Iraq’s 2018 government formation: unpacking the friction between reform and the status quo

This report analyses the 2018 government formation process in Iraq. It argues that the process is marked by two competing trends, a bottom-up movement demanding institutional change symbolised by a low voter turnout and incumbency rate, and a top-down system that reinforces identity-based politics and the post-2003 order. The failure to officially identify the largest governing political bloc exemplifies this friction and paves the way for political instability. This report is based on interviews with Iraqi officials and activists in Baghdad, Basra, Mosul, Ramadi, Erbil and Sulaymaniyah between March and December 2018. This report is the final in a series of three produced by IRIS as the outcome of a project examining the mobilisation strategies and results of the 2018 Iraqi elections

The 2018 Iraqi federal elections: a population in transition?

On 12 May 2018, Iraqis went to the polls to vote for their next parliament, prime minister and cabinet. The elections delivered a surprise, with Muqtada al-Sadr’s Saairun Coalition winning the most seats of any bloc, although not enough to form a government alone. The results also carried a number of clear messages about the state of Iraqi politics, not least the low turnout and the decision of many Iraqis to boycott the elections, reflecting a general malaise and disillusion with the current political leadership and bloated bureaucracy. The revelations of electoral fraud and the very low turnout (of 44.5 percent) indicate that it will be difficult for the political class to overcome its reputation for maintaining the status quo – and for the citizenry to accept it. This report is the second in a series of three produced by the Institute of Regional and International Studies (IRIS) as the outcome of a project examining the mobilisation strategies and results of the 2018 Iraqi elections. This project forms part of the Conflict Research Programme, funded by the UK Department for International Development

Sectarianization and desectarianization in the struggle for Iraq’s political field

Iraq’s political system, an elite pact justified through ethno-religious consociationalism or sectarian apportionment (Muhasasa Ta’ifiyya), was created in the aftermath of invasion and regime change in 2003. The system’s legitimation was based on a very specific understanding of Iraqi society and the role of elections in managing that society. However, this system did not prevent the brutal civil war that raged in Iraq from 2004 until 2008. Once the civil war ended and communally justified violence declined, other negative consequences of the system became increasingly apparent, namely the widespread and systematically sanctioned political corruption at its core and the institutional incoherence the system created. A sustained post-civil war challenge to the system has come through a series of mass demonstrations, starting in 2009, but reaching their peak, in terms of size and ideational coherence, in 2019. In the face of its unpopularity, the majority of Iraq’s politicians may have moved away from the overt promotion of sectarianism, but the political system still functions, as it has since 2003, with systemic corruption and coercion taking the place of sectarian ideology in terms of delivering elite cohesion and defending the status quo

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies