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ICRC activities on behalf of Iraqi civilians 2000-2001

11-06-2001 Operational Update

     

 

 Despite improvements in the economic situation of the country in 2000, owing to the United Nations' oil-for-food programme and high oil prices, the civilian population of Iraq continues to suffer the tragic effects of international trade sanctions.  

 The ICRC, while recognizing that humanitarian aid can never be sufficient to cover the needs of a people living under embargo or halt the collapse of public infrastructure, has since August 1999 been carrying through a large-scale assistance programme in the spheres of public health and water and sanitation.  

 The aim of this paper is to give an update on the implementation of these activities so far and to outline strategies and programmes for the coming year, adapted in accordance with the changing needs. The ICRC's work is now firmly focused on those areas which cannot be covered under the oil-for-food programme. In addition to large-scale emergency projects to rehabilitate buildings, the ICRC has set up a capacity-building programme at the local level.  

   

 I. Iraq today  

More than ten years have gone by since the imposition of international trade sanctions on Iraq in August 1990 and the Gulf war of January 1991. Over the past decade, large swaths of the population have been reduced to poverty. The country's infrastructure, once one of the most sophisticated in the region, lies in ruins. While the years 1999 and 2000 have brought some first hopeful signs of an improvement in the general economic situation - owing to the United Nations'oil-for-food programme, coupled with high oil prices and an apparent weakening of the sanctions regime - it is clear that it will be years before Iraq gets back on its feet, even if the sanctions were to be lifted tomorrow. Public infrastructure continues to disintegrate after years of neglect, due to a lack of funds for maintenance and repair of buildi ngs and equipment and a shortage of spare parts and, increasingly, of qualified staff. The continuous decline of public services such as the health sector and water and sanitation networks is a cause for particular concern.

 The sanctions regime and the oil-for-food programme  

Iraq's major source of income is the oil-for-food programme which, since December 1996, has allowed the country to use its oil revenues to buy humanitarian supplies under the supervision of the UN Security Council. Over the past two years, the quantities of humanitarian goods arriving in Iraq under the oil-for-food programme have continued to increase, with a marked increase in the availability of food, medicines and medical equipment as a result [1 ] . In December 2000 the programme entered its ninth phase.

In spite of this, it becomes increasingly clear that the oil-for-food programme in its current form does not respond to a number of priority needs of the country, such as the maintenance and repair of public infrastructure and the training of qualified staff. Most affected are the following sectors: health care, drinking water production, sewage evacuation and electricity production. Contaminated drinking water and the low quality of the primary health care system are identified by international organizations in Iraq as the main reasons for the high levels of child mortality and malnutrition [2 ] Negotiations between the UN and the Iraqi government on the introduction of a " cash component " , which would allow funds from the oil-for-food programme to be spent inside the country, as in northern Iraq, have so far not borne fruit.

 Northern Iraq  

In northern Iraq, the situation is rather different from the centre and south of the country. The " cash component " of the oil-for-food programme, which is only available for northern Iraq, has allowed the UN to embark on large infrastructure projects the impact of which is increasingly visible. Current UNOHCI (United Nations Humanitarian Coordination for Iraq) strategy involves increasing the number of projects in rural areas, whereas so far most of the projects were concentrated in urban areas. The main problem is that local capacities are not sufficient to absorb the money channeled to northern Iraq by the oil-for-food programme.

 Notes:  

 1. See UN Security Council resolution 1284 adopted in December 1999, renewing Security Council resolution 986 of 1995.  

 2. See UNICEF report CF/DOC/PR/1999/29, published in August 1999.  

   

 II. ICRC presence  

The ICRC remains deeply concerned about the consequences of the sanctions in humanitarian terms. As set forth in its 1999 Special Report A Decade of Sanctions , the organization remains convinced that exemptions to sanctions and humanitarian aid, although essential in order to address urgent and specific needs, can never be more than partial, stopgap measures. They can be no substitute for a country's entire economy, meeting the basic needs of 22 million people and ensuring the maintenance of a whole country's collapsing infrastructure.

After ten years in which there have been practically no investments in public infrastructure, many installations, built in the 1960s and 1970s, are reaching the end of their life span and need either replaci ng or a complete overhaul. This is clearly beyond the financial means and human resources of any single organization.

It is increasingly clear that another major factor affecting levels of public service is the shortage of qualified staff in many fields, for instance mechanics and nurses, and a general drop in levels of training and education.

In summer 1999 the ICRC embarked on an ambitious assistance programme in Iraq, outlined in its Special Report A Decade of Sanctions , to help alleviate the plight of the civilian population and address the above problems. This programme aims to meet needs not covered by the oil-for-food arrangement, and comprises two major elements:

  • the implementation of an integrated health-care programme . In a first phase this focused on the maintenance and/or rehabilitation of hospitals and primary health care centres. Now that the work on the buildings has nearly been completed, the stress is on training and capacity building in the health sector and on influencing health policy. In accordance with this integrated approach, the different elements of ICRC health-related activities – primary health care, psychiatric activities, water and sanitation and structural rehabilitation – are carefully coordinated.

  • the extension of the existing water and sanitation programme , partly in response to the continuing drought. This involves maintenance and rehabilitation of public infrastructure. Now the ICRC is focusing on rural areas which cannot be covered under the oil-for-food programme.

In accordance with the new needs, the ICRC, while continuing to implement large-scale structural rehabilitation programmes, is expanding its trai ning and capacity-building activities at the local level, particularly in the health sector. Similar discussions are taking place for water and sanitation activities. Through these activities, the ICRC also hopes to demonstrate the extent of the prevailing needs to the international community.

The ICRC, which during the Iran-Iraq war (1980-88) and the Gulf war (1991) carried out humanitarian tasks linked directly to the conflicts, has since then built up its presence in the country and extended its work in order to respond to the new needs of the population. From 12 expatriates and 92 local employees in 1994, the ICRC had increased its staff to 34 expatriates and 265 local staff in Iraq in 1999, and 36 expatriates and 330 locally hired staff in 2001. To cover these activities, the budget was also increased from 14 to 21 million Sfr in 1999 and to 27 million Sfr in 2000. The budget for 2001 is 24 million Sfr.

Because of its aid projects and regular presence throughout the country, the ICRC has become a reference for the country's situation from the humanitarian standpoint. The ICRC has its main delegation in Baghdad and three offices in northern Iraq (Arbil, Dohuk and Sulaymaniyah). In April 2000 an office was opened in Basra, to coordinate and develop activities in the south, primarily in the health sector and water and sanitation. In view of the huge financial input from the oil-for-food programme in northern Iraq, the ICRC has adapted its activities there and has almost completely disengaged from assistance programmes and activities in the health sector.

 Other humanitarian players  

UNOHCI (United Nations Humanitarian Coordination for Iraq) is the ad hoc agency coordinating implementation of Security Council Resolution 986. All the UN agencies, apart from UNHCR, are involved in supervising implementation of the oil-for-food progr amme in their specific fields through small-scale but regular programmes. The ICRC has established close coordination mechanisms with these bodies.

The International Federation of Red Cross and Red Crescent Societies supports a public health programme, carried out in cooperation with the Iraqi Red Crescent Society. A few international NGOs are active in central Iraq, mainly in the health and education sectors. There are considerably more NGOs in northern Iraq, many of them conducting programmes under Security Council Resolution 986.

   

 III. Humanitarian response  

 1. ICRC activities to help the wounded and sick  

In 1999 and 2000 the deterioration in the Iraqi health system continued, with medical facilities unable to provide proper treatment for the wounded and sick. In response to this situation the ICRC set up a three-pronged medical emergency programme in 1999, comprising repairs to hospitals and primary health care centres, deliveries of medical material and a training programme for medical professionals.

 (i) Rehabilitation of hospitals  

By the end of May 2001,   the ICRC had completed major renovation work on five hospitals in Basra, Mosul and Baghdad and work on two others was well under way. The goal is to have renovated nine hospitals by the end of the year.

Particular attention is paid to the water supply and sewage disposal systems, which are essential for the functioning of the hospitals, and to the surgical facilities. The work furthermore involves repairs to heating and cooling systems, smaller utilities (elevators, laundry, kitchen) and electricity networks, to ensure that they are functional and reliable. The technical staff of the hospitals is also trained to carry out the necessary maintenance work.

  • At Basra Teaching Hospital (500 beds, 7 storeys) hygiene conditions for the patients have improved drastically following the comprehensive renovation of the sanitary facilities, toilet shafts and showers, including the redesign of the piping system. The conditions in which patients are treated have greatly improved since the complete rehabilitation of the operating theatre floor (ten operating theatres). The ICRC also carried out repairs and maintenance on the air-cooling system, the water boilers and the elevators etc. Work had begun at the end of 1999 with extensive repair work on the roof (waterproofing a surface of 6,000m2) before the winter rains. The basement, which had been permanently flooded, was drained and cleaned. The third phase of the work, which is now starting, will tackle the windows, doors and the vital problem of electricity supply.

  • The second phase of work on Baghdad's Al-Karama Teaching Hospital (450 beds in 10 pavilions) was completed by the end of May 2001, with the rehabilitation of four pavilions (kidney, burns, ENT and internal medicine) . The first phase, completed by the end of August 2000 after eight months of work, included the comprehensive rehabilitation of buildings for surgery, for emergency admissions and for outpatient consultations, as well as the operating theatres and the paediatric wards, and the construction of new water-supply and sewage systems. A third phase of repair work on other pavilions has now begun.

  • Rehabilitation work at Ibn Al-Khatib Infectious Disease Hospital (280 beds, 3 storeys) in Baghdad, the only facility of its kind in Iraq, was also completed at the end of January 2001. This involved   the construction of two new isolation wards, the improvement of the water system, the upgrading of the sewage system (rehabilitation of all the toilets and the redesigning of the sewage network, including the addition of five new cesspools), and renovation of the laboratory.   The installation of new air-conditioners and repair of the generator have brought great relief to the patients and hospital staff given the long hot season in Iraq and the many power cuts. The ICRC also provided some much-needed equipment and furniture.

  • In Al-Rashad Psychiatric Hospital (1,200 beds) in Baghdad, work on the first two wards (of a group of four) as well as the laundry buildings and the water-supply and sewage-evacuation system was completed and handed over to the Ministry of Health in mid-February 2001. Food for the patients is now prepared in much better conditions thanks to the comprehensive rehabilitation of the kitchen and the attached water system. Furniture and televisions were provided for six living rooms in the different units. Work will continue over the next five months, the serious overcrowding in the hospital being the major limiting factor. There is no other hospital of this kind in Iraq. The maintenance of the rehabilitated premises will remain one of the most important problems.

  • At the end of July 2000 Al-Batool Maternity and Paediatrics Hospital (178 beds on 4 floors) in Mosul (1.2 million people) was handed over to the Iraqi Ministry of Health, after having being extensively rehabilitated by contractors under the supervision of ICRC engineers. Seven and a half months were necessary to complete the civil and electromechan ical works, including the construction of a new emergency wing, rehabilitation of the main building and repairs to the existing water and sewage systems. Ten months on, the hospital is working very well and preventive maintenance is carried out by the personnel of Nainawa Health Directorate.

  • Construction of a new sewage treatment plant (60 m3/h) serving a complex of 3 hospitals (1,250 beds) in Mosul -- Al Batool, Ibn Sina and Al Zahrawi -- began in July 2000. The major civil works covering both the plant and the sewage-drainage and lifting system have already been completed. The work should be completed by June 2001 with the installation of mechanical equipment. After this, effluent should be of such a quality that it can be used for agricultural purposes.

  • In May 2001 work began on Ta'mim General Hospital (400 beds) in Kirkuk and Hilla General Surgical Hospital (306 beds) in Babil. The priorities are the same as for other hospitals: ensuring that the building is safe with watertight roofing and functional water-supply and sewage systems, operating theatres and cooling systems. The work should be completed by November 2001.

  • In northern Iraq, a comprehensive rehabilitation programme is making good progress in two smaller regional hospitals (100 beds each) in Rania (Sulaymaniyah governorate) and Soran (Arbil governorate). The programme includes renovation of the kitchens and of the water-supply and sanitation systems and extension of operating theatres and maternity wards, as well as repairs to the roofing and electrical systems. After completion in June 2001 the two medical facilities will guarantee basic health standards in the area for some 200,000 people each.

 (ii.) Enhancing basic health care  

Hand in hand with the hospital rehabilitation programme, the ICRC is implementing a primary health care project . The aim is to mitigate the effects of socio-economic hardship on public health through improved access to and quality of preventive and curative primary health care services in project areas in at least 3 governorates.

The main problems identified in the health centres are: a dramatic shortage of skilled personnel, especially nurses and paramedical staff, shortage of diagnostic and treatment facilities, limited range of services especially as far as preventive care is concerned, and a weak infrastructure and referral system.

The first phase of the ICRC's pilot project in primary health care started in October 2000 in Diyala governorate 80km north of Baghdad, after extensive discussions with the Ministry of Health. Encouraging results have since led the ICRC to extend the project to Basra and Nainawa governorates (Mosul). The plan for 2001 is to involve a total of 26 primary health care centres, which each have between 60 and 400 outpatients a day.

The project follows an integrated approach combining repair work on essential buildings, water and sanitation activities, training and continued technical support in a comprehensive programme to improve primary health care in project areas, and is being carried out in close cooperation with the Ministry of Health through the involvement of the local medical authorities. In this support it is assumed that other aspects of the PHC are the full responsibility of the Ministry of Health like the provision of drugs and the health information system.

By May 2001 the ICRC had rehabilitated eight health centres -- four out of the eight selected in Diyala governorate, two of the five selected in Basra governorate, and two out of three in the Mosul area -- renovating the buildings and supplying equipment and furniture. Supply of air-conditioners and generators is also part of the rehabilitation work.

Refresher courses are then held for health workers at the rehabilitated health centres, focusing on specific topics such as vaccination and growth monitoring, health education and pharmacy management. A training manual has been produced in Arabic. Insufficient cleaning and maintenance of premises, however, hinder any improvement in health care. Cleaners are therefore given on-the-job training and detergents and equipment are provided to cover the needs for the first three months after renovation. These training activities are seen as the basis for the functional rehabilitation of health centres in project areas.

  • The ICRC provides funds for workshops on " District Team Problem Solving " , a concept developed by WHO to promote district-based problem-solving in public health. District teams are taught how to identify priority areas of concern and design solutions that can be put into practice without external assistance. The aim of the training is to strengthen the " Health for all " strategy of the Iraqi Health Ministry and its decentralization process.

  • One of the major problems in the medical field over the past ten years is that professionals could not keep abreast of the latest scientific developments. The ICRC provides the Ministry of Health's central library with 20 different medical journals on a regular basis. Seven different journals are distributed to the 14 Health Directorates. The goal is to ensure that the central medic al library and the libraries in rehabilitated hospitals and health centres are supplied with relevant professional periodicals and journals and a selection of recently published essential reference books and documents.

  • The need for more and better qualified nursing staff poses challenges at all levels of the health system. At the request of the Ministry of Health, the ICRC is setting up an on-the-job training programme in post-operative care for nurses at Basra Teaching Hospital, in co-ordination with the programmes run by other humanitarian health agencies. Training began in May 2001 with a series of lectures at the hospital, starting with a review of general knowledge and behaviour in nursing practice. Specialized courses covering different surgical service units and intensive care are then held over two-week periods, including one week full-time work under supervision. The goal is to develop a practice-oriented nurses training programme for teams of health professionals working in the rehabilitated health facilities, to be integrated in the national curriculum of in-service training.

ICRC strategy is moving away from large-scale reconstruction projects towards smaller but more integrated public health activities with emphasis on on-the-job training for staff. The crucial element in the long run for the ICRC is the transition from a resource-intensive pilot project towards one which influences primary health care policy, for instance promoting decentralized management. This is an essential but long-term process which does not show immediate results. A co-ordinated effort is needed from all agencies to support the Ministry of Health in adapting its policy to the current situation. The main focus of health care in Iraq is still on sophisticated health-care treatment. It is important for the authorities to strengthen preventive health and first-line treatment as essential elements in a health care system.

 (iii.) Psychiatry programme  

In mid-2000 a programme was launched for the staff of Iraq's main psychiatric facility, Al-Rashad Hospital for the chronically mentally ill in Baghdad, to improve the quality of care available for the over 1,200 inpatients by improving drug treatment and occupational therapy services. The project comprises the following main components: training of psychiatrists, development of occupational therapy and basic repairs to infrastructure. The hospital water-supply system was rehabilitated in 2000, and renovation of the kitchen, the laundry, the wards and the occupational therapy workshops is now nearing completion, as seen above.

The main achievement of the ICRC programme was to establish procedures in the hospital regarding occupational therapy . While a number of occupational therapy workshops already existed in Al Rashad hospital, the lack of material and qualified staff meant that they were not functioning and needed to be reorganized. Now, each of the 5 wards has a functional workshop equipped with furniture and material, supervised by one or two trained occupational therapists. The activities performed are painting, drawing, sewing, macramé, woodwork and gardening. Seminars on psychiatric care and occupational therapy are organized for the staff. More than 100 patients have already been involved in occupational therapy activities and 60 of them participate on a regular basis.

The underlying strategy is to try to change the therapeutic methods and attitudes of Iraqi psychiatrists and to update their knowledge after ten years of isolation owing to the embargo. Following discussions with psychiatrists in Baghdad, the ICRC recommended to the Ministry of Health a list of essential anti-psychotic dru gs which could be purchased under the oil-for-food programme. Their availability in sufficient quantities would help to decrease the use of electroshock therapy. So far the ICRC has organized two missions by expatriate psychiatrists to exchange opinions on diagnosis and therapies for different psychiatric conditions with their Iraqi colleagues.

The ICRC regularly provides medical journals and modern psychiatry books to the six different hospitals with psychiatric departments. In mid-2000 a first conference on psychiatry was held in Iraq, funded by the ICRC.

 (iv.) Assistance for children affected by cancer  

A suspected increase in the number of cancer patients in Iraq, especially children with leukaemia, has prompted the ICRC to develop a programme for enhanced care of children with cancer, with special emphasis on psychological support for the children and the families and an improvement of treatment conditions. An assessment is under way of the quality of care in oncology wards in Basra, Baghdad and Mosul and of urgent needs in terms of material and drugs. The ICRC hopes to be able to make recommendations to the Ministry of Health concerning appropriate material which can be ordered under the oil-for-food programme.

 2. ICRC water and sanitation projects: Repair of basic infrastructure  

Contaminated drinking water is identified by international organisations in Iraq as one of the main reasons for the high levels of malnutrition and child mortality [3 ] . In close co-ordination with the Iraqi authorities the ICRC has therefore strengthened its efforts to rehabilitate water treatment plants. However, public infrastructure is clearly in such a state that huge investments, beyond the capacity of any humanitarian organization, would be necessary, for instance to overhaul water and sewage networks in cities, rather than merely keeping them functional.

The lack of spare parts and a shortage of funds to pay trained staff to maintain the system and the deterioration of the management and technical skills of the authorities are other severe long-term problems facing Iraq's water and sanitation infrastructure.

Two years of severe drought led to record low water levels in rivers and dams and a crucial situation in particular in the summers of 1999 and 2000. Despite a relatively high rainfall over winter 2000-1, both in the mountains of the north of Iraq and in the lower lands, the situation in the coming months will remain difficult, especially in southern Iraq, with shortages of water for irrigation. Should rainfall be low in the coming winter, the situation could become critical again as there are no water reserves in the dams. Low water levels can force treatment plants to a standstill, thus leading to the slow deterioration and then breakdown of the machinery, and, in turn, a shortage of clean drinking water for the population. Low water levels also result in high concentrations of pollutants in the water.

The ICRC aims to ensure that the population benefits from a reliable water and sewage system providing services in line with WHO standards, ensuring a safe and healthy environment and minimizing waterborne diseases. It works to ensure that existing water treatment plants continue functioning at their normal capacity by means of an appropriate maintenance and rehabilitation programme.

 
 
 
 

In 2000 the ICRC rehabilitated 34 water-treatment plants and 6 sewage-evacuation plants, and provided 22 other plants with the necessary materials for maintenance and repairs, thus covering the needs of over 6 million people. It carried out repairs and maintenance work on water and sanitation systems in 7 major hospitals and began building a new sewage-treatment plant and drainage system serving 3 hospitals in Mosul.

   
 

In selected rural areas, new water treatment plants using the roughing filter technology are built. This method, introduced to Iraq by ICRC engineers, has the advantage that plants can be built with local resources and require relatively little maintenance. It treats the raw water without addition of chemicals for the sedimentation process.

The Jassan plant in Wasit governorate, 100 km south-east of Baghdad, completed in mid-2000, was the third such facility built by the ICRC in Iraq, and supplies water to 7,000 inhabitants who previously did not have access to clean water. In January 2001 the ICRC began building its fourth roughing filter station (50m3/hr) in Al Bazoon, Missan governorate, in southern Iraq, which will serve some 3,000 people from September 2001.

 Electricity supplies are also affected by the situation in the country and a general lack of maintenance. A sufficient energy supply is essential in a flat country like Iraq for all water and sewage evacuation stations. The ICRC therefore repaired 46 generators in key pumping stations in 2000, giving a total backup capacity of 19,000 kVA and enabling water and sewage plants to increase their production.

At present the ICRC is concentrating its efforts on the south of the country , where the s ituation is extremely critical. Current priorities are the installation and repair of drinking water production facilities in badly affected rural areas and the repair of the sewage-evacuation system of the city of Basra, which has largely broken down and presents a major health hazard.

  • This is not the first time that the ICRC has worked on Basra sewage network. In 1996 the ICRC embarked on a large-scale programme focusing on rehabilitating 14 sewage-lifting stations in Basra. Since the oil-for-food programme had not yet been set up, this involved importing and then installing the pumps. The work was completed in 1998, but ICRC teams continued to follow up the structures in 1999 and 2000. In 2000 the ICRC undertook the emergency rehabilitation of two sewage lifting stations pumping waste to the city's treatment plant. As a consequence, the drainage of waste significantly improved, benefiting some 300,000 people. Another six emergency projects addressing critical problems in the water-supply chain and wastewater-disposal system are currently being implemented in Basra.

  • In Baghdad in early 2001 the ICRC completed the first stage of rehabilitating Rustumiyah sewage treatment plant (20,000 m3/h), which serves the eastern part of the city (4,000,000 inhabitants), as two new pumps of 10,000 m3/h, provided through the oil-for-food programme, were installed. A major health threat in certain districts of Baghdad was averted by the emergency rehabilitation of Al-Dora sewage-lifting station in Baghdad at the beginning of 2000, which evacuates the waste water of some 2.5 million people.

  • The ICRC's goal in northern Iraq is that internally displaced persons and rural communities in particular should have access to water and benefit from sanitary conditions in accordance with WHO standards. The focus is therefore on basic infrastru cture such as water-supply systems and sewage-evacuation networks requiring either maintenance work or emergency repairs. An important criterion for new projects in 2001 will be, apart from the humanitarian needs, that for some reason they cannot be carried out under the oil-for-food programme.

  • In 2000 ICRC engineers helped improve the water situation in a camp for 5,000 displaced persons in Arbil by extending the internal network and increasing the number of water-distribution points. Sewage systems were also installed in poor neighbourhoods of Sulaymaniyah, which has a high incidence of waterborne diseases. Studies have now been finalized for seven water and sewage plant rehabilitation projects in northern Iraq and tenders launched. These projects will improve the hygienic and health conditions of around 350,000 people.

  • In 2000 the critical water situation in Batel, Dohuk Governorate, was significantly improved by drilling a new deep well. Batel's population of 3,000 inhabitants is growing steadily due to the resettlement of displaced persons. In Koya the first stage of a new sewage system was completed at the beginning of 2001 in three poor areas populated mainly by displaced families. This project has improved the health conditions and noticeably reduced the number of cases of infectious diseases.

 Note:  

 3. See UNICEF report CF/DOC/PR/1999/29, published in August 1999.  

 IV. Other ongoing activities in Iraq  

 1. Relief for the displaced  

In Iraq thousands of people are still displaced, in particular in northern Iraq where, according to the authorities, fighting between riv al Kurdish factions over the past years displaced some 120,000 people. Many of the displaced are living in tents, open spaces, or unheated public buildings. In northern Iraq, the ICRC carries out individual surveys of displaced families, and works with the Iraqi Red Crescent to distribute non-food items.

In 2000 the ICRC carried out a survey, in cooperation with the Iraqi Red Crescent and local authorities, of the internally displaced population in southern Iraq. A group of 400 families (2,334 people, of a total of around 80,000) was identified as the most vulnerable and received an ad hoc supply of non-food items. A programme to find permanent solutions for displaced persons is under discussion with the local authorities.

 2. Assistance for amputees  

Iraq has a high number of military and civilian amputees, mainly war-disabled from the Iran-Iraq and Gulf conflicts but also casualties of the fighting in northern Iraq and people injured by landmines. An estimated 3,000 patients per year receive ICRC prostheses. Of these, over 50% are mine victims.

The ICRC supports five prosthetic/orthotic centres, three belonging to the Ministry of Health, one to the Ministry of Defence and the other to the Iraqi Red Crescent Society. The support includes supplies of raw materials and components, technical follow-up and staff training. Since early 2000 an ICRC physiotherapist has been working with the prosthetic/orthotic team to improve physical rehabilitation services for amputees. Physiotherapy equipment was distributed to all centres to support the gait-training programme and rehabilitation of patients.

The ICRC prosthetic/orthotic centre in the northern Iraqi city of Arbil is run and financed entirely by the Norwegian Red Cross. An average of 60 amputees are fitted per month. At the beginning of 2001 an agreement was reached between the ICRC and the Norwegian Red Cross to extend the delegated project to include both Arbil and Mosul.

 3. Prisoners of war and persons unaccounted for  

Persons still unaccounted for as a result of the Iran-Iraq and Gulf wars continue to be a source of concern for the ICRC, which repeatedly acts as a neutral intermediary between the parties involved. So far, almost 100,000 prisoners of war from the Iran/Iraq conflict and about 70,000 from the 1991 Gulf war have returned to their families under the auspices of the ICRC. In 2000 over 4,100 Iraqi prisoners of war were repatriated from Iran.

 4. Detainees  

The ICRC continues to visit detainees in northern Iraq arrested for security reasons or in connection with the fighting between the various Kurdish factions, in order to assess their psychological and material conditions of detention. Wherever improvements are deemed necessary, the ICRC makes representations to the leaders of the respective factions.

In 2000 the ICRC carried out 123 visits to 32 places of detention in northern Iraq, where it visited 792 people and issued 296 detention certificates.

At Abu Ghraib prison near Baghdad, the ICRC regularly visits foreign nationals without consular representation, who are protected by humanitarian law.

In 2000 the ICRC continued to visit 64 foreign detainees and distributed hygiene kits and personal items and blankets to all foreign detainees.

 5. Promotion of humanitarian law and principles  

The ICRC is pursuing its efforts to make the rules of humanitarian law and its own m andate more widely known. To this end, regular contacts are maintained with the deans of law faculties in Iraqi universities in order to discuss means of cooperation and support the teaching of humanitarian law.

In cooperation with the Iraqi Children's Cultural House, the ICRC regularly produces a children's magazine called Sindibad of Baghdad. In 2000 over 30,000 copies of the magazine were distributed throughout the country.

In northern Iraq, courses and seminars are organized for officers responsible for raising awareness of humanitarian law. An average of 35 officers take part in each course.

 6. Building the capacity of the National Society  

The ICRC continues to provide the Iraqi Red Crescent Society with financial and technical support for capacity-building initiatives, particularly in dissemination and tracing. About 20 of the National Society's dissemination officers conduct sessions on humanitarian law and the fundamental principles of the Red Cross and Crescent Movement in 18 governorates. Each dissemination officer gives at least three sessions per month, reaching over 100 people a month in their respective governorates.

Besides tracing and dissemination activities, the Iraqi Red Crescent and the ICRC have agreed to extend their cooperation in the future into the fields of emergency response and health services, including first aid.

 ANNEX 1: Plan of action 2001 Health Sector  

 

 Primary Health Care  

 Medical assistance  

 Surgical assistance  

 Psychiatry  

 Objective  

Improved access and quality of preventive and curative primary health care services in project areas in at least 3 governorates. Equipment and training of health personnel in 15 rehabili tated health centres.

Keep professional knowledge updated; facilitate research and scientific activities. Support continuity of service provision in rehabilitated hospitals and health centres.

Emergency stock for treatment of war wounded. Surgical equipment for rehabilitated hospitals if not provided through normal channels.

Improved motivation of health personnel for provision of good psychiatric care, including occupational therapy service. Support to Ministry of Health (MoH) in informing the general public about mental health. Support to MoH to develop a community health programme, including OPD services.

 Activities  

1. Supplies:

furniture, equipment (standard list); computers (2 in project area)

 

2. Courses :

- health centre staff (15 HC)

- DTPS (8 districts)

3. Support to MCH (consultant)

4. Support other PHC services

5. Health promotion

6. Service Monitoring

1. Medical journals and books (copies to all governorates)

2. Nurses training (in-service): Basra Hospital postoperative care

3. Support to child oncology (expat consultant and supplies)

4. Emergency purchase of drugs and medica l supplies

1. Stock for 550 WW spread over 4 depositories in Iraq.

2. Surgical materials ad hoc

1. Psychotropic drugs (through oil-for-food programme with Security Council).

2. Occupational therapy and recreation (training of staff, supplies for workshops, TV and radio for wards).

3. Journals, books, seminars

4. Health promotion through PHC and media (e.g. press articles).

    

 ANNEX 2: Map  

   

  Partial or complete rehabilitation of water treatment plants / sewage treatment plants.

Extension of infrastructures as a response to the draught.

    

 For further information, please contact the External Resources Division.