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Internal injuries

by Sarah Fleming
The accumulation of years of war, internal strife and UN sanctions has crippled the once-prosperous nation of Iraq. Nowhere is the evidence of this more stark than in the lives of ordinary people.

“When Karl, an ICRC orthopaedic technician in Iraq, visited a Baghdad market, he was so distressed to see a family reduced to selling their little boy’s bike that he bought it on the spot and gave it straight back to the boy.

Sadly, the sight of people crouched in the markets behind pitiful heaps of possessions, which they are forced to sell in order to survive, is a familiar one in Iraq. Spiralling inflation means that prices may go up several times a day, and a kilo of rice costs one-fifth of the average monthly wage of a professional person.*

Those who still have something to sell are the lucky ones. Iraq used to be a prosperous country and one of the world’s largest oil-producers. Now, those who were already poor are destitute. The health system is nearing collapse and the doctors are in despair, unable to obtain enough medicines and equipment to treat even the most vulnerable people: malnourished children. Far too many of them do not leave the wards alive.

In such conditions, the ICRC is clearly powerless to help on a large enough scale. It is nonetheless trying to mitigate the consequences of war for civilians through major water and sanitation and orthopaedic programmes.

*Figures quoted were valid in September 1995, and the situation may well have worsened by publication.



The benefits of clean water

One way of protecting children from potentially fatal diseases is to guarantee the quality and quantity of drinking water. The existing water plants, many of which suffered collateral damage during the Gulf War and the subsequent uprisings, had been constructed in more prosperous days by foreign companies and were maintained by qualified engineers and technicians. Not only are they complicated to operate, but human resources have become scarce and spare parts cannot be imported. Andrea, who is in charge of the ICRC’s five-million-Swiss franc water programme, explains: “Our original plan was simply to ask for lists of the parts needed, but we soon realised that those running the stations often have no idea of what is wrong with their equipment. In Basra we actually found a 14-year-old boy in charge of a pump.”

In early 1995, for the second time since the Gulf War, the ICRC launched a whirlwind but meticulous study to establish needs, with the aim of enabling the authorities to improve the selected water stations in their governorates. Andrea, by his own admission no nuts and bolts man, found himself examining installations to find out which precise part was failing to function. Now he presides over fat files, crammed with details of everything from the tiniest parts to the most sophisticated pumps, and keeps track of the thousands of bits arriving from Geneva via the long-suffering ICRC administrator in Jordan, who spends 50 per cent of her working time on complicated paperwork required by the embargo. Andrea has some parts assembled in his workshop in a shed behind the Baghdad delegation and oversees the three teams of locally hired technicians who are installing the new equipment and spare parts where necessary and instructing those responsible in the art of maintenance.

What we saw

Our visit to a government paediatric hospital has been arranged by the local Red Crescent. We are ushered in like celebrities, greeted by the Director, offered tea. After a decent interval of polite conversation we are accompanied down wide sunlit corridors to the wards. We are taken into one room after another, big, dingy rooms of several beds each, smelling faintly of vomit and excrement. As we move, more and more people join us, staff and patients’ relatives, pressing round us, eager to talk. They tell us why the children can’t be treated properly, they prompt each other. “It’s because of the sanctions.”

We have to clear the room so that the photographer can work and I can take notes. And what terrible notes: a litany of names, ages, weights, complaints... all mild problems by Western standards, but the children are without exception severely underweight for their age, too weakened by poor diets and hygiene to rally from the gastro-enteritis, meningitis, marasmus and polio that assail them. They stare at us, miserable, confused, grizzling. One girl (pictured here) lies still and watches us. Her eyes are alert and calm but the nurse says that this is the typical look of a child desperate for food but unable to absorb nourishment. Her skin is pinched, grey and lifeless – she is nine months old and weighs only 4 kg: my son weighed more than that at birth. The flies crawl over her face. The staff try to lift her clothes to show us her emaciated body. We tell them we don’t want to see, we can see that she is ill, leave her in peace.

And then, the awful culmination of our visit: on a bed in the corner of a ward sits a woman, straight-backed, cross-legged, alone, cradling a bundle. The bundle is her dead child. Somebody prompts her, and she pulls down the edge of the cloth exposing the little face, waxen. The woman is waiting for her family to come and fetch her. She looks numbed. The photographer sets up his tripod next to her. Everybody else moves back, in deference. He clicks away, asks for more film, pats her hand in sympathy. She bends her head and sobs briefly, then recovers her composure and covers up her baby again. He had died of gastro-enteritis. We leave, embarrassed, moved, depressed. Maybe we are voyeurs, maybe we were being manipulated, but this is what we saw.

Landmines: a lingering menace

Iraq may have up to 10 million landmines on its territory, left over from the war with Iran in the 1980s. In 1994, in cooperation with the government, the ICRC set up two limb-fitting centres in Basra and Najaf. It also enabled a centre to start work in Mosul. This sparkling and pristine structure, encased in white containers and donated to the Iraqi Red Crescent Society in 1993 by the Swedish Red Cross, had been unable to function until then as the necessary materials were unobtainable in Iraq.

Nashwan, the centre’s highly motivated manager-orthopaedic technician, enters enthusiastically into a competition, encouraged by Mary, the programme’s second orthopaedic technician, to see which of the three ICRC-supported centres can produce the most artificial limbs with the least staff. He is aided by two technicians, both amputees themselves, and Karl, who travels up periodically from Baghdad to advise on the difficult cases. As Mary says, “We are not doing the work for the Red Crescent: the technicians are highly competent people who are unable to work without the necessary materials.” The ICRC pays for and imports the materials, manufactures limbs in its Baghdad workshop, provides training and boosts salaries to attract qualified staff. Its support for centres strung out along the Tigris and the Euphrates, where the population is concentrated, means that people can get to a centre nearer their homes and avoid the prohibitive expense of travelling to Baghdad.


Hard facts

A United Nations survey in August 1995 showed that 50% of rural people in Iraq had no access to drinking water. In Thiqar governorate in the south, 90% of rural people had no access to clean water and 15.8% of the total population obtained water from unsafe sources. Much of the “treated” water is not safe for public consumption.

According to an FAO/WFP mission in September 1995, the prevalence of wasting (body weight/height ratio less than 80%) was comparable to levels found in sub-Saharan African countries.



Troubles in the north

If people in central government-controlled Iraq are suffering, those living in Iraqi Kurdistan are scarcely better off, despite the programmes being run in the area by the nearly 100 local and foreign humanitarian agencies. People there are living in an atmosphere of insecurity and suffer the effects of the constant fighting between rival Kurdish groups: arrests, displacement and the dangers of being caught in the crossfire.

The ICRC has therefore extended its water and sanitation and orthopaedic programmes to the north. Spare parts are to be delivered directly to water installations and an orthopaedic centre is to open shortly in Arbil. The UK Mines Advisory Group in Kurdistan is in despair at Kurds who “recycle” mines planted near their villages, and several thousand people are estimated to need artificial limbs in the area. In addition, as far as security conditions, chaotic registration systems and the general state of upheaval allow, delegates concentrate on visiting detainees and checking that those released are safe. Here, as in the rest of Iraq, needs are immense.

Sarah Fleming
Sarah Fleming is an editor at the ICRC. She visited Iraq in September 1995.

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