9/25/2003 - The Health of the Children of Iraq

Reliable data on child health in Iraq has been sparse over the past fourteen years, but even more so since the recent war and occupation. Nevertheless, rapid assessments, performed by independent observers not associated with the Iraqi Government, presented a dire picture of increasing child death and suffering in Iraq. The situation is not likely to be reversed unless the tenor of the Coalition Provisional Authority (CPA) occupation changes dramatically.

Child health in Iraq during the 1980's was one of the most advanced in the region and steadily improving. This trend was reversed by the Gulf War of 1991, and the thirteen years of United Nations sanctions. Infant mortality rates more than double and under-five mortality rates shot to 131 deaths/1000 live births by 2000. Estimates of the excess child deaths during the 1990's range from 200,000 to one million children. Recent mortality rates are not available, but given he worsening of those societal factors known to impact on child health and mortality, it is likely that the situation of Iraq's children has worsened considerably.

The physical development of children was easier to assess (by age, weight, height determinations) and indicated that malnutrition rates more than doubled from 1990-1999; one quarter of Iraqi children were chronically malnourished. Moderate improvement of child nutrition was noted after 1996, due largely to the often-maligned U.N. Oil for Ford Program (OFFP) which supplied 60% of all Iraqis with minimum food requirements, and prevented widespread famine in the country. Specific malnutrition interventions by NGO's, e.g. The United Nation's Children's Fund's (UNICEF) targeted nutrition programs, were also effective. Since the War of 2003, the interruption of food distribution, disruption in the water purification, sewage removal and electricity availability, resulted in a sharp increase water borne dysentery, leading to acute malnutrition. Many hospitals appear as they did in 1991, cribs filled with wasted, bony infants with intractable diarrhea.

The major factors which now impact on the health and well-being of Iraqi children are similar to those that arose after the Gulf War, complicated by additional unresolved problems created by the Coalition Provisional Authority (CPA) occupation.

Security. The collapse of Iraqi civil society, during and after the war, affected child health in a number of ways. With the complete breakdown of law and order, and the continued uncontrolled violence, hospitals could not provide even minimal services. Basic medications looted from hospitals have not been replaced, and hospital staff, especially nurses, face the risk of being mugged, abducted, and raped. Children are now seen in hospital emergency rooms with traumatic injuries, either from bullet wounds or bomb blasts; the children often are caught in the crossfire between vigilantes and looters, or struck by bullets fired by nervous CPA soldiers.

The health of Iraqi children is dependent on the efforts of a large and active cadre of professionals working with U.N. agencies and foreign non-governmental organizations. The U.N. Field Security Office reports that there have been 70 violent attacks on NGO'S and diplomatic missions. Workers from the International Committee for the Red Cross (ICRC), World Health Organization, Christian Children's Fund, Mines Advisory Group, UNICEF and other U.N. Agencies have been murdered. Since the bombing of the U.N. headquarters in Baghdad on August 19, and a second bombing on September 22, numerous organizations have scaled down operations, or pulled out of Iraq temporarily. Unless the CPA can provide security for relief workers, the reconstruction of Iraq is unlikely to move forward.

Explosive remnants of war. The ICRC has been particularly concerned with injuries to children from unexploded or abandoned munitions. Unexploded American cluster bombs are particularly hazardous to children. They are of a size and shape that are attractive for children to play with, and have resulted in traumatic injuries and death of unsuspecting children.

Food. The OFFP, which provides food for more than half of the 26 million Iraqis, will terminate in November 21, 2003. An orderly transition to a civilian authority that can provide efficient public food distribution will be necessary, particularly in the central and southern parts of Iraq. The World Food Program (WFP) will have delivered 2.2 million metric tons of grain to Iraq by the end of October. WFP will continue to support the public distribution system which provides food at outlets at a reasonable cost. Unfortunately, after three wars and thirteen years of crippling sanctions, the average Iraqi does not have the buying power to provide an adequate diet for his family

Electricity, water and sanitation. Electricity is tightly linked to public health in Iraq. Electricity drives water purification plants, and pumps sewage along major pipes, through pumping stations to sewage treatment facilities. When electricity is interrupted, untreated sewage flows into the rivers, contaminating the major source of water for drinking and bathing. It is estimated that one million cubic meters of raw sewage is discharged each day into the rivers of Iraq creating a public health crisis.

At present, electricity is down 2-3 hours a number of times each day in Baghdad, and more frequently in other parts of Iraq. The major cause of power outages is destruction of high power lines by acts of sabotage using grenades or other explosives.

In addition to the effect of electrical shortages on child health, the entire water and sanitation network is in disrepair. Damage of pipelines and pumping stations from corrosion, obsolete equipment, Coalition bombing and looting has created major seepage of sewage into the leaky public water system, contaminating the public water supply. Access to safe water has fallen to half pre-war quantities in most parts of Iraq. International NGO's (Oxfam, ICRC, UNICEF and USAID-supported projects) have targeted repair of the water and sanitation system and the electrical power grid as a high priority.

Health Care. Many hospitals, pharmacies and health care centers were extensively looted and damaged after the war. Efforts by international NGO's and USAID programs to rebuild clinics, repair hospital electrical systems, replace equipment, restock pharmacies with drugs and vaccines, reinitiate vaccination programs, provide security for staff, and help some hospitals provide a wide range of medical services have had some notable successes. Further, the OFFP program delivers fifteen truck loads of medicine to Baghdad warehouses every other day for distribution to rest of Iraq. Despite ongoing efforts, many of the 282 hospitals and the a number of community health centers are not able to provide adequate services. One half of 85 hospitals recently assessed were either unable to function or had major difficulties in delivering medical services. Major problems were destroyed structures, lack of drugs, supplies or laboratory equipment, and staffing problems due to security issues or inability to pay salaries.

Auditors are able to quantitate megatons of grain, truckloads of medicine, and kilowatts of electricity delivered to the people of Iraq, and these indicators of reconstruction are improving. The quality of life for Iraqi children is not. Many children, especially girls, are afraid to go to school, have fathers who are unemployed, have no fuel to boil contaminated water, do not have enough food to eat, see sewage flowing in front of their houses, live in the vicinity of discarded munitions, and struggle to survive one more day. A large infusion of money from the U.S. Administration, other committed countries, and international organizations has been allocated to address these problems in the coming months. However, without a comprehensive plan for improved security, and the coordinated involvement of United Nation Agencies and the international relief community, the Coalition Provisional Authority is likely to fail in its efforts to rebuild Iraq. The burden of that failure will fall upon Iraqi children.

This article refers to data in reports from the United Nations Children Fund, International Committee for the Red Cross, Oxfam, Food and Agriculture Organization, World Food Program, Medicine For Peace, United States Aid to International Development, and the Health Coordination Group.

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