Just nine months after getting married, 25-year-old Iman decided to undergo liposuction at Al-Ameerat Hospital in Baghdad in 2022 to get rid of some sagging around her abdomen. Her family claims that a mistake during the surgery resulted in her death.
Iman is one of many women who have died as a result of a “medical error” in Iraq’s booming cosmetic surgery industry. The rising demand for plastic surgery has led to a proliferation of unlicensed beauty centers, non-specialists performing complex surgeries, and surgeon impersonators.
“Her health was in excellent condition,” Iman’s mother told Daraj. “She used to exercise regularly before I left her for a while. When I returned, she had minor abdominal sagging that bothered her. She insisted on getting rid of it, despite my objections and my attempts to persuade her not to. It was not worth the risk.”
The procedure cost $5,000 and was supposed to take a maximum of two hours. Iman’s family waited for about 6 hours for her to leave the operating room, before discovering that she had died and had been secretly transferred to the Medical City Hospital. The surgeon (with the initials H.A.S.) who performed the surgery fled to an unknown destination.
A plastic surgeon who asked to remain anonymous due to the sensitivity of the issue and fear of administrative repercussions, said that liposuction requires a specialized medical staff to deal with potential complications.
According to him, the most common cause of death during such an operation are “blood clots that occur a few hours after the operation and, if not promptly addressed, these clots can travel to the lungs and kill the patient.”
He went on to accuse private hospitals of covering up medical disasters. “Unfortunately, some private hospitals sometimes cover up surgeries performed by unauthorized doctors, in exchange for financial compensation,” he said.
“These can be dentists, pharmacists, and graduates of medical analysis institutes,” he added. “They perform plastic surgeries without being specialized, and without considering the serious consequences, which in some cases can lead to a patient’s death.”
Such issues were confirmed by the Baghdad Branch of the Iraqi Medical Association (IMA) in the reports it submitted to the Interior Ministry in 2021 and 2022. The reports actually name several of the beauty centers that employed mid-level staff to perform both surgical and non-surgical cosmetic procedures.
The IMA Baghdad Branch identified eight individuals impersonating cosmetic surgeons, and proved that some of them performed liposuction procedures in private hospitals. They also warned of the existence of 36 fake beauty centers in Baghdad alone.
In recent years, dozens of beauty centers have popped up in Iraqi cities. Most operate without official permits or are managed by non-specialists. In line with this trend, the number of victims suffering from permanent disabilities as a result of plastic surgery has increased, according to the IMA.
Many of these centers are still open, despite the formation of the Inspection and Monitoring Committee for Health and Cosmetic Centers, Pharmacies, and Unlicensed Drug Depots, led by Dr. Hani Musa Al-Aqabi, Deputy Minister of Health for Technical Affairs. The committee was founded on May 22, 2023 and consists of 11 members, which include 4 public managers, the head of national security, and dentist, pharmacy, and nursing representatives.
One day after the cabinet’s order to form the committee, the President of the Supreme Judicial Council, Dr. Faeq Zaidan, issued a memo directed to public prosecutors and appeal courts, urging the closure of unlicensed clinics that do not have the required IMA permits to practice, as stipulated by Article 4 of the 1984 Medical Association Law.
Licenses for Rent
According to the doctors we interviewed for this investigation, some beauty centers operate under licenses that were obtained by specialized doctors. However, in reality, these doctors are not the ones performing the surgeries; they instead receive a fee from these centers to falsely use their names and licenses.
A member of the IMA in Baghdad did not deny these practices and said it was complicated dealing with beauty centers, which he described as “fictitious” or “fake” for operating without a license or for being run by non-specialists. According to him, this is why the IMA included the names of fake centers and their operators in the statements and reports that they have made.
According to the Ministry of Health, only cosmetic and dermatological specialists are allowed to open beauty centers and clinics. The Ministry’s Specialized Centers Authority on July 5, 2018, set the conditions for non-surgical plastic procedures.
They apply to dentists specializing in oral and maxillofacial surgery, who are allowed to perform relevant cosmetic interventions on the face and jaws using fillers, botox, and mesotherapy. Dentists practicing other dental specialties are restricted to only performing procedures limited to the middle and lower thirds of the face.
Graduates from general science colleges working with laser devices in government and private healthcare institutions are allowed to work in non-surgical beauty centers. However, their role must be limited to performing non-invasive interventions only in an assisting capacity under the supervision of a licensed doctor. They should have completed the required training and have the necessary certifications.
However, in reality many non-specialists are conducting plastic surgery, even though some of them lack formal training or only have certification from short courses.
According to a source within the Ministry of Health, around 80 percent of Iraqi beauty centers operate without proper licenses. The same source also said that some barber shops in Baghdad have been transformed into beauty centers, while specialized doctors are renting out their licenses to people who lack qualifications.
Maryam and Sarah
Maryam, an employee in Baghdad’s private sector, became a victim of these fake beauty centers. The 30-year-old told Daraj that for a long time she did not share the plastic surgery obsession which her friends had. They tried to change her negative view of cosmetic surgery for months until, in February 2023, she finally decided to go to a beauty center in the Mansour area of Baghdad.
“All I wanted was a plump face,” said Maryam. Unfortunately, that was not the case. After undergoing a facial injection, her forehead ended up being uneven.
She sought the help of a dermatologist in the Karrada region, who told her that she was suffering from acute inflammation, as a result of injecting a large amount of fat contaminated with bacteria. He also told her that the person who did the injection was a fake doctor, not a qualified physician.
Maryam suffered psychologically, which prompted her to quit her job and withdraw from social life. She even avoided looking at herself in the mirror. She continues to receive treatment till today in the hope of recovering her face.
“My facial features have changed dramatically due to an impersonator who has no experience in plastic surgery,” she said. “How can I differentiate between a legitimate center and a fake one?”
35-year-old Sarah became victim of a beauty center located on Al-Rubaie Street in Baghdad. According to Sarah, the place was filled with people who, like her, were attracted by the low-price offers.
Sarah suffered from serious complications which required medical intervention. According to a dermatologist, she had been injected with a dose of low quality filler which caused a blockage of her facial and upper lip arteries.
Botox, fillers, and more
A dermatology specialist, M.H, confirmed that unlicensed beauty centers compete with each other by using cheap materials with cheap prices to attract the largest possible number of clients “without considering the disastrous deformities these materials may cause.”
According to him, a good quality filler or Botox injection typically costs between $100 and $200, while some centers offer them for prices as low as $30 to $50. “These products cannot be considered safe,” he said.
As for other procedures such as facelifts, the source said that they are usually performed in licensed centers with costs amounting up to $ 2,300. Some beauty centers offer an alternative to a facelift known as thread lifting, whereby fees are “determined according to the type and number of threads being used.”
He proceeds to say how the cost of eyelid surgery can reach $ 800 in a licensed center. “An eyebrow lift or cat-eye surgery is currently one of the most popular surgeries,” he added. “It is performed under local anesthesia with fees starting at US$ 383.”
He pointed out that many centers offer even lower prices, yet they use low-quality materials, employ non-specialized staff, or operate in a medically unsound environment.
Regarding the penalties imposed on individuals impersonating as doctors, lawyer Watheq Al-Daradji told Daraj that, according to Resolution No. 160, an impersonator of any public position or job can be punished with imprisonment for a maximum of 10 years.
In line with Resolution No. 160, the Rusafa Court of Appeal issued a 10-year prison sentence against a person pretending to be a doctor, said lawyer Muhammad Al-Saadi, who pleaded on behalf of a girl who suffered from complications from an arm liposuction procedure in 2023. This sentence was issued in absentia against the person who pretended to be a doctor. Al-Saadi said that the police were still looking for the man who fled as soon as he learnt a complaint had been filed against him.
The relevant authorities do not regularly disclose the official numbers of fake beauty centers in Iraq, and the figures that circulate are often inconsistent or limited to specific regions.
In its 2020 report, the Federal Board of Supreme Audit (FBSA) indicated that there were 20 licensed beauty centers in Iraq in 2019, estimating that there were also around 92 unlicensed beauty centers. On March 5, 2023, the Parliamentary Health Committee stated that the number of licensed centers in Iraq had reached 71.
Although there are more licensed beauty centers in the country each year, the prevalence of unlicensed centers has not diminished.
In 2022, IMA head Jassim al-Azzawi said in a televised interview that there are 470 unlicensed beauty centers in the Mansour district of Baghdad alone. This indicates that the real number of unlicensed beauty centers in Baghdad and across the country is arguably significantly higher.
The widespread and escalating nature of the beauty center phenomenon, along with the varying statistics, has drawn the attention of several state bodies, including the Federal Board of Supreme Audit (FBSA).
In a recent report, the FBSA described the measures taken to curb the proliferation of unauthorized beauty centers as “weak.”
The report furthermore criticized the Health Ministry for its leniency towards offenders and its failure to enforce the Public Health Law and penalize perpetrators.
They believe the the law is also outdated, as which Article 96-I-A stipulates that the owner of a place subject to health approval or control who violates the law can be punished with “a fine not exceeding 250,000 dinars,” (around US$ 170), or “closure for a period not exceeding 90 days, or both.”
These penalties are inappropriate, according to FBSA, as they have become outdated to the extent that “some beauty centers are almost impossible to hold accountable.”
Meanwhile, in a letter issued on September 9, 2019, the Health Ministry accused the Interior Ministry of neglecting to take much needed action against beauty centers violating the law.
Today, some form of cooperation between the two ministries appears to have finally taken place. The Ministry of Interior released a statement on April 20, 2023 announcing the closure of 20 unlicensed beauty centers in Baghdad as part of a campaign with the Ministry of Health.
The statement listed the names of the beauty centers as follows: “Juniya for Hair Transplant, Hala Beauty at Palestine Street; Fiona at the intersection of Maisalon Square; Allen, Caris, Salon Samer, Phoenix Center at Zayouna; Simon Beauty Center, Alsa Beauty, Beauty Hair at Ar-Rabie Street; Al-Khatoun Beauty Center, Noor Medical Complex, Laser Medical Clinic at Sha’ab district; Different at Hayy Ur; Aym Clinic for Beauty and Laser at Al-Bunook district; LuxoLook Beauty Clinic at Karrada; Ward Center at Karrada near Al-Rabea Bridge; Baqiat Allah Center and U center at Slikh district.” Their plastic surgery rooms were sealed due to having no specialized doctors.
According to the statement, the Ministry also closed 11 beauty centers in other governorates and arrested 36 unlicensed owners who were detained, in anticipation of further legal action. The statement furthermore called upon citizens to report unauthorized centers through the free phone number 144.
However, a tour conducted for this investigation found that six of the beauty centers mentioned in the statement were still operating, namely: Beauty Hair, Simon Beauty Center, Hala Beauty Center, Allen, LuxoLook Beauty Clinic, and Ward Center.
A lawyer at the Courts of Appeal in the Karkh district is currently handling a case which concerns a medical error that occurred in one of the beauty centers. He commented on the ease of licensing beauty centers, which at times perform procedures endangering the lives of their clients.
According to him, some of these centers are affiliated with political figures or owned by people closely connected to influential parties, who in turn shield them from scrutiny and accountability, making it difficult to hold them responsible.
“What is the point of the Iraqi Medical Association announcing the presence of hundreds of unlicensed beauty centers in Baghdad when the joint campaign by the Ministry of Interior and the Ministry of Health resulted in the closure of only 20 centers?” he asked.
Furthermore, he pointed out that the Ministry of Health in 2022 had announced the suspension of granting licenses for private healthcare establishments, including beauty centers, until new regulations were issued.
“Taking that into consideration, how would these new centers open and operate?” the lawyer asked. “Unfortunately, I know the answer. Their licenses are actually issued by the parties that support them in exchange for money.”
“ The unlicensed beauty centers are no different from casinos, nightclubs, and brothels, where armed groups receive money in return for providing protection.”
A security official confirmed that the police arrested a doctor earlier this year who worked in the field inspection committee of the IMA Baghdad branch. He was caught receiving substantial sums of money near a beauty center, which he had visited multiple times before his arrest, receiving payments in order to conceal its illegal operations.
According to the source, the doctor confessed that he was working on behalf of Mustafa Al-Saadi, the head of the IMA Baghdad branch. Consequently, Al-Saadi was arrested but released on bail after spending only a few months in custody. The case is still pending.
Furthermore, the source mentioned that the widespread phenomenon of unlicensed centers with the support of influential and corrupt figures prompted the Iraqi prime minister to establish a high-level committee to address the issue of beauty and healthcare clinics, as well as unlicensed pharmacies and drugstores.
The committee is also monitoring the recruitment of unqualified foreign staff. The prime minister emphasized that the committee must submit a monthly report on its findings.
Unlicensed Foreign Staff
In addition to operating without official permits, many of the so-called “phantom” centers recruit foreign staff who lack proper qualifications. The FBSA has documented this practice, and has found in one of its reports that most foreign staff enter the country on tourist visas.
The IMA also tackled the issue in the reports submitted to the Interior Ministry, affirming that the nationalities of the foreign staff include Iranians, Turks, and Syrians. They perform cosmetic procedures in Baghdad without proper legal authorization and the majority of them work in hair transplant centers.
The IMA also highlighted that in some beauty centers, non-specialized mid-level staff members conduct cosmetic procedures without proper medical supervision and without being licensed. These illegal practices put patients’ lives at risk.
Beauty centers, both licensed and unlicensed, rely heavily on social media platforms to promote their services. Some of them use explicit images to attract young customers.
They compete with each other by offering cheap deals, all the while seducing customers with claims of advanced world-class equipment and specialized staff.
These centers sometimes invite interested individuals to participate in training courses to perform cosmetic procedures and upon completion, they are awarded a certificate.
According to the Al-Nahrain Center for Strategic Studies, participants may opt to use these certificates to open their own beauty centers, while claiming “their credentials are accredited by reputable international universities to attract and entice customers.”
In April 2023, the Communications and Media Commission (CMC) called on media outlets to stop broadcasting ads for beauty centers that contain explicit images “undermining the sanctity of life. The CMC also urged to raise awareness about the risks of unlicensed beauty centers.”
The Beaulight Beirut Academy located in Baghdad’s Mansour district offers cosmetic courses for both genders, including injections such as mesotherapy, plasma, Botox, fillers, thread lifting, and cheek dimples.
The academy informed Daraj that participants would receive three international certificates in non-surgical cosmetics (American, British and German) in addition to an American International Badge for a total cost of $2,000.
Surprisingly, the same center was featured among the 20 non-compliant centers listed by the IMA in 2020. The latter claimed to have referred these centers to the authorities to be held accountable.
One beauty specialist likened the practice of issuing fake certificates to participants to giving children grenades with the safety pins removed in a densely populated city.
He warned against participating in such courses and wondered how people could believe centers that claim to be licensed and authorized to issue multiple official certificates, both American and British certificates, within a period of just days.
He also emphasized these centers use deceptive names, such as “American Academy” or “American Association,” to mislead people into thinking they are affiliated with the American Medical Association.
The only authorized entity to issue such certificates is the Accreditation Council for Continuing Medical Education (ACCME) in Chicago, which issued a warning in October 2017, disclaiming any responsibility for courses falsely held under its name.
The doctor asserted that the promotion of courses in the field of non-surgical cosmetics on social media platforms is misleading and false. There is no truth to the claim of receiving an “American Board certificate.”
Nadia, a 29-year-old mother of a young girl, was one of those attracted by the social media ads promoting a beauty center. She visited a presumed family doctor in the Sha’ab district of Baghdad to have a Lip Contour Tattoo procedure.
Afterwards, Nadia noticed that the tattoo was unevenly distributed. The “doctor” tried to fix his mistake, but instead, he eventually caused scarring on Nadia’s cheeks. Distressed by the outcome, Nadia visited a private hospital where a dermatologist informed her that her skin was severely inflamed due to the use of a poor-quality substance.
“This procedure has become a nightmare that haunts me,” she told Daraj. “The treatment took four months. My face is no longer as before. I still suffer from excessive sensitivity from time to time, all because of a fictitious center and doctor operating under the watchful eyes of official authorities, without fear of accountability.”
*The investigation was conducted under the supervision of the Network of Iraqi Reporters for Investigative Journalism (NIRIJ)