BAGHDAD — In its largest reconstuction effort since the Marshall Plan, the United States government has spent $53 billion for relief and reconstruction in Iraq since the 2003 invasion, building tens of thousands of hospitals, water treatment plants, electricity substations, schools and bridges.
But there are growing concerns among American officials that Iraq will not be able to adequately maintain the facilities once the Americans have left, potentially wasting hundreds of millions of dollars and jeopardizing Iraq’s ability to provide basic services to its people.
The projects run the gamut — from a cutting-edge, $270 million water treatment plant in Nasiriya that works at a fraction of its intended capacity because it is too sophisticated for Iraqi workers to operate, to a farmers’ market that farmers cannot decide how to share, to a large American hospital closed immediately after it was handed over to Iraq because the government was unable to supply it with equipment, a medical staff or electricity.
The concern about the sustainability of the projects comes as Iraq is preparing for pivotal national elections in January and as rebuilding has emerged as a political imperative in Iraq, eclipsing security in some parts of the country as the main anxiety of an electorate frustrated with the lack of social, economic and political progress. American forces are scheduled to begin withdrawing in large numbers next year.
In hundreds of cases during the past two years, the Iraqi government has refused or delayed the transfer of American-built projects because it cannot staff or maintain them, Iraqi and American government officials say.
Other facilities, including hospitals, schools and prisons built with American funds, have remained empty long after they were completed because there were not enough Iraqis trained to operate them.
“As large-scale construction projects — power plants, water-treatment systems and oil facilities — have been completed, there has been concern regarding the ability of Iraqis to maintain and fund their operations once they are handed over to the Iraqi authorities,” said a recent analysis prepared for Congress by the Congressional Research Service.
The Government Accountability Office and the special inspector general for Iraq reconstruction have also issued reports in the past several months about the potential failure of American-financed projects once they are transferred to Iraq.
Stuart W. Bowen Jr., inspector general for Iraq reconstruction, said his watchdog agency had “regularly raised concerns about the potential waste of U.S. taxpayer money resulting from reconstruction projects that were poorly planned, badly transferred, or insufficiently sustained by the Iraqi government.”
The blame is shared, officials said. While Iraq has often been guilty of poor management, American authorities have repeatedly failed to ask Iraqis what sort of projects they needed and have not followed up with adequate training.
And whether or not the American-built health centers and power plants are ever used as intended, the American companies that won the lion’s share of rebuilding contracts from the federal government have been paid.
The Iraqi government, prodded by American officials here, has pledged to begin spending more of its own money on reconstruction, but the country is facing a substantial budget deficit because of declines in international oil prices.
Prime Minister Nuri Kamal al-Maliki has insisted that reconstruction is the next task. What is not clear is where the $400 billion the government says it needs will come from.
“We will use the revenue we have from oil, but the government feels it has to do more than that to rebuild,” said Ali al-Alak, an adviser to Mr. Maliki.
In the meantime, the Americans — military and civilian reconstruction specialists alike — continue to depart in large numbers, taking with them their money, equipment and expertise.
Despite the $53 billion spent by the United States, many Iraqis have criticized the rebuilding effort as wasteful. Ali Ghalib Baban, Iraq’s minister of planning, said it had not had a discernible impact. “Maybe they spent it,” he said, “but Iraq doesn’t feel it.”
Iraqis, for whom bombed-out buildings are an unremarkable part of urban existence, also say they have seen little evidence of rebuilding.
“Where is the reconstruction?” asked Sahar Kadhum, a resident of Kut, about 100 miles southeast of Baghdad. “The city is sleeping on hills of garbage.”
Indeed, despite the billions in American funds, more than 40 percent of Iraqis still lack access to clean water, according to the Iraqi government. Ninety percent of Iraq’s 180 hospitals do not have basic medical and surgical supplies, according to the aid organization Oxfam. Iraqis also have disproportionately high rates of infant mortality, cerebral palsy and cancer.
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