Humanitarian Crisis Looms for Iraq, Aid Workers Warn

Hillary Mayell
for National Geographic News
April 15, 2003
Skies punctuated by columns of black smoke, cities covered with dust,
limited access to clean water and sanitation facilities, and looted
hospitals are ominous harbingers of the post-war health problems facing
the people of Iraq, warn health officials with government and
international aid agencies.

Saddam Hussein's reign of terror, two earlier wars—the Iraq-Iran war from 1980 to 1988, and the 1991 Gulf War—and 12 years of economic sanctions imposed by the United Nations have devastated the once prosperous country.

Public health workers say the most pressing health-related issues facing Iraq in the coming days and weeks are providing clean drinking water, ensuring access to medical and health care, and securing the food supply. All are dependent on halting the looting, vandalism, and arson currently underway.

"The looting has had devastating consequences for humanitarian relief agencies and civilians," said Sarah Zaidi, a researcher with the Center for Economic and Social Rights. "ICRC (International Committee of the Red Cross) convoy trucks have been vandalized, the UNICEF office was completely looted. People have gone into hospitals and taken blood supplies, antibiotics, beds, equipment—things you can't imagine they'd have any use for. Years of work are being destroyed."

Pitfalls of Dirty Water

The looting is also preventing much needed infrastructure repair work.

Three out of every four Iraqis live in cities and depend on treated water. Electricity is needed to process and pump water and to operate sewage plants. Power stations were one of the early targets of allied bombers, and power has been out in some sections of the country for nearly three weeks.

Even prior to the bombing, water treatment and power plants were decaying due to lack of replacement parts. The United Nations estimates that 500,000 tons of raw sewage was being dumped back into the country's waters on a daily basis before the war.

"Water quality and sewage treatment are a big, big problem that's been recognized for a long time," said Michael McCally, a professor of public health and preventive medicine at Oregon Health and Science University. "When we visited water treatment and sewage plants in January they were in pretty horrible shape. The Iraqi power system was generating about half of what it was 12 years ago. Now people are taking untreated water straight out of the rivers and canals—and hopefully boiling it, but they're low on fuel too."

Waterborne illness increased radically after the invasion of Kuwait. Health officials are preparing for a similar surge in Iraq.

Infants and children under five are particularly susceptible to waterborne diseases. Typhoid, cholera, illnesses caused by organisms such as such as Lysteria and Giardia, and viral gastroenteritis can all lead to diarrhea, which is one of the major causes of death among children worldwide. In Iraq, respiratory infections and diarrhea account for 70 percent of deaths in children under five years of age.

"When dirty water and malnourished kids are widespread, you get increased disease and death," said McCally. "These are totally preventable, treatable diseases."

The U.N. Children's Fund recently ranked 195 countries and territories by mortality rates of children under five; only 32 countries had rates higher than those for Iraq.

Living on Food Rations

Malnutrition, particularly among children and pregnant women became a serious problem in Iraq when the United Nations imposed economic sanctions in 1990.

Around 18 million people in a country of 24.5 million lack secure access to food, according to the United Nations' World Food Program (WFP), and 60 percent of the population depends solely on food distributed by the government.

"The Iraqi government established a highly efficient distribution system when the Oil for Food (OFF) was instituted in 1996," said McCally. "But the food rations are very basic refugee rations. It's wheat, rice, beans, some cooking oil, dried milk; that sort of thing. That'll let you get by for a while, but they're not nutritionally complete."

The Oil for Food program, which allowed Iraq to sell oil for food, medicine, and basic supplies, was suspended March 17 when the United Nations evacuated its personnel from Iraq.

A confidential memo prepared prior to the war by the U.N. Office for the Coordination of Humanitarian Affairs estimated that 30 percent of children under 5 would be at risk for death from malnutrition in a "medium-impact" war scenario. The report, which was obtained and released by humanitarian aid groups opposed to the war, went on to say that "all U.N. agencies have been facing severe funding constraints that are preventing them from reaching even minimum levels of preparedness."

Once again, security issues are a problem. Since the start of the conflict, only about 220 trucks carrying food and water have been allowed into Iraq from Turkey. WFP hopes to deliver around 1.6 million tons of food in the next six months.

"As soon as security permits, WFP will open humanitarian corridors into Iraq out of other neighboring countries, including Jordan and Iran," said WFP spokesperson Khaled Mansour. "WFP international staff are on standby in Cyprus ready to re-enter northern Iraq, pending clearance from a joint UN security assessment team."

The agency's Baghdad office has been looted and very little property remains, according to reports from two agency officers in the Iraqi capital.

Smoke, Dust, and Debris

Only a few oil wells have been torched, unlike the 1991 Gulf War, when fleeing Iraqi troops set fire to more than 600 Kuwaiti oil wells. Still, smoke from oil-filled trenches in Baghdad, bomb and looter-ignited fires, and the destruction of weapon caches found by coalition troops will inevitably lead to an increase in asthma and other respiratory problems, health experts say.

"Smoke inhalation is not good for you. We know that in this country where we think the air quality is pretty good," said McCally. "Do we know how many people will be damaged, how severely, and when? No. We do know more people will be going to hospitals. If you're old in Iraq and breathing smoke for a day or two, you're likely to wind up with complications of heart disease or exacerbated lung disease."

Smoke from oil fires contains a range of contaminants such as sulfur, mercury, dioxins, and furans. But particulate matter, small particles of dust or soot in the air, may pose an even greater problem. Chemicals that are very toxic can bind themselves to particulates, which can be inhaled quite deeply and trapped in the lungs.

"We are getting reports from a couple of people who stayed behind [in Iraq] that the bombing has been pretty targeted, but it still brought down a lot of houses," said Zaidi, who is based in New York. "Bringing a building down causes an incredible amount of dust. Just think of the devastation caused by the dust, debris, and environmental contaminants from 9/11, and replicating that many times over, in a city of 5.5 million."

Access to Medical Care

The medical system in Baghdad has virtually collapsed. The dead are left unattended, and the increasing summer heat and deteriorating water and electricity supplies create a high risk of epidemic disease, the Red Cross said in a release Monday.

Doctors and health care workers are staying home to protect their families. At the same time, hospitals are being stripped of beds, equipment, supplies, and medicines. In addition, the civil unrest is making it impossible to repair power stations, and few hospitals have back-up generators.

People with chronic illnesses, in addition to those who sustained injuries during the war are unable to receive needed treatment. Humanitarian agencies poised outside of Iraq are calling on coalition forces to establish order.

"It's tragic really, said McCally." Fourteen years ago, if you were an Arab or Muslim looking to advance yourself, Iraq is where you went to start a business, to go to school, or continue your medical education. Life there has just plummeted."

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