multi-stage sampling technique was distributed in five geographical regions in Iraq to collect the data from the head of household between 1st October and 31st of December 2019. Multiple logistic regressions were recruited to determine the significant contributing variables in this study.
 Results: A total of 365 heads of households (response rate: 86.1%) with the mean age of 48.36 + 11.92 years (ranged 35-78) included in the study. Most of the respondents (61.4%) complained of healthcare inaccessibility, 59.7% believed that health resources were not available, 53.7% claimed a deterioration in the quality of care, and 62.2% believed that the political / media position did not contribute to positive changes during the past two decades. Indeed, most respondents (66.0%) believe that the current healthcare system is worse than before. In the multivariate analysis, there was a statistically significant relationship between the characteristics and opinions of the respondents. Old age group (p = 0.003), men (p = < 0.001), married (p = 0.001), low educated (p = < 0.001), rural resident (p = < 0.001), unemployed (p = 0.003), monthly income of less than USD 400 (p = < 0.001), consider themselves to be unhealthy (p = 0.001), and those who think that people are unhappy now than two decades ago (p = 0.012) have a more negative opinion of the health system.
 Conclusion: Most Iraqis surveyed expressed disappointment from the health system after the 2003 United States–British Coalition military invasion. The current health system is faltering at all levels and does not meet the citizens' basic needs. Health Transformation Program (HTP) has become inevitable to develop an accessible, affordable, high-quality, efficient, and effective health system.
Highlights
Since the 2003 United States–British coalition military invasion, Iraq has been in a state of continuous deterioration at all levels, including the health sector
Iraq is a member of the United Nations (UN), the Non-Aligned Movement (NAM), the Organization of the Petroleum Exporting Countries (OPEC), the World Trade Organization (WTO), and several other regional and international organizations
We have found that the old age group, unmarried, males, unemployed, rural residents, those who believe that people are unhappier than two decades ago, and those who have an annual income of less than USD 400 more negative opinion on the current health system
Summary
Since the 2003 United States–British coalition military invasion, Iraq has been in a state of continuous deterioration at all levels, including the health sector. Iraq is a member of the United Nations (UN), the Non-Aligned Movement (NAM), the Organization of the Petroleum Exporting Countries (OPEC), the World Trade Organization (WTO), and several other regional and international organizations. And geographically, Iraq constitutes the most significant part of ancient Mesopotamia (the ancient historical region extending between the Tigris and Euphrates). Ancient Mesopotamia, part of the so-called Fertile Crescent, covers the regions between the Euphrates (East) and the Nile (West). The Iraqi people in Mesopotamia are innovators and skilled makers of human civilization. They taught the humanity of the writing and were the first to convert the language of speech into letters and the first who established written legal code for humanity. Iraqis were the first who invented the wheel in history, and the first electric battery was "Baghdad Battery" and agriculture, urban planning, foreign trade, astronomy, medicine, engineering, mathematics, and many other sciences [3]
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