A report on Iraq under a decade of sanction
Iraq, Health, 3/3/2000
Eight years of war with Iran (1980- 1988) followed by the Gulf War of 1990-1991 left Iraq and the Iraqi people exhausted. The economy and, as a result, the infrastructure of the country lay in ruins. Now, after nine years of trade sanctions, imposed by the UN after Iraq's invasion of Kuwait in August 1990, the situation of civilian population is increasingly desperate. Deteriorating living conditions, inflation, and low salaries make people's everyday lives a continuing struggle, while food shortages and the lack of medicines and clean drinking water threaten their very survival.
In mid 1999 the International Committee of the Red Cross extended its budget for the year by 60% in order to fund new programs in the fields of health and water and sanitation, which are to continue in the year 2000-- in full awareness of the fact that humanitarian aid cannot nearly cover the overwhelming needs of 22 million people.
In Iraq, it is the weakest and most vulnerable who suffer from sanctions-- the elderly and people with chronic diseases.
According to a UN Children's Fund (UNICEF) survey published in August 1999, infant mortality in most of Iraq has more than doubled in the nine years since UN sanctions were imposed. In central and southern Iraq, home to 85% of the population, the death rate for children under five rose from 56 per 1,000 live births in the period 1984-1989 to 131 per 1,000 in 1994-1999.
The survey, which was prepared with the Iraqi government and the World Health Organization, did not specifically blame trade sanctions for the crisis which has seen some 500,000 Iraqi children die since the Gulf War.
As for the autonomous Kurdish territory of northern Iraq, the survey found that deaths among children under five had dropped from 80 deaths per 1,000 live births in 1984-1989 to 72 deaths per 1,000 live births between 1994 and 1999 (after having risen to 90 per 1,000 in 1990-1994).
For the first time in decades, diarrhea has reappeared as the major killer of children. The highly specialized Iraqi doctors are now faced with third-world health problems which they were not trained to handle.
According to UNICEF statistics from November 1997, a third of all children under five are chronically malnourished. This represents a 72% rise since 1991. Results from a nutritional survey of 15,000 children of the age of five, conducted by the Iraq Ministry of Health together with the UNHCR and WFP in May 1998, show that the level of malnutrition has stabilized since 1997 but that the situation is unlikely to improve substantially unless water and sanitation and other sectors receive larger financial input.
Given the gravity of the nutritional situation, in February 1999 the World Food Program (WFP) launched a US $21 million appeal to help more than one million people in Iraq suffering from the effects of food shortages and poor water supply, including 200,000 acutely malnourished children (in particular the under-fives). These children have not had proper drinking water or sanitation since they were born.
Moreover, standards of care in hospitals and health centers have reached appalling levels, despite the doctors' dedication and high qualifications. Iraq's 130 hospitals, many of them built by foreign companies in the 1960s and 1980s, have not received the necessary repairs or maintenance since the Gulf War, but above all since the imposition of sanctions. The buildings are in an advanced state of disrepair (cracked and leaking roofing, broken windows and doors, bulging floors), as are the hospital sewage works, the electricity and ventilation systems, and the elevators. Expensive imported equipment, or even more basic items are no longer being replaced.
Equally worrying is the state of the primary health centers, which serve the widest sector of the population. Public health in Iraq rests on the existence of over a thousand basic dispensaries covering the entire country and 84 intermediary health centers, which are in charge of coordination. The centers cannot function properly owing to the shortage of equipment and material. They often lack the most basic tools such as stethoscopes, sterilizers and writing paper. The negative impact on the treatment received by patients and hence on their health, is immense.
Another major threat to the health of the population is the quality of the drinking water. The Gulf War severely damaged Iraq's infrastructure, interrupting the power supply and consequently the operation of pumping and treatment facilities. Since then, money and spare parts have not been available to repair sewage works and purification plants, which are often working at reduced capacity or not at all. This had led to an overall deterioration in the quality and quantity of drinking water and the rapid spread of infectious diseases, such as cholera.
A UNICEF / Government of Iraq survey in 1997 on the availability of water and sewage systems reported than more than half of the rural population did not have adequate access to clean drinking water, while for sewage disposal some 30% of the total population, predominantly in rural areas, were without adequate services. Much of the of the waste is discharged directly into rivers and streams, so that much of the water supplied is contaminated or below acceptable standards.
The low availability of power, averaging 50% in rural areas, frequent cuts and unstable supply place an additional strain on the installed electrical equipment. This, added to the fact that the chemicals used to purify the water contain around 30 times more impurities than before the embargo, leads to premature deterioration of the equipment, which subsequently requires more maintenance.
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