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 Monday February 10, 2003 18:07 by Justin Moran - Sinn Fein maigh_nuad at yahoo dot com
 Full text of report included MONTREAL - War in Iraq would have devastating effects on the country's 13 million children, many of whom are already malnourished and living in ''great fear'' of another conflict, says the report of a Canadian-led, fact-finding team released Thursday. The document, based on a trip to Iraq Jan. 20-26 by 10 health experts, concludes that, ''Iraqi children are at grave risk of starvation, disease, death and psychological trauma''. They ''are more vulnerable to the adverse effects of a new war than they were before the Gulf War of 1991'' but ''the international community has at present little capacity to respond to the harm that children will suffer by a new war in Iraq'', it adds. Our Common Responsibility The Impact of a New War on Iraqi Children
This independent report was compiled by an the International Study Team, an international team of researchers, academics and practitioners expert in physical and mental health, food security, infrastructure, gender, humanitarian law and emergency preparedness. The Team’s visit to Iraq took place from 19-26 January 2003. The report describes the status and vulnerabilities of children in Iraq, examining the likely humanitarian impact of a military conflict on the civilian population, particularly children. Assessment and analysis is based on in-country data collection from a wide variety of sources including the United Nations, international and national non-governmental organizations, and Iraqi government officials. Existing published and unpublished reports were consulted and reviewed. In-country field research also included assessment visits to Baghdad, Kerbala, and Basra. More than 100 unaccompanied visits and interviews took place in individual households, involving children and their parents. The specific program, including all meetings and visits, was determined solely by the International Study Team. Team experts were unobstructed in their work. No financial or any other support was received from the government of Iraq. Financial support for this report was received from more than twenty leading humanitarian non-governmental organizations in Canada, the United States and Norway. Contributors participating in their personal capacities as the International Study Team: Team Leader: Dr. Eric Hoskins Public Health and Medical Care Contributors: Mr. Rupen Das Emergency Preparedness and Infrastructure Administration, Logistics and Distribution: War Child Canada This report is available from: War Child Canada
© Copyright 2003, International Study Team. All rights reserved. Our Common Responsibility
Canadian Action for Indonesia and East Timor
Executive Summary
Our Common Responsibility: The Impact of a New War on Iraqi Children, a report by the International Study Team assesses the vulnerability of Iraqi children today as compared to 1991. The report comes as the United Nations Security Council meets to consider the report of the United Nations weapons inspectors. As such, this report is directed to the Security Council, to the government of Iraq, and to the international community as a public document encouraging these entities to take into account the plight of Iraqi children when considering the alternatives of war and continued weapons inspections. This report examines the physical and mental well-being of the 13 million Iraqi children based on data collected in Iraq between 20 and 26 January 2002. The team conducted interviews, collected data, and reviewed existing data pertaining to the state of children in Baghdad, Basra, and Kerbela in Iraq. In addition, the Team independently visited more than 100 Iraqi families (children and their parents) in their homes. The main findings of the report are presented in sections divided into Physical Well-Being, Mental Well-Being and Emergency Preparedness. The first section, Physical Well-Being concludes that despite some improvements in the health and nutritional status of children from their post-1991 Gulf War state, Iraqi children are still in a significantly worse state than they were before the 1991 Gulf War. Similarly, because most of the 13 million Iraqi children are dependent on food distributed by the Government of Iraq, the disruption of this system by war would have a devastating impact on children who already have a high rate of malnutrition. The state of the physical well-being of Iraqi children thus makes them much more vulnerable to war today than they were in 1991. Perhaps the most startling findings are based on field data collected by two of the world’s foremost child psychologists who are leading experts on the psychological impact of war on children. They found that Iraqi children suffer significant psychological harm from the threat of war that is hanging over their head. This finding, based on the first ever pre-war psychological field research with children, is powerful evidence that the concern for children’s well-being needs to be considered in the decision making process about to take place in the United Nations Security Council. Finally, a review of the available data on emergency preparedness indicates that the international community has at present little capacity to respond to the harm that children will suffer by a new war in Iraq. The study was initiated and organized by the International Study Team, an independent group of expert academics, researchers and practitioners examining the humanitarian effects of military conflict on the civilian population. In 1991, the International Study Team produced a comprehensive report on the humanitarian effects of the Gulf War. Based on more than 9,000 independently conducted household interviews in 300 locations across all parts of Iraq, the International Study Team report has been acknowledged as the most comprehensive study of the impact of war on civilians. The team members are: Team Leader: Contributors: The International Study Team received financial support for Our Common Responsibility from the following organizations: Canadian Action for Indonesia and East Timor, Canadian Auto Workers, Canadian Catholic Organization for Development and Peace, Canadian Friends Service Committee (Quakers), Canadian Labour Congress, Center for Crisis Psychology, University of Bergen, Norway, Centre for Studies in Food Security, Ryerson University, Toronto, Canada, Inter Pares, International Physicians for the Prevention of Nuclear War (IPPNW), Mennonite Central Committee Canada, Copies of the final report can be obtained from: War Child Canada An electronic version of this report will be accessible at www.warchild.ca
· Iraqi children are even more vulnerable now than they were in 1990, before the 1991 Gulf War. In summary, a new war in Iraq would be catastrophic to Iraq’s 13 million children, already highly vulnerable due to prolonged economic sanctions. Iraqi children are at grave risk of starvation, disease, death and psychological trauma. The International Study Team is forecasting, should war occur, a grave humanitarian disaster. While it is impossible to predict both the nature of any war and the number of expected deaths and injuries, casualties among children will be in the thousands, probably the tens of thousands, and possibly in the hundreds of thousands. Physical Well-Being 6 Mental Well-Being 17 Emergency Preparedness 23 Military Force 27 Conclusions 29 References 31 Tables and Charts Three Basic Principles of International Humanitarian Law Protecting Children 4 “It is not true to assume that the suffering of Iraqi children cannot get worse.” The strategic and political considerations of such a decision are complex and subject to debate, but they are not themselves the focus of this report. Instead, the aim of this report is to concentrate international attention on the approximately 13 million children who reside in Iraq, and to identify and highlight the likely negative humanitarian impacts of a military conflict on their health and well being. The threat of war comes at a time when Iraqi children are perhaps least equipped to withstand further stresses on their physical and mental well-being. Compared to the period immediately preceding the 1991 Gulf War, Iraqi children are now much more vulnerable to any attack. The life-sustaining infrastructure around them – health care, water, sanitation, food supply and infrastructure – has broken down and is badly in need of repair. This report examines the current humanitarian status of Iraqi children, their vulnerabilities, and the potential impact of a war in Iraq. It examines eight key sectors that, together, provide a snapshot of the humanitarian condition of children in Iraq. These sectors are (1) Household Economy, (2) Food Security, (3) Infrastructure and Environment, (4) Health and Nutrition, (5) Gender (6) Child Psychology, and (7) Emergency Preparedness. Analysis of the above sectors is based on data collected in published and unpublished reports, interviews with United Nations, governmental and non-governmental officials, research, household interviews and field visits conducted in Iraq from January 19-26, 2003. Field visits were carried out in Baghdad, and the two southern cities of Basra and Kerbela. Field data concerning the psychological impact of the risk of conflict on Iraqi children and the ability of these children to withstand another war was collected from more than 100 households in Baghdad and Basra. In addition, more than 200 12-year-old Iraqi children completed a questionnaire to assess their mental health. Data used in this report was only acquired from reliable sources and excluded all Iraqi government data. Rigorous scientific methodology was employed throughout the study. Conclusions reflect the considered analysis of the most reliable data available by acknowledged experts in the various sectors. The International Study Team takes no position on the current political crisis with Iraq. Instead, it has as its sole objective the advancement of principles concerning the protection of civilians, and to highlight dangers faced by children caught in the crossfire of war. In recent years, the Security Council has embraced the concept that protection of civilians, particularly children in armed conflict, is a fundamental part of their peace and security agenda. Yet despite this development, decisions are regularly taken without full regard, or sometimes despite it, for the well being of children. The authors of this report have a simple request: give serious consideration to the humanitarian implications of pursuing a military solution to the crisis with Iraq. On behalf of the smallest of the world’s citizens, and also the most vulnerable, we ask this of you. At the same time, we address this report to the government of Iraq. The past 12 years has witnessed tremendous human suffering of the Iraqi people. Iraqi sovereignty means not only independence, it means responsibility. The government of Iraq has a profound responsibility to protect and nurture its 13 million children. As the search continues for a diplomatic solution to the current political crisis, we implore the government of Iraq to act in the best interests of the Iraqi child and fully implement Security Council resolution 1441, calling for an end to its weapons programs. Context Iraq is inhabited by approximately 13 million adults and 13 million children. More than 4 million children are under five years of age. Just prior to the 1991 Gulf War, Iraq was described by the United Nations as a high-middle-income country, with a modern social infrastructure. Although the Iran-Iraq war caused enormous economic damage, and more than 100,000 deaths, Iraq’s health, education and other social programs continued to advance throughout the 1980s. Life expectancy, at 67 years, was at a level equivalent to Brazil. Nearly all urban dwellers and 72 percent of rural residents had access to clean water, while 93 percent of Iraqis had access to health services. Iraq’s medical facilities and public health system were well developed (UNICEF, 1993). With Iraq’s August 1991 invasion of Kuwait, and the subsequent 1991 Gulf War, a country on the verge of joining the ranks of developed industrial states was temporarily plunged into a pre-industrial era (Khan, 1991). Over a period of six weeks, coalition forces dropped more than 90,000 tons of explosives on Iraq. Between 50 and 70 percent of bombs dropped missed their intended targets (Haines, 1993). Civilian deaths during the Gulf War, the subsequent civil uprisings, and the Kurdish refugee crisis were estimated at between 40,000 and 80,000 deaths. As many as 100,000 Iraqi soldiers were also killed (Ahtisaari, 1991; Daponte, 1993). The Gulf War resulted in a complete breakdown of the Iraqi civilian infrastructure. Bomb damage reduced postwar electricity to just 4 percent of prewar levels. Oil refineries, food storage facilities, industrial complexes, sewage pumping stations, telecommunications facilities, roads, railroads and dozens of bridges were destroyed during the war. Water supply in Baghdad was reduced to 5 percent of prewar levels (Joint WHO/UNICEF Team Report, 1991). Sewage systems were paralyzed, with raw sewage backing up into homes and hospitals. Raw sewage from most of Baghdad’s then 4 million inhabitants was pumped untreated into the Tigris river, southern Iraq’s main source of drinking water. A breakdown in food distribution resulted in country-wide food shortages, widespread malnutrition and, in some areas, pre-famine conditions (IST, 2001). The breakdown in electricity, water and sanitation led to outbreaks of infectious diseases, including cholera, typhoid, gastroenteritis, malaria, meningitis, measles and others. The combination of malnutrition and infectious diseases resulted in dramatically increased rates of infant and child deaths – a three-fold increase – resulting in more than 50,000 child deaths in 1991 alone (IST, 2001). In Iraqi Kurdistan, more than 2 million Kurds were forcibly displaced from their homes and sought refuge in neighbouring Turkey and Iran. Many thousands died from exposure and disease. In the south of Iraq, a civil uprising was brutally suppressed resulting in more than ten thousand civilian deaths. Since early 1991, despite substantial attempts to recover from the damage caused during the Gulf War, Iraq has remained subject to a sanctions regime that has crippled basic services and made it impossible to recover economically. By mid-decade, although modest improvements in social services had been made, the social infrastructure (electricity, water, sanitation, health care, education and the economy) were still functioning at a fraction of their prewar state. Malnutrition remained high, and mortality rates among children tripled prewar levels. Meanwhile, until Iraq complied with UN Security Council Resolution 687, which mandates the elimination of Iraq’s nuclear, biological and chemical weapons programs, sanctions remained in place, furthering jeopardizing civilian recovery. It remains a subject of considerable debate the degree to which Iraq has complied with the terms of UN Security Council Resolution 687. In 1996, Iraq finally accepted the terms of UN Resolution 986, which permitted the controlled sale of limited quantities of Iraqi oil in order to purchase essential humanitarian supplies. To date, Iraqi oil valued at approximately $61 billion has been exported under the Oil-for-Food program. Of this amount, some $26 billion worth of humanitarian supplies have been delivered to Iraq – on average $4.3 billion per year since the program began. An additional $10 billion worth of supplies are currently in the production and delivery pipeline. It is worth noting that prewar food imports alone amounted to $3 billion per year, while the cost of returning the civilian sector of Iraq to its prewar state has been estimated at more than $200 billion (Arab Monetary Fund, 1993). Since the inception of the Oil-for-Food program, there has been modest improvement in certain sectors, particularly child malnutrition and drug supply. Overall, however, the social infrastructure remains badly broken down and worn out, unable to meet even the basic needs of the civilian population. Illness and disease remain at high levels, and mortality rates of children remain more than double their 1990 levels. Now, in early 2003, Iraqi civilians face the renewed threat of military conflict. This threat, and the accompanying uncertainty, has already led to increased anxiety and fear among Iraqi children. More physically and mentally vulnerable than they were in 1990, the 13 million Iraqi children now face a future potentially even more grave and more devastating than that which they suffered during the 1991 Gulf War. War is always most deadly for the civilian population, particularly women and children. A war in Iraq will be no different. Indeed, it is because the international community has been witness to the humanitarian disaster resulting from the 1991 Gulf War that it is known that this war will result in many thousands of child deaths. This is indeed a great price for the children of Iraq to pay, and must be weighed against the rational and serious requirement that Iraq must rid itself of all efforts to possess nuclear, chemical or biological weapons. As the international community weighs its options to deal with the political crisis involving Iraq’s government, it is essential that it also give equal and serious consideration to the tragic consequences a military conflict would have for Iraqi children. Legal Framework The Security Council The United Nations Security Council (UNSC) is the world’s primary authority for making decisions concerning international peace and security. Its mandate is based on the Charter of the United Nations. This instrument has been accepted by almost every government, including the United States, its allies and Iraq, as a binding obligation of the highest order. According to Article 25 of the Charter member states agree to implement the decisions of the UNSC. The Charter also states that “the Security Council shall act in accordance with the Purposes and Principles of the United Nations” (art. 24). In the implementation of its responsibilities the UNSC has acted to restore Kuwaiti sovereignty after Iraq’s 1990 invasion, to impose sanctions on Iraq, to attempt to address humanitarian concerns, and to take steps towards destroying Iraq’s weapons of mass destruction (WMD). Sanctions were imposed by UNSC Res. 661 (6 August 1990). UNSC Res. 687 (3 April 1991) created the regime of weapons inspections after the 1991 Gulf War. To mitigate the adverse humanitarian impact of sanctions, the Oil-for-Food Program (OfF) was proposed by UNSC Res. 706 (15 August 1991) and finally adopted by UNSC Res. 986 (14 April 1995). It was accepted by Iraq in May 1996 and, under the terms of the Oil-for-Food program, the first oil flowed in December 1996. The program has since been revised several times. A revision in 1999 allows Iraq to sell as much oil as it can produce, although Iraq’s production remains well below what it has actually contracted to sell (UNHPI, 2002). Although 72% percent of the monies are now earmarked for humanitarian assistance, delays in the delivery of drugs, medical supplies and other humanitarian goods have limited the system’s effectiveness (Interviews, 2000a). The circumstances of children in armed conflict has increasingly been a focus of the Security Council’s agenda. Annual reports on the issue are presented by the Secretary General’s office, and the UN Special Representative to the Secretary General for Children and Armed Conflict regularly meets with the Council. The issue of the protection of civilians during warfare, the topic of several UNSC resolutions, is now the subject of annual discussions. It is fair to say that the plight of war-affected children has not gone unnoticed by the UNSC. On the contrary, there have been substantial gains in recent years, and many Council members are genuinely and seriously concerned with the issue. This report calls upon the UNSC to consider, in a serious, comprehensive and verifiable manner, the impact of an armed conflict on Iraqi children. For the UNSC to do so would be in accordance with its own statements of concern for the well-being of children in armed conflicts and further enhance the credibility of these important statements and resolutions. The Laws of War War leaves children exposed to the most ruthless and unforgiving environment on earth. To mitigate the harm to children during wartime, States have agreed to respect several principles of human rights and humanitarian law at all times. Thus the Convention on the Rights of the Child (CRC) is non-derogable – that is, it applies at all times without exception - as do the laws of international humanitarian law. The most basic rules of international human rights and humanitarian law apply regardless of the legality of the use of force. These rules purposefully impose restraints on how states may fight wars against each other. In a conflict involving the United States and Iraq the most prominent of the legally binding instruments of international human rights law relevant to the protection of civilians are: l The Convention on the Rights of the Child While each of these instruments provides explicit protections for children during armed conflicts, it is the Fourth Geneva Convention that provides the most explicit lex specialis (relevant law) during an armed conflict in Iraq. In part, this is true because although the Convention on the Rights of the Child is non-derogable - applies at all times without exception - the United States (Somalia being the only other country) is not a party to the CRC. In addition, rules derived from customary international law will apply to all parties in the conflict. There are three commonly cited primary rules of laws of war related to the protection of civilians that are found in the above-mentioned sources of law. These are the most basic of the laws and govern the interpretation of other rules of law. The rules are aimed at protecting both the direct physical integrity of protected human beings, as well as providing indirect protection of facilities necessary for human survival. Here they are stated with the emphasis on the child. The first of these laws is that children are not to be the object of attack. Every child is considered not to be officially a part of the armed forces of his/her country when an attack takes place and is therefore protected by this rule. This includes the children of soldiers who are off duty, as well as those soldiers participating in an armed conflict. And all children in Iraq, without distinction as to nationality, are unambiguously protected by customary international law. The customary law protection is elaborated in United Nations Resolutions UNGA (Res. 2444 and 2625). An example of this is the statement in the resolution concerning Respect for Human Rights in Armed Conflict where it is stated “[t]hat it is prohibited to launch attacks against the civilian populations as such” (UNGA Res. 2444). The United States government has unambiguously accepted this resolution as customary international law (UN Doc. A/C.3/SR.1634). A second law is that soldiers must always distinguish between children and combatants. This corollary to the first principle of law must be interpreted in the interest of the protection of children and provides a positive obligation for states. This distinction serves as the basis for the protections in the first principle and in the following principle of law. This law is customary international law and is reflected in words immediately following the statement of the first law in the same resolution which reads: “distinction must be made at all times between persons taking part in the hostilities and members of the civilian population to the effect that the latter be spared as much as possible.” This provision requires states to make effective and identifiable efforts to ensure that children are protected as effectively as possible, even if this means that military action that is considered otherwise necessary must be suspended. And finally the third principle of law is that facilities essential for the survival of children must not be the subject of attack. Again, the United Nations resolutions indicated above provide the basis for this understanding. While neither the United States nor Iraq have ratified the 1977 Protocols that elaborate these laws, these protocols form the basis of some of the principles of customary international law. Attacks on civilian supporting electrical facilities, food warehouses, schools and hospitals, among others, are prohibited. These three principles are directed to soldiers at every level from the commander-in-chief to the enlisted infantryperson. Each of these provisions have been strenuously discussed and negotiated over many years by the diplomatic representatives of states and with substantial involvement by the military of these states. In addition to these three overriding principles of law, there are numerous specific protections that should be extended to children. The following is a short list of the specific protections provided for children in the Fourth Geneva Convention, which will apply to any armed conflict in Iraq, and to which the article numbers in parenthesis refer: l Safety zones may be established to protect children (art. 14) The majority of these rights are legal imperatives. That is, they are stated using the word “shall” indicating that states have no choice but to implement them, or they violate international humanitarian law. All of the provisions of the Fourth Geneva Convention may be implemented by a body of enquiry (art. 52, 53, 132, and 149, respectively in the four Geneva Conventions). Although there is no standing body, such a body is to be formed at the request of any party to the conflict. If the parties to the conflict cannot agree on the modality for such a Commission, they are required to then agree on an individual that can determine the procedure for the enquiry. Once this enquiry body makes a determination that there is a violation of law, “the Parties to the conflict shall put an end to it and shall repress it with the least possible delay.” Failure to implement a determination of this body constitutes an additional violation of international law. A weakness inherent in using the above laws to protect children is that there is no body that can effectively require states to act in accordance with the law. Nevertheless, the mere fact that a violation of law is established contributes substantially to de-legitimizing government acts that are contrary to these most basic dictates of humanity. “Armed conflict kills and maims more children than soldiers.” Household Economy For most Iraqi families, grinding poverty is an everyday reality. After two wars and twelve years of sanctions, most families have depleted their resources by selling whatever they could to compensate for lost income. In 1989, 1 Iraqi Dinar was equal to US$3 (UNICEF Annual Report, 2002). In 2003, on the currency markets in Baghdad, 2,200 Iraqi Dinars buys US$1 – less than 1/6,000th its prewar value. Furthermore, salaries have not kept up with inflation. An average schoolteacher now earns between US$3 and US$5 per month, while most public servants earn between US$3 and US$6 per month (UNICEF, 2002). Iraq’s unemployment rate currently stands at more than 50% (ICRC, 2002), with more than 50% of Iraqi families living below the poverty line and working multiple jobs to make ends meet (UNICEF, 2002). As a result, the purchasing power of average Iraqi families has plummeted since 1990, with many families lacking the basic financial resources to make ends meet. Sharp declines in household economy have also affected national educational levels (UNICEF, 2002 “Working Together”). Many children are being forced to drop out of school for financial reasons, and at least 23% of children are not attending primary school (UNICEF MICS, 2000). In addition, rehabilitation of the educational sector in the South/Central regions under the OFFP has been slow, compromising the capacity of average Iraqi families for self-advancement and gainful employment through education. Adult literacy rates fell from 89% in 1985 to 57% in 1997 (UNDPa). Children are also being forced into the workforce because of family need, and there is a visible rise in the number of children working as peddlers and beggars on the streets (UNICEF, 2002). As a result of a combination of factors, including rapid inflation, increasing commodities prices, the sale of household resources, rising unemployment and a decline in educational levels, Iraq’s household economy is in a far more critical state than in 1990. In the face of a new war, few Iraqi families will have the necessary resources to sustain themselves. Food Security Availability and accessibility of food constitute the two essential elements of food security for children (FAO, 2003). Following the 1991 Gulf War and twelve years of sanctions, Iraqi families do not yet possess food security. Agricultural production has been hampered by economic sanctions, while imports under the Oil-for-Food Program have increased household dependency on government-distributed food rations. Many families’ food intake remains nutritionally poor, with inadequate caloric, protein and micronutrient value. Entitlement and access to food has been hindered by the fact that the majority of Iraqi families are now very poor. Most have long since exhausted household financial resources, and are now living day-to-day under conditions of extreme poverty. Importantly, existing social, economic, and nutritional data indicate that Iraqi children are now more vulnerable to malnutrition then they were before the last Gulf War. Agriculture In 1989, agriculture comprised only 5 percent of Iraq’s Gross Domestic Product (GDP). According to the United Nations, Iraq imported more than 70 percent of consumed foodstuffs, valued at more than $3 billion per year. Following the 1991 Gulf War, sanctions initially prohibited the importation of seeds, fertilizers, pesticides, insecticides, crop spraying equipment and other agricultural inputs. Gradually, exemptions were granted for most essential items and inputs, yet financial resources were limited until the beginning of the Oil-for-Food Program in 1996. At the same time, the Iraqi government embarked on a vigorous program aimed at reducing dependency on food imports, by providing incentives to farmers and encouraging production and diversification of crops. The result has been that, in 2003, although production of wheat (for example) is approaching prewar levels, yields per hectare remain below levels attained in the late 1980s. Furthermore, recent droughts have reduced production and yields during the late 1990s. Limits to Food Production Despite the above efforts at increasing domestic production, drought, inadequate supply of essential agricultural equipment and products such as fertilizers, pesticides and spare parts have negatively affected Iraqi agriculture. A shortage of imported feed, overgrazing, and inadequate veterinary services have also contributed to a decline in livestock production. By 2000, the ratio of imported versus domestically produced foodstuffs revealed a continued heavy dependency on imported foods. Domestic wheat production in 2000 was approximately 300,000 metric tons. Wheat imports amounted to approximately 3.3 million metric tons. In this sense, only 8 percent of wheat was produced domestically; 92 percent of wheat supplies were imported. Similarly, only 7 percent of vegetable oil, 1 percent of sugar and 4 percent of rice was produced domestically in 2000 (FAOSTAT, 2003). Iraq’s Food Dependency Commodities Domestic Production (metric tons) Imports (metric tons) Import Dependency (Imports as a percent of total prod.) Food support programs in Iraq started on a modest scale in the mid-1980s. This program provided food to approximately 1 million civil servants at subsidized prices (UNICEF, 2002c). Immediately, following the imposition of the UN embargo of August 1990 (Resolution 661), a food rationing system was introduced to offer essential staples to all Iraqi residents (including foreigners living in Iraq). In its initial phase, the food ration program supplied roughly 1,093 kilocalories per person per day of basic foodstuffs (UNICEF, 2002c). In response to the rapid post-war deterioration of the socio-economic conditions in Iraq, the Oil for Food Program (OFFP) was initiated in 1996. The OFFP was never intended to be a substitute for normal economic activity. As long as the current sanctions remain in force, however, it is the only reliable tool available for seriously addressing the humanitarian situation in Iraq. Despite its shortcomings, the Oil-for-Food Program has made a significant difference in the lives of Iraqis. Routine distribution of food on this scale is a major logistical operation that appears to be running smoothly. Some 24 million people (20.5 million in the south/centre and 3.5 million in northern Iraq), currently receive an average of 2,230 kcal per person per day (kcal/p/d) (UNICEF, 2002c). Funds authorized for food by the OFFP are used to handle a massive food distribution regime which involves some 60,000 metric tons/month in the North and some 350,000 metric tons/month in the South/Central regions. In northern Iraq, food is distributed by the World Food Program, and in the South/Central regions by the government of Iraq. Funds for both programs are paid for through the sale of Iraqi oil. A massive network, involving the Ministry of Trade (in the South/Centre) and WFP (in the North) import OFFP-approved food. It should be noted that the Iraqi government is not allowed to purchase domestically produced foods for the rationing program, even when Iraq has bumper crops. This situation has contributed to Iraq’s significant and continuing dependence on food imports and foreign suppliers. Imported food, once cleared through the ports, is distributed to regional warehouses. The food distribution system is divided into two separate networks, one network for handling wheat, and a separate network for all other food items. Wheat is then transported from regional warehouses to regional mills (both private and public) and once milled sent to local ration centres. Other items are sent directly to ration centres from the regional warehouses. Ration centres then transfer the various food items to the network of local agents according to the number of individuals they are supplying. Families receive their monthly ration by paying 250 ID (approximately US$0.125). The Iraqi food rationing system has been identified as one of the most efficient mechanisms of food distribution in the world by various UN agencies and observers visiting Iraq, and has been practically free of abuse due to strict control by the authorities (UNICEFa, 2002). Cheaters are fined the market price equivalent of items included in the food-basket and, in the case of retail agents, loss of license is the minimum penalty. On average, the monthly rations provide 2,215 kilocalories of energy and 49.4 grams of protein per person per day (United Nations Office of the Iraq Programme, 2002). The food-basket has a very low vegetable protein content and does not include any animal proteins. Moreover, some of the rationed items can only last for two thirds of the month. According to an FAO/WFP report in April 2000, monthly food rations only lasted for 21 days and milk powder 12 days. This means that families have to buy additional food items in the market place. Low household purchasing power, a combination of high unemployment, devaluation of the Iraqi dinar and low monthly wages, means that most Iraqi families are 100 percent dependent on food rations for their survival. It is estimated that, even with food rations, 72 per cent of the average household income is spent on food. Since many households do not have any additional source of income, families often resort to selling part of their ration to purchase other necessities in the private market, items such as meat, medicine and clothing. UNICEF reports indicate that close to 60 per cent of the population in Iraq (approximately 16 million people) are fully dependent on the food ration distributed each month by the government (UNICEF, 2002c). Anticipating a possible military conflict, in August 2002 the government began providing an advance ration together with the current month’s ration. Iraqi families have now received an ‘advance’ of five months of food rations, to enable them to stockpile food at home in case of war. However, quantities of pulses, dried whole milk and vegetable oil have declined in these rations due to low in-country stocks. Current stocks for vegetable oil are sufficient to last only one and half months, while stocks for pulses and dried whole milk will not be adequate to cover even a one-month ration (UN, Office of the Iraq Programme, 2002). According to the WFP’s food price monitoring mechanism, food market prices are extremely sensitive to changes in the political arena. After September 11, for example, the prices of food-basket items increased significantly which required WFP intervention. UNICEF estimates that over 18 million people out of an estimated population of 26 million are food insecure in Iraq and “even a short-term interruption in basic services that would follow a conflict in Iraq” would have very negative effects on their lives (UNICEF, 2003). A war situation, which may also involve the destruction of transportation facilities, ports, bridges and warehouses would likely lead to rapidly increasing food prices in the markets. That situation, coupled with the fact that most of the urban Iraqi population are dependent on government rations and would be unlikely to cope with food shortages without immediate and massive emergency assistance, means that war would most certainly have a massive negative impact on the civilian population.
Infrastructure and Environment Electricity Iraq had an installed capacity of 9,500 MW prior to the Gulf war with electric generation being provided by a mix of thermal, hydroelectric and gas turbine stations. One unusual feature of Iraq’s power system was a high reserve capability – almost 46% of installed capacity. (International Study Team, 1991) This installed capacity of 9,500 MW was reduced to about 300 MW as a result of allied bombings. Repairs since have restored generation capacity to about 3,500 MW, 68% of peak load in 1990 of 5,162 MW and about 37% of installed capacity. About 75% of the transmission lines were again made operable (International Study Team, 1991). In numerous interviews it was cited that the capability for further repair had been exhausted. The lack of spare parts and the poor condition of the transmission and distribution networks has been the primary factor limiting capacity of the Iraqi government to repair and rebuild its electric grid (OIP, 2002). Damage to the electrical system has had profound negative impact on public health, water and wastewater systems, agricultural production and industrial capacity. Since the early 1990s until recently, the government of Iraq has not been able to significantly increase its generation capacity through the construction of new power plants. Although the reasons have been varied, they have been primarily connected to the sanctions regime. Lack of funds for 99 approved projects valued at $360 million will forestall the addition of an extra 1,090 MW generating capacity. Materials for two new power plants (Ai-Shimal and Salah al-Din) worth about $81 million that have arrived cannot be utilized because applications for main equipment are not approved (OIP, 2002). Unlike the situation in 1991, Iraq’s stockpile of spare parts for their electricity system is almost non-existent as most of the spare parts that they have been able to import are used for routine maintenance. Any further damage to the system will decimate their ability to generate and distribute power. Considering the poor conditions of their existing equipment, they will not be able to cannibalize parts from damaged systems to the same degree that they did in 1991. The impact of damage to the existing electricity system will likely be even more catastrophic than it was in 1991. At that time absent or erratic power supply limited hospitals and health centers in their ability to sterilize equipment and refrigerate vaccines and medicines. Water and wastewater stations were also limited in their ability to treat and distribute water and treat and dispose of raw sewage. Directly as a result of this Iraq has seen mortality and morbidity rates increase due to increased levels of water borne and waste borne diseases (International Study Team, 1991).
Water and Sewage Before the Gulf War of 1991 Iraq had a modern physical infrastructure of water treatment plants and distribution systems to provide safe potable drinking water to its urban population. The crippling of the electricity generation system as a result of the 1991 Gulf War and subsequent events had a significant impact on the water and wastewater systems. In the years following the Gulf War, most of the water treatment plants were operating at 30-70 percent of design capacity due to the lack of spare parts. Chlorine was being rationed at all plants with supplies on hand varying from a few days to four weeks. It was estimated early in 1991 that the operational capacity of the water system would deteriorate to about 5-10 percent of capacity within months due to the lack of spare parts, chlorine and regular power supply. The wastewater systems in Baghdad and in most Governorates south of Baghdad were operating anywhere from 0-70 percent capacity (some plants were not operating at all) with the lack of spare parts and electricity as the main rate limiting factor (International Study Team, 1991). It is interesting to note that direct physical damage either from the bombing or from looting during the civil uprisings was found to be only a minor factor in the impairment of the water and wastewater systems. The primary rate limiting factors were the lack of spare parts, the supply of chlorine and erratic electricity supply (International Study Team, 1991). At present 50% of sewage treatment plants are inoperable and another 25% do not meet national environmental standards (UNDP, 2003). Most sewage treatment plants’ operating capacities stand at an average of 33-48 percent as contracts for major mechanical and electrical parts are either unfilled or on hold under the sanctions regime (OIP, 2002). Even the quality of water has been severely affected. In the southern governorates the turbidity of 70 percent of tested water exceeded 10 Nephelometric Turbidity Units (NTU). In some places the turbidity exceeded 25 NTU. The standards should not exceed 1 NTU (UNICEF, 2002). Garbage collection and sewage treatment has been affected also. It is estimated that about 500,000 tons of raw sewage is dumped into fresh water bodies every day – particularly the Tigris river, the south’s main source of drinking water (UNDP, 2003). Garbage collection in Baghdad has dropped from 1.5 kilograms per capita per day for 4.25 million people in 1990 using 800 garbage collection trucks to about 0.5 kilogram per person per day for 5.6 million people now using only 80 garbage collection trucks assisted by another 400 hired garbage collectors (UNICEF, 2002). In 2003, safe drinking water is a serious problem right across the country because of the inability to process water and the wastewater properly. Cases of diarrhea have increased from an average of 3.8 episodes per child/year in 1990 to 15 episodes per child/year in 1996. During the same period typhoid fever increased from 2,240 to 27,000 cases per year. (UNICEF, 2002). In addition to this deterioration in water supply and water quality, Iraq is now only recovering from one of the most serious droughts in recent history. Water resources are now less than half normal levels. The United Nations agencies estimate that recent droughts may have affected up to 70 percent of all arable land. (UNDP, 2003). In addition, salination affects more than 75 percent of land in Iraq and is one of the major causes for desertification (UNDP, 2003). With the health of children so severely affected by a crippled and crumbling water and sewage treatment system, any further disruption of these systems would be catastrophic for the children of Iraq, further increasing morbidity and mortality rates to unacceptable levels beyond the already high levels that they are at now. Child Vulnerability Analysis- Infrastructure and Environment - Health and Nutrition By most accounts, prior to 1990 Iraq had one of the best health care systems in the Middle East. The World Health Organization previously described Iraq’s health infrastructure as “a first class range of medical facilities” (Medact, 2002), including well-established public health services, hospitals, primary care facilities and an ample supply of medicines and medical equipment (Popal, 2000). The Gulf War and twelve years of economic sanctions have had a devastating effect on Iraq’s health infrastructure, resulting in a significant decline in the health and well being of Iraqi children (Hoskins, 1997). Death rates of children under five have more than doubled over the past decade, with 70% of deaths attributed to diarrheal disease and respiratory tract infections (UNICEF, 2003a). Marginal gains in health services under the Oil-for-Food Program (OFFP) are having a limited impact on child morbidity and mortality in South/Central Iraq due in part to persistent deficiencies in the water and sanitation sectors. In addition, inefficiencies and delays in the procurement of essential medicines and medical equipment under the OFFP are resulting in frequent shortages and reduced capacity within publicly funded hospitals and health clinics. While there have been improvements in immunization coverage and malnutrition rates in the past several years, overall Iraqi children are much more vulnerable to starvation, death and disease than they were in 1990. Child Morbidity and Mortality The under five mortality rate for South/Central Iraq is currently estimated at 131 per 1,000 live births, 2.3 times the level recorded in 1990 of 56 per 1,000 live births (UNICEF, 2003b). Infant mortality has also increased during the same period, from an average of 50 per 1000 live births to 107 per 1000 live births (UNICEF, 2003a). However, this increase is not consistent throughout the country. In the three predominantly Kurdish governorates in northern Iraq, the so-called self-administered region, under five mortality has actually improved, decreasing from 80 deaths per 1000 live births (1984-1989) to 72 deaths per 1000 live births (1994-1999), a decrease of 10 percent (UNICEF, 2003b). Gains in the North are attributed to special consideration under the OFFP, which allocates 13% of Iraqi oil revenues to the North, administered under the direction of the United Nations. Under-Five Mortality Rates in Iraq Poor water quality, sanitation and environmental conditions, compounded by malnutrition, continue to have the most significant impact on child morbidity and mortality. Significant repair of the water, sanitation and electrical facilities, damaged during the 1991 Gulf War, has been hindered by ongoing economic sanctions. In the South/Central regions of Iraq, this has resulted in persistently high rates of diarrheal disease in children. Water quality analysis undertaken by the World Health Organization in combination with the Ministry of Health shows high rates of contamination in water samples and a 40 percent decline in potable water production during the 1990s (WHO, 2002). Iraqi children currently experience an average of 14.4 days of diarrhea each month, compared to an average of 3.3 in 1990 (UNICEF, 2003a). While rates of diarrheal disease remain much higher than 1990 levels, from 1998 to 2001 the number of cases of diarrhea in children under five decreased by 19 percent (UNICEF, 2002b). In addition to diarrheal disease and acute respiratory infection, the main health problems of Iraqi children include: nutritional anemia, vitamin A deficiency, iodine deficiency, malaria, leishmaniasis (kala azar) and measles (UNICEF, 2003b). The World Health Organization has noted a decrease in the number of reported cases of both cholera and typhoid over the past three years (WHO, 2002). Government officials and hospital directors also report an increased incidence of childhood cancers in South/Central Iraq, but this reported increase is difficult to quantify as there is only limited reliable epidemiological data. Furthermore, the impact of depleted uranium from radioactive shell material used by coalition forces during the Gulf War, and its possible association with childhood cancers in Iraq, remains scientifically unproven (Medact, 2002). Nutrition There is no nationally representative data on malnutrition available prior to 1990 (Garfield, 1999). The earliest available data is that collected by the International Study Team in August 1991, one year after the imposition of sanctions. However, several published, but unverifiable, reports suggest that a
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