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The stranglehold
of sanctions:

Life in Iraq after nine
years of sanctions

by Julie Bassam
After two wars (the Iran-Iraq war of 1980 to 1988 and the Gulf war of 1991) and nine years of UN-imposed trade sanctions, the Iraqi economy lies in tatters. As US and British air strikes continue to exacerbate the situation, Iraq is experiencing the worst drought for decades. The ICRC is increasing its medical assistance and water and sanitation activities.
The stench outside Fudhailiya Health Centre, in a poor suburb of Baghdad, is unbearable - an overpowering stew of sewage, sweat and filth simmering at a steady 50°C. The smell follows you into the dingy interior of the ramshackle one-floor building where it is no cooler. The doctor is invisible in the swarm of black-clad women jostling to be examined and to receive their medicines. A glance around the premises says it all: cracked walls and ceilings, bulging floors, broken ventilation fans. Children stare at a visitor, wide-eyed yet indifferent. There are a few rusty, rickety pieces of furniture, and no medical equipment in sight. Nearby is the refrigerator where the vaccines are kept. During the long power cuts each day, they are moved to a makeshift cold box.

It is difficult to believe that, just a decade ago, Iraq boasted one of the most modern infrastructures and highest standards of living in the Middle East. The world's second largest oil producer, it implemented ambitious projects and development programmes in the 1960s to 1980s. It had a modern, complex health care system, with hospitals built on western models and using the latest equipment. Sophisticated water-treatment and pumping facilities were constructed throughout the country. By 1990, Iraq presented many features typical of a modern society: reliance on imported food, dependence on imported technology and engineering skills, and interdependence of the different branches of the economy.

No wonder then that Iraq's infrastructure should have proved so vulnerable to the effects of comprehensive trade sanctions. The population, and in particular doctors, technicians and teachers, are now exposed to third-world problems for which they were never prepared. Salaries are as low as US$ 2 a month. People have had to sell their belongings in order to survive - first their cars, then household appliances, even furniture and books.
Hospitals and health centres
As in a war, it is the weakest and most vulnerable who suffer most under sanctions - young children, pregnant women, the elderly, the sick. Standards of care in hospitals and health centres have reached appalling levels, despite the motivation and high qualifications of the doctors. In the 400-bed Al Karama Teaching Hospital in central Baghdad, which is fairly typical of Iraq's 18 large referral hospitals, "nothing works except the physicians," laments the director. The buildings are in an advanced state of disrepair.

The hospital sewage treatment plant has not been working for years. There is a lack of soap and disinfectants, a lack of syringes, gauze, intravenous (IV) lines and fluids. There are few functioning diagnostic tools. Only two of the hospital's 12 operating theatres are in use and even in those, lamp bulbs and trolleys are broken, the central oxygen supply is out of order, and few anaesthesia machines are working. There is a shortage of painkillers, especially those used for post-operative care.

Convinced of the urgent need for action, the ICRC has launched new projects in the health sector, and is extending its water and sanitation programmes. The ICRC plans to rehabilitate ten hospital and 20 health centre buildings (including the rebuilding of Fudhailiya Health Centre) across the country, and to provide them with essential surgical and medical equipment. It will also develop primary health care programmes to support doctors with management and teaching methodology.

The driest year since 1932
Iraq's giant installations for treating and pumping water on the Tigris and the Euphrates rivers are in a pitiful state after nine years of shortages - of electricity, spare parts, chemicals and funds. They now face an additional challenge - the worst drought in decades. By mid-1999, a mere 50 mm of rain had fallen, 5 per cent of the annual average. The potential consequences for agriculture and drinking water supplies are devastating.

The ICRC, which since 1991 has contributed to the rehabilitation of 155 of Iraq's 1,500 water purification plants, launched emergency measures in May this year. Vulnerable river intake structures are being extended and new ones installed, thus ensuring that water still reaches the pumps that take it to the plants for treatment, despite lower river levels. A number of waterways are being partially diverted and local dredging carried out. Chlorine powder will be provided for rural water supply schemes.

The ICRC endeavours to provide a rapid response to some of the needs which are not covered by the oil-for-food programme. It is convinced, however, that humanitarian action alone can be no substitute for a country's economy. It can never meet all the needs of 22 million people; nor can it ensure the maintenance of the collapsing infrastructure - so important in terms of health - of a whole country.
Sanctions can kill
"Sanctions are a blunt instrument, damaging mostly those who are powerless to affect the political change the international community demands," said Dr Astrid Heiberg, president of the Federation, in a speech last year to the UN General Assembly. Nearly ten years after sanctions were imposed on Iraq, evidence of Dr Heiberg's statement can be found in every village, hospital and clinic throughout the country. The humanitarian crisis continues with little relief in sight despite efforts to mitigate some of the effects with programmes such as 'oil for food'.

To assist those most affected, the Federation and the Iraqi Red Crescent have both relief activities and longer-term rehabilitation programmes within the health and medical sectors. In a report released last year, UNICEF found that over 250,000 children under the age of five suffer from severe malnutrition. For this reason, the Federation and the National Society are continuing a supplementary feeding programme to over 10,000 children. Additionally, medical kits were distributed to almost all hospitals throughout the country. Longer-term programmes include: rehabilitating primary health care centres; expanding community-based first-aid programmes, with a particular emphasis on support for landmine victims; and supplying the Mosul IV-fluid factory with the necessary spare parts to increase production.

"The biggest problem facing the Movement in Iraq is donor fatigue," explains Robert Watkins, former Federation head of delegation in Bagdhad. "Financial support is a shadow of what it was a few years ago," he says. With the Balkans claiming most of donors' funds, the people of Iraq continue to be on the sharp end of sanctions with little hope of relief.

Julie Bassam
Julie Bassam is ICRC editor for the external resources division.

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