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I started training to be a doctor in the aftermath of the gulf war. It was a dark time to commit to a career of healing. U.S. sanctions and relentless bombings had decimated our medical infrastructure and endangered our access to medical supplies. Surrounded by devastation, we fought to heal, to operate, to comfort often with the barest of resources. Every day was a battle in itself, trying to save lives as our facilities crumbled around us.

The U.S. invasion of Iraq in 2003 pushed a teetering health care system to the brink. Bombings and counterinsurgency operations relentlessly flooded hospitals with injured civilians. Overwhelmed with patients and scrambling for time, doctors and other medical workers around the country were forced to make heart-wrenching decisions about whom, realistically, they could save. Direct attacks on hospitals perhaps dealt the final blow to Iraqs crumbling health care capabilities, once a source of pride across the Middle East.

Now the world is witnessing another war in which a health care system that was already under distress is being destroyed. I see alarming parallels between what I witnessed in Iraq to what is happening in Gaza, from widespread shortages of essential supplies to soaring infection rates to military targeting of hospitals. When health care services, infrastructure and expertise are destroyed during war, they are often lost forever. In their absence, a permanent public health crisis threatens the lives of survivors who have nowhere else to go. As someone who has devoted much of his career to documenting the grave consequences that come from attacking health care, I cannot help but feel a haunting dj vu in Gaza.

Although targeting hospitals and health care facilities during war is illegal under the Geneva Conventions, with very narrow exceptions, these attacks have increased sharply over the past two decades, especially under the aegis of fighting terrorism. In 2021 the World Health Organization reported that at least 930 health care workers were killed in 600 attacks during the Syrian civil war. Syrian and Russian forces have seemingly attacked hospitals under the claim that they were striking terrorist targets.

Comparable incidents have occurred in several other conflict zones, including Yemen, Sudan, Ethiopia and Libya. A particularly haunting episode was the U.S. bombing of Doctors Without Borders trauma hospital in Kunduz, Afghanistan, in 2015, killing at least 42 people. The United States later admitted that it was a tragic mistake; the hospital that was struck was not, in fact, controlled by the Taliban, as was originally reported. Russia has conducted over 1,110 attacks on health care operations in Ukraine since it began its invasion the most that the W.H.O. has counted in any humanitarian crisis to date. These attacks have included bombings of hospitals, torture of medical personnel and assaults on ambulances.

The concept of civilian collateral damage has become disturbingly normalized, resulting in the targeting of hospitals, the easy killing of the sick or injured and the erosion of civilian health care during wartime. When it comes to global conflict, hospitals are no longer safe havens. With the right justifications, they readily become battle sites.

When hospitals are turned into battlegrounds, they cease to provide care, paving the way for health crises that persist long after the guns fall silent. Last February, I returned to Iraq to further study wars impact on the global surge of antibiotic-resistant bacteria. Over the past decade, the U.N. has been sounding the alarm on antimicrobial resistance the resistance of bacteria to antibiotics and other drugs predicting it could cause 10 million deaths annually by 2050.

In conflict zones, the collapse of health care infrastructure and the unchecked use of antibiotics fuel the spread of resistant bacteria far beyond immediate areas of hostilities. One example is Iraqibacter, or Acinetobacter baumannii, a superbug that was brought back to U.S. hospitals by injured troops who served in Iraq and Afghanistan. Iraqibacter infects wounds and spreads through bloodstreams to cause a range of medical woes, including sepsis, meningitis, loss of limbs and death. A 2022 study published in The Lancet lists Iraqibacter as one of the six deadliest among drug-resistant pathogens. Together, these six pathogens are responsible for millions of deaths.

During my month in Iraq, I spent time among Mosuls ruins, reconnecting to the city of my childhood memories and my fathers birth. The 2016-17 battle of Mosul is said to be one of the deadliest urban military operations since World War II a comparison that is also eerily being applied to Israels offensive in Gaza. For nine long months, Iraqi security forces backed by the United States fought to reclaim the city from ISIS fighters. The battle, marked by intense aerial bombardment, saw health care facilities become central, intentional battlegrounds. Nine of the 13 public medical centers serving Mosul and its surrounding community were severely damaged.

I took an afternoon to drive by the remains of Al Shifa hospital complex, once the citys largest. Where there was once a sprawling main hospital, I saw nothing but a shell. The gutted structure, exposing concrete slabs and twisted rebar, stood on the Tigris Rivers western bank as a somber testament to the citys loss. Six years after the battle, the scars of war remain visible everywhere. Neighborhoods erased during the war have yet to be rebuilt. The citys public hospitals are in ruins, despite reconstruction efforts, and many displaced families have yet to return home. Local clinics are still overwhelmed, and antibiotic resistance is one of the highest in the region. Mosuls sewage a dangerous cocktail of toxic waste and debris poses a threat to those already suffering from health issues.

Mosuls destruction not only highlights the immediate, physical impact of war but also how challenging it is to rebuild essential services in its wake. It is a living testament to how health care crises tend to compound one another, creating incredibly dangerous environments long after the cessation of hostilities.

Gazas plight has eclipsed the devastation I witnessed in Mosul and other conflict zones, with death and injury rates soaring to unthinkable levels. Marooned in what amounts to a public health dystopia, the residents of the Gaza Strip cannot flee, as in other conflicts. In northern Gaza, nearly all hospitals have shut down because of the lack of electricity, working sewerage, clean water, food and essential health care supplies. Doctors struggle to provide care to a young population amid severe shortages. They are encountering unusual injuries, potentially indicative of new weapons being tried in the conflict, all while being killed themselves. A Doctors Without Borders report published by the medical journal The Lancet last month warned that antimicrobial resistance may lurk as a silent threat in the enclave. Infants are in neonatal care while tanks and snipers are at the hospitals gates. Worst of all, there seems to be no end in sight.

Since I began writing this essay, there have been new reports of widespread diseases ravaging Gaza. As if the aerial destruction werent enough, Israels assault on Gaza has set off a public health time bomb. The imperative is clear: The war must be brought to an immediate end, substantial humanitarian aid must be poured in, and Gazas medical and surgical services must be restored. The world must not stand for the targeting of the sick and dying no matter what the military justification is.

Omar Dewachi is the author of Ungovernable Life: Mandatory Medicine and Statecraft in Iraq. He is a medical anthropologist and global health practitioner based at Rutgers University.

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Opinion | The Destruction of Gazas Health Care Promises Grave Consequences - The New York Times

Fifteen years ago today, an Iraqi journalist stood up in the middle of a press conference in Baghdad and shouted in Arabic, This is a farewell kiss from the Iraqi people, you dog! and then proceeded to hurl his shoes, one after the other, at then-President George W. Bush. The gesture by the journalist, Muntadhar al-Zaidi, had dire effects on his own life a risk he was well aware of beforehand but it lives on in the public imagination worldwide as perhaps the most effective individual protest against Americas bloody and ultimately disastrous invasion and occupation of Iraq.

Al-Zaidi flung his footwear just weeks after United States voters had given Barack Obama a landslide victory to succeed Bush, in no small part on the strength of the position that Bush had launched a dumb war. If Bush thought he might somehow repair his outgoing 24 percent approval rating with a press conference alongside an apparently stable and benevolent Iraqi leader, he was mistaken or was at least thwarted by al-Zaidis viral protest.

But beyond putting a U.S. president on his heels and relegating his Iraqi partner to a hapless goalie trying to block the second shoe, the event presaged an era of American presidential politics that has been rife with indignities: Think Representative Joe Wilson shouting You lie! to President Obama, the U.N. General Assembly laughing uproariously at President Trump, and Marjorie Taylor Greene belting Liar! to President Biden.

I dont think something like that would seem out of place today, in a world where people feel emboldened to express their displeasure with pretty much anybody without hesitation, said Jennifer Loven, who covered the 2008 press conference as the chief White House correspondent for the Associated Press. The fact that that was so unusual just 15 years ago seems kind of weird to me now. In the months and years afterward, dozens of copycat incidents occurred around the world with angry citizens, inspired by al-Zaidi, firing shoes at political figures.

Lost in the coverage of the theatrics, though and the subsequent memeification of the moment was the fact that al-Zaidis life changed forever in that moment. The Iraqi journalist, now 44 and living in Baghdad, was sentenced to three years in prison (spending nine months there) and describes being tortured. He claims to have been blacklisted from the media industry and today struggles to make a living as a consultant. For this story, he offered a detailed account of his thinking, his actions, and the punishment he endured as a result of his encounter with Bush. Loven and others who were at the infamous press conference also shared their memories and impressions. They were unanimous in thinking in the heat of the moment that the first airborne shoe wasnt merely a protest but a bomb that would blow them all up and unanimous in being unnerved by what happened to al-Zaidi afterward.

Jennifer Loven, chief White House correspondent for the AP in 2008: These secret trips were still remarkable for us in the White House press pool, even by the end of Bushs tenure. You go to Andrews Air Force Base in the dark of night, turn in your phone and computer, board the plane in the hangar with all the windows down, and youre not allowed to tell anybody that youre going, all that cloak-and-dagger stuff that surrounded one of these trips. So naturally, when all those protocols are in place, you just get a heightened sense of, Oh, we must be in danger. And of course there was danger, as there always was with these war-zone trips.

President Bush had a lot he wanted to say about his legacy before he left office. And so he was taking this trip, which had some very practical aspects to it around the signing of the U.S.-Iraq Status of Forces Agreement, but it was also a bit of a good-bye lap. I wouldnt call it a victory lap. But I do remember that Bushs relationship with the Iraqi prime minister, Nouri al-Maliki, was important to him. Al-Maliki wasnt universally loved, but he was doing a reasonably good job by that time, and I think there was a sense of pride around that. So you kind of take the wins you can take. That was probably part of the calculation of taking the trip, that this was a guy you could feel good standing next to. Did we know where this was all going? No, but probably if you asked the Bush team at the time, theyd say they could feel like, We didnt make a giant mistake. It turned out well in the end.

Olivier Knox, White House correspondent for Agence France-Presse in 2008: We were watching to see if there would be a Status of Forces Agreement signed between Bush and Nouri al-Maliki, basically the rules of the road for American troops in Iraq for Bushs successor, Barack Obama. But there was also a symbolic portion Bush sort of summarizing the American experience in Iraq and giving his farewell.

Muntadhar al-Zaidi, chief correspondent for Al-Baghdadia TV in 2008 and the man who threw his shoes at President Bush: Leading up to that 2008 press conference, what I had seen was my country invaded and occupied without justification. Maybe the Iraqi people were desperate to get rid of Saddam. Regardless, I didnt want to see it done by foreign forces. My people were humiliated. The American forces killed people in the street. They scared and intimidated my people when they raided their houses in the middle of the night. So the Americans behaved in a savage way.

As a journalist, I covered many stories of rape by American soldiers. There was one child that was raped and killed and then the American soldier accused the insurgents.

AP photographer Evan Vucci captures Muntadhar al-Zaidi in the moment after he threw his shoes at Bush. Reporter Olivier Knox, then of AFP and now at the Washington Post, is at right. Photo: Evan Vucci/AP

Knox: Obviously, Bushs trip to Iraq was going to look very different from inside Iraq as it would look from inside the United States, even though by then it was pretty well established that the president had misled the country into war, no weapons of mass destruction would be found, and we were all keenly aware of the enormous civilian and economic toll. Which is in part why AFP had local reporters as well because it was always envisioned that the final product would be some kind of a combination story from the two perspectives.

I spoke to the local AFP reporter after the shoes were thrown. What just happened? I asked. Oh thats Muntadhar al-Zaidi, he said. Hes been saying for six months that if he ever ends up in the same room as George W. Bush, hell throw his shoes at him. Which raises the question: If the Iraqi press corp knew, why didnt Iraqi security?

Al-Zaidi: I didnt tell anybody what I was going to do. But I did plan it, which included considering the consequences. I even recorded my will, thinking that I could be shot and killed by the American guards. Or, short of death, enduring torture, solitary confinement, and defamation. I even decided to wear slip-ons so they were easy to take off. My initial plan was to only throw one. But if I missed my target and had an opportunity to throw another, it would be easy to throw the second one. So I was ready physically and spiritually.

On the way into the press conference, the Iraqi security was like I hadnt seen before. We were scanned and searched. Iraqi security even took my shoes off and checked them. When they did that, I thought to myself, Thats the weapon I have, and smiled.

Right before entering the room with Bush, two American guards were randomly frisking members of the Iraqi press pool, which I took to be a great indignity. If you are in the U.S. and the Russian president comes, American journalists arent checked by Russian guards. One of them, after searching the journalists in front of me, slapped them on the butt, which I took as a great insult. I prayed to God that he would not search me, for fear that I would get angry and lose control before I had a chance to carry out my plan. He did not search me.

Then I was in the room of the press conference with my crew: a cameraman and a reporter. I took off my ring, which had sentimental value, and gave it to my cameraman. I said, Listen, give it to my brother and say hi. I didnt say why. Then I gave him my wallet. Then I gave him my money and my identification.

My first impression of Bush when he entered the room was a devil without horns. I saw him as a weak person. I was thinking, How come this weak person waged wars in Afghanistan and Iraq and killed many people, including Americans, and destroyed the American economy? My impression was that he was a nobody. I felt sorry for my people, for the American people, that this nobody caused all this damage.

When the time came, I did think about not reacting. I thought to myself, Why do you want to do this? Youre still young. Youre chief correspondent of a TV channel. You have money. You have a car. Youre not yet married. You have a future. Why do you want to sacrifice all of this? At that moment, my adrenaline got low. My heartbeat got low. For a few moments, I felt relaxed. But suddenly, I had another thought to myself: If I dont do it, I will consider myself a coward all my life. If I dont do it now, I will betray the blood and sacrifice of my people. Then the adrenaline went back up.

Bush was talking, saying he would have a dinner with Maliki after the press conference. And I said to myself, I have a good dinner for you. Youll eat my shoe!

When Bush finished talking, I stood up and yelled, I want to give you a good-bye kiss from the Iraqi people, you dog!

I wanted to give him a warning. This is what we call the ethics of knights, or knights honor.

Evan Vucci, staff photographer for the Associated Press in 2008: Al-Zaidi was behind me to the right. I heard him yelling. I turned to the noise, thinking it was a suicide bomber, and got off like two frames with my camera.

Knox: All of a sudden, we saw something solid and black sail over our heads. My first thought was, Is that something thats going to go boom? We all sort of hunched down. Covering the White House means you become very aware that the last place you want to be is between the Secret Service and a threat to the president of the United States.

Loven: I notice in my peripheral vision a black thing going really fast right next to my head, and I freak out. Leading up to that, there are so many security measures. You know, when you travel by helicopter from one part of the Green Zone to another, you wear a bulletproof vest. There are lots of messages sent about This is not a safe place. So in my mind, I thought bomb immediately. So I dive to the floor and my shit scatters everywhere. And Bush ducks and then another one comes. It was chaos.

Al-Zaidi: The room was filled with armed men. This confrontation was not a game. First, I felt satisfaction, but then I felt the pain. After I threw the second shoe, one cameraman pulled me by my belt and put me down. Then I was attacked by the guards of Prime Minister Maliki and one American guard. I was screaming, insulting George Bush, yelling, You are a dog, you killed my people! And they shut my mouth. They beat me, they broke my nose, and they broke my teeth. I think I even swallowed a tooth.

Knox: Iraqi security were beating him. All I could see was a dogpile with fists flying.

Bush in the moments after ducking the two shoes. Photo: SAUL LOEB/AFP via Getty Images

Loven: They were beating the shit out of him. He was first beaten up by his peers, then Iraqi security. All I could remember was total mle behind me. But I was in reporter mode, just trying to do my job. So once I realized it was a shoe, I called my desk, and theres people sitting there waiting for me to dictate news alerts to them. I call and say, You have to put this on the wire: Man throws shoe at Bush. And theyre like, No, were not putting that on the wire, thats ridiculous. Im like, No, you have to. Its a really big deal! They didnt understand. It was just weird. Man throws shoe at Bush doesnt tell you very much. I explained it and then they did put it on the wire.

Vucci: All the photographers in the room were freaked out. None of us got that photo of Bush and the shoe in the same frame. We were all worried. This is a once-in-a-lifetime photo, and it happened in front of you and you missed it.

When they were beating him up, I was concerned about getting the photos I did have out of the room. I was worried that the Iraqis beating up al-Zaidi were embarrassed and would want to destroy the image. So I switched the cards in my camera and put the card with the images in my pocket.

Dana Perino, the press secretary, ended up getting a black eye (a boom mic fell on her). In all the chaos, I look behind the podium and I see the shoe on the ground. And Im like, Man, that would be an awesome souvenir.

(Perino, now a host on Fox News, declined to be interviewed for this story.)

Knox: And then they dragged al-Zaidi behind closed doors.

Loven: The Iraqi journalists were apologizing to Bush, and he and Maliki played it off. Bush was even a little jokey about it. And he talked about the ability to protest. The content of what he said was the right thing to say. Thats what happens in free societies, the president said.

Knox: There was fresh blood on the carpet.

Loven: There was a trail of the blood that led down the hall. And, I mean, you could hear the guy screaming.

Vucci: I remember being unnerved by the screaming. It was loud. Like, Okay, its probably under control. You dont gotta beat the guy. Hes no threat. Why do you need to continue to do that?

Al-Zaidi: They took me outside the room. They tied me with cable, and Malikis nephew beat me with a pipe. He broke my foot. I knew it was Malikis nephew because he was his personal guard. He always stood behind Maliki.

The Iraqi journalists who were apologizing to Bush were pro-occupation, pro-Maliki. They were propagandists. They took bribes to write stories praising the prime minister. So I was not surprised that they were against me.

I was surprised by the western journalists. They were hearing me being beaten and tortured. But none of them asked the president or the prime minister a question about me being beaten and tortured.

Loven: That day, facts were hard to come by. We could hear him screaming, but we wouldnt have any way of knowing in the moment what was actually happening. Im sure we asked about it either later in the trip or back in the U.S.

Eight days after the Baghdad press conference, a reporter asked Deputy Press Secretary Tony Fratto at a White House press briefing, Is the White House at all concerned about reports by the brother of this Iraqi journalist who is being held for throwing his shoes at the president? His brother says, in visiting the journalist in jail, he sees signs hes been tortured, missing a tooth, cigarette burns on his ears

Fratto responded, Hes in the hands of the Iraqi system. I dont have anything more on the shoe thrower. I think its been explored extensively, and I have nothing new for you.

Knox: At the Baghdad press conference, we had no firsthand indication that while al-Zaidi was being treated roughly, he was being tortured.

Vucci: If I was in a position to show Iraqi security doing that to that man, I would have absolutely shown that. My job is to document the world around me. Theres just no way for me to actually see it. I couldnt get out of the room. But I do remember that after they subdued him, it should have stopped. Thats just human decency.

Knox: We were focused on the president. The shoe throwing completely redefined the trip. Bush knew this entire trip was going to be boiled down to that one act of defiance. It was no longer about President Bush sending a symbolic message or grappling with a Status of Forces Agreement. It became about a very angry journalist throwing his shoes at the president of the United States in a gesture of loathing. And one that we were familiar with because years earlier, when the marines pulled down the Saddam statue, Iraqi citizens lined up to pound the statue with their shoes. We were familiar with the cultural message there, the importance that it was a shoe and not a reporters notebook.

Al-Zaidi: A judge at the trial said, You attacked and insulted a guest of our country. Theres a law against that. I said, We are Arabs, we are known for generosity. But the law doesnt apply with Bush because he didnt come as a guest. He came to Iraq by force. He invaded. Based on my argument, the judge asked the prime ministers office if Bush had been invited. The prime ministers office replied that he was, and I was given my sentence three years in prison for assaulting a foreign head of state during an official visit.

The just outcome would have been putting George Bush in prison, not me. I would ultimately spend nine months in prison, three of those months in solitary confinement. A very small cell that basically only fit my body. Each day is like a year. I was not allowed to talk to anyone. And only allowed to go to the bathroom three times a day. Sometimes I peed in a water bottle. I got through it with yoga, working out. I prayed. Im a Muslim, but Im against the Islamic Party. Theyre medieval.

While in prison, I did find out about the statue of my shoes that was erected. The government tore it down the next day. I was honored that Iraqi society supported me but was laughing at how the government was afraid of a shoe statue.

When I was released, the first statement I made was Im a free man now, but the nation is still in a prison.

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The Bush Shoe Throw Oral History: Where Is al-Zaidi Today? - New York Magazine

Iranian-backed proxies continued to attack US forces in Iraq and Syria this week, including overnight between Wednesday and Thursday, according to media reports.

Irans Tasnim News Agency boasted of one such attack on Thursday. It said there had been explosions at the US outpost near Conico in eastern Syria. This area is near the Euphrates River and east of the city of Deir ez-Zor. Iran has many militias that operate on the western side of the river near Deir ez-Zor. The US operates on the eastern side with the US-backed Syrian Democratic Forces, which fight ISIS.

Iranian media outlets said there were reports of a missile attack on this base. They also cited Al Mayadeen, a pro-Iranian news channel based in Beirut, which reported: On the other hand, some news sources reported a drone attack on the American forces in al-Shaddadi base in Syria.

Having so many media outlets that are pro-Iranian regime report on these attacks sends a clear message. It shows how Iran wants to increase these operations.

Tehran has been frustrated in attempts to back Hamas in Gaza and achieve a ceasefire there to help Hamas stave off the continued Israeli operations. In fact, its clear now that Iran and its proxies are concerned.

IDF operations will continue into January, Al Mayadeen reported. Tehran needs to keep Hamas intact to some extent in Gaza while maintaining Hamass influence in the West Bank.

Toward that end, Iran seeks to inflame Syria and Iraq and to use the war in Gaza to increase attacks on the US. Tehran wants the US to leave Syria and Iraq so that Iran can dominate Syria, Iraq, Lebanon, and Yemen and then threaten Israel directly.

There have been recent attacks on Al-Asad Airbase in Iraq, where US forces are. In addition, the Syrian Democratic Forces located rocket launchers after an attack near Shaddadi, Kurdistan 24 reported. Omar Abu Layla, an expert on Syria, also wrote on X about the attacks on Conico.

There have been almost 80 attacks on US forces in Iraq and Syria since Hamass October 7 attack on Israel.

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Iran-backed attacks on US forces in Syria and Iraq continue - The Jerusalem Post

Just south of Baghdad, the urban sprawl gives way to glimpses of green, with lush date palm groves bordering the Euphrates River. But few risk spending much time there. Not even the Iraqi military or government officials venture without permission.

A farmer, Ali Hussein, who once lived on that land, said, We do not dare to even ask if we can go there.

Thats because this stretch of Iraq more than twice the size of San Francisco is controlled by an Iraqi militia linked to Iran and designated a terrorist group by the United States. Militia members man checkpoints around the borders. And though sovereign Iraqi territory, the area, known as Jurf al-Nasr, functions as a forward operating base for Iran, according to one of the dozens of Western and Iraqi intelligence and military officers, diplomats and others interviewed for this article.

The militia that controls the land, Khataib Hezbollah, uses it to assemble drones and retrofit rockets, with parts largely obtained from Iran, senior military and intelligence officials say. Those weapons have then been distributed for use in attacks by Iranian-linked groups across the Middle East putting this former farmland at the center of fears that the war in Gaza could grow into a wider conflict.

Such attacks have increased sharply over the past two months as Khataib Hezbollah and other groups linked to Iran have rallied to show their solidarity with Palestinians. Since Oct. 17, Iraqi groups have launched at least 82 drone and rocket attacks against U.S. military installations just in Iraq and Syria, wounding 66 service members, according to the Pentagon. Many of the attacks used weapons from Jurf al-Nasr, regional intelligence sources say.

Responding to the recent attacks, the United States bombed two locations in Jurf al-Nasr, killing at least eight members of Khataib Hezbollah, according to the Pentagon as well as the militant group.

They have rockets, mortars, missiles, said Gen. Kenneth F. McKenzie Jr., who retired last year as the head of U.S. Central Command, which oversees American forces in the region. He said he did not know the exact ranges that the weapons might have now, but that in 2020 when he oversaw the last U.S. effort to reduce the arsenal some could reach targets in Jordan, Syria and Saudi Arabia.

For decades, Irans Middle East strategy has been to meld informal military power through local armed groups with political influence over government policies. Starting in the 1980s, it helped finance and arm Lebanese Hezbollah. Then it gave expansive military and political support to the Syrian regime of Bashar al-Assad; military aid to the Houthis in northern Yemen; and support for the Al Ashtar Brigades in Bahrain.

But Iraq is Irans most natural regional partner, even if the countries once fought a long war against each other.

They share a 1,000-mile border; many families have relatives on both sides; and economic ties are strong. Also, Iraq, like Iran, has a Shiite Muslim majority, and it is home to some of the most important Shiite shrines.

After Iraqs 2021 elections, Iranian-linked political parties, most with militia wings, claimed for the first time a large enough share of parliamentary seats to form a governing coalition and select the prime minister, Mohammed Shia al-Sudani. This tied him politically to parties whose priorities are often shaped as much by Tehrans concerns as by Baghdads.

For the United States, Tehrans political gains in Baghdad, and the commandeering of Jurf al-Nasr by a militia allied with Tehran, are a startling reversal of fortune.

Over the past 20 years, Republican and Democrat governments alike invested $1.79 trillion in overthrowing Saddam Hussein, battling Al Qaeda and joining Iraqs fight against the Islamic State, all with the aim of creating stability and a reliable ally.

Instead, Iran, more than ever, is the predominant influence in Iraq today, said Hoshyar Zebari, who was Iraqs foreign minister for 10 years and finance minister until 2016.

Irans interests, he said, affect every sector of the security forces, the military, the provincial governors.

Since the rise of Irans theocratic regime in 1979, it has wanted to force the U.S. military out of the Middle East. Sajad Jiyad, an Iraq analyst and nonresident fellow at Century International, a research group, said that when President George W. Bush described Iran as part of an Axis of Evil, it sounded as if Washington was saying, Youre next Iraq, Iran, North Korea, were coming for you.

So Iran focused on creating, training and arming Iraqi Shiite militias to attack American forces on Iraqi soil. The U.S. military said that between just 2003 and 2011, Iranian-backed groups were responsible for the deaths of 603 U.S. troops in Iraq.

One of those groups was Khataib Hezbollah, which from its inception was closely tied to Irans Quds Force, the wing of Irans Islamic Revolutionary Guards Corps responsible for proxy militias around the region.

In 2011, the American military withdrew from Iraq, and in 2014, the Islamic State invaded. The Iraqi Army collapsed and the government in Baghdad asked its friends Iran and the United States for help.

Iran responded quickly, sending trainers and weapons and helping recruit a volunteer Iraqi force eventually known as Popular Mobilization Units to fight the ISIS invaders alongside Iranian-linked militias, including Khataib Hezbollah. The United States sent help, too, but several weeks later.

Part of the battle took place in Jurf al-Nasr, then known as Jurf al-Sakhar, an Islamic State staging ground for attacks on nearby Shiite villages and on pilgrims, millions of them Iranians, who traveled through the area on their way to Shiite shrines in Karbala and Najaf.

Iran always made protection of those shrines a priority, said Kareem al-Nuri, then a commander in the Badr Corps, another Iranian-linked armed group.

Jurf al-Nasr was also strategically located, with roads that led west to Syria, a route to ferry weapons to Iranian-backed Lebanese Hezbollah.

During the fighting, Khataib Hezbollah emptied every Sunni village, telling people they would be able to return once the Islamic State was gone. Human Rights Watch and Amnesty International documented hundreds of disappearances, primarily of Sunni men, in the area; the 2019 U.S. State Departments Human Rights Report said 1,700 people were held in a secret prison there.

When the fighting was done, Jurf al-Nasr remained under the control of Khataib Hezbollah.

In 2016, Khataib Hezbollah and other Iranian-linked militias, along with the Popular Mobilization Units, became part of the Iraqi security apparatus, with the Iraq treasury paying salaries for fighters and providing weapons including for units that have continued to attack U.S. forces.

This year, Iraqs prime minister, Mr. Sudani, approved a three-year budget with more money for the fighters, who now number more than 150,000, to grow by at least 20 percent a major expansion, according to Michael Knights, a fellow at the Washington Institute for Near East Policy, who follows Iraqs armed forces and their ties to Iran.

Iran denies that it controls the armed Iraqi groups that have attacked U.S. forces, but in a recent interview, its foreign minister, Hossein Amir-Abdollahian, said he viewed the United States as complicit in Israels war in Gaza, adding that the militias were created to fight terrorism and occupation.

Experts say the Iraqi militias with the closest ties to Iran like Khataib Hezbollah have a shared ideological vision with Tehran, as Inna Rudolf, a senior fellow at the International Center for the Study of Radicalization in London, put it. That vision largely accepts Irans theocratic philosophy of governance and the broader goals of forcing U.S. troops out of Iraq and destroying the state of Israel.

Today, a reporter visiting near Jurf al-Nasr cannot miss the overwhelming signs of Khataib Hezbollahs presence.

The checkpoints on the roads into the area fly the groups flag white with a sketch of a fist gripping a stylized Kalashnikov rising out of a globe, and the words Party of God in Arabic calligraphy. The central street in the nearby town of Mussayib, outside the checkpoints, is lined with martyrs flags imprinted with photos of militia men who lost their lives fighting in Iraq, and with large posters depicting Irans celebrated Quds Force leader, Gen. Qassim Suleimani, who was assassinated by the United States in 2020.

In interviews in Mussayib and other villages, residents who refused to give their names said that they didnt know what was happening in Jurf al-Nasr but that the only people who traveled through the checkpoints were Khataib Hezbollah operatives and foreigners speaking Arabic with an Iranian or Lebanese accent.

Western and Iraqi diplomats and intelligence officers, however, paint a picture of what goes on there, just 40 miles south of Baghdad.

They say Iranian Revolutionary Guards and Lebanese Hezbollah trainers teach drone assembly and how to retrofit precision guidance systems onto rockets and surface-to-air missiles. For the rockets, General McKenzie said, upgraded components will come from Iran.

Khataib Hezbollahs rocket arsenal is mostly composed of shorter-range conventional Katyusha rockets, but also includes some longer range ones, said former and present intelligence and military officials, including General McKenzie, and Khataib Hezbollah commanders.

Some weapons are shipped into Syria, according to Western and Middle Eastern military and intelligence reports. From there, they can be transported to Russia or Lebanon, said an intelligence official in the region.

It is unclear, several people interviewed said, whether the longer-range rockets are entirely under the control of the Iraqi armed groups or if Iranian Revolutionary Guards supervise closely the use of the most sophisticated weapons.

The former farmland also includes storage facilities for weapons, with smaller quantities stored elsewhere in Iraq, according to Western and Iraqi security officials, as well as people close to Khataib Hezbollah.

Israel has long worried about Khataib Hezbollahs growing weapons stockpiles. In 2019 Israeli warplanes hit a large arms depot in Baghdad in an area partly controlled by Khataib Hezbollah. In both 2019 and 2022, Israel struck Khataib Hezbollah camps in Syria, just over the Iraqi border. It has never hit Jurf al-Nasr.

In an interview in September, Prime Minister al-Sudani did not respond to questions about military activities in Jurf al-Nasr. In October, he publicly condemned the attacks on U.S. bases and camps, but his words have had little effect. In the September interview, though, he said he hoped that families displaced from Jurf al-Nasr could go back home.

For those families, returning seems a receding dream.

We have not heard anything about what happened to our lands, to our homes, said Abu Arkan, 70, who was displaced in 2014.

Then he waved a reporter away.

I do not want to talk about this subject any longer because it depresses me, he said. Nobody comes to us to bring us back. No one compensates us for what we have lost. We are like ghosts.

Reporting was contributed by Eric Schmitt from Washington, Farnaz Fassihi from New York, Falih Hassan from Baghdad, and Kamil Kakol from Erbil, Iraq.

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Why Fears of a Broader Middle East Conflict Are Growing in Iraq - The New York Times

This photo taken on Dec. 16, 2023 shows a member of Iraqi security forces voting ahead of the provincial elections in Baghdad, Iraq. Iraqi security personnel cast their votes on Saturday in 15 of the country's 18 provinces ahead of the provincial elections slated for Monday following a 10-year hiatus. (Xinhua/Khalil Dawood)

BAGHDAD, Dec. 16 (Xinhua) -- Iraqi security personnel cast their votes on Saturday in 15 of the country's 18 provinces ahead of the provincial elections slated for Monday following a 10-year hiatus.

The voting began after 7 a.m. local time (0400 GMT) when soldiers and policemen lined up to cast their ballots at polling centers in the Iraqi capital of Baghdad and several other cities in the 15 provinces of the country, excluding the three provinces of the semi-autonomous Kurdistan region.

According to figures from Iraq's Independent High Electoral Commission, more than 1 million voters from the security personnel are expected to cast ballots in 565 polling centers in the 15 provinces.

The last provincial elections in Iraq were held in April 2013.

Members of the Iraqi security forces line up to cast their votes ahead of the provincial elections in Baghdad, Iraq, Dec. 16, 2023. Iraqi security personnel cast their votes on Saturday in 15 of the country's 18 provinces ahead of the provincial elections slated for Monday following a 10-year hiatus. (Xinhua/Khalil Dawood)

This photo taken on Dec. 16, 2023 shows a member of Iraqi security forces voting ahead of the provincial elections in Baghdad, Iraq. Iraqi security personnel cast their votes on Saturday in 15 of the country's 18 provinces ahead of the provincial elections slated for Monday following a 10-year hiatus. (Xinhua/Khalil Dawood)

An Iraqi security officer shows his inked finger after casting his vote ahead of the provincial elections in Baghdad, Iraq, Dec. 16, 2023. Iraqi security personnel cast their votes on Saturday in 15 of the country's 18 provinces ahead of the provincial elections slated for Monday following a 10-year hiatus. (Xinhua/Khalil Dawood)

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Iraqi security personnel cast ballots ahead of provincial elections - Xinhua