The ICRC in Iraq – fighting despair and disintegration
24-12-2002 Operational Update
Because of its diverse aid projects and 20-year presence throughout the country, the ICRC has become a reference for the humanitarian situation in Iraq. It has stated repeatedly that aid can be no substitute for a country's entire economy, or meet the basic needs of 22 million people.
During the Iran-Iraq war (1980-1988) and the 1991 Gulf War the ICRC carried out humanitarian tasks directly related to the conflicts. Since then it has adapted its work to respond to the new and increasing needs of the population, in the fields of health, orthopaedics and water and sanitation.
Health programmes – from infrastructure to training
Public infrastructure in Iraq continues to disintegrate after years of neglect, due to a lack of funds for maintenance and repair and a shortage of spare parts and of qualified staff. To limit the effects of this on the health system, the ICRC launched an ambitious project in 1999: initially, this focused on physical maintenance or rehabilitation of health facilities, later broadening to include general health activities.
The ICRC has conducted major renovation work on hospitals in various parts of the country. Particular attention has been paid to the water supply and sewage disposal systems and to surgical facilities. The work has involved repairs to heating and cooling systems, smaller utilities (lifts, laundries, kitchens) and electrical circuits. The technical staff of the hospitals were also trained to carry out the necessary maintenance work. Now, the ICRC is moving away from large-scale reconstruction projects towards smaller public health activities, emphasizing practical training for staff.
Some of the ma jor infrastructure projects have included:
Basra Teaching Hospital (500 beds) - comprehensive renovation of the sanitary facilities and ten operating theatres; extensive repairs to the roof, basement, windows and electrical circuits.
Al-Karama Teaching Hospital, Baghdad (450 beds) - comprehensive rehabilitation of surgical, emergency and outpatient buildings; overhaul of paediatric wards and operating theatres, re-building of water and sewage networks.
Al-Rashad psychiatric hospital, Baghdad (1,200 beds) – renovation of wards, kitchen and water and sewage networks
Ta'mim General Hospital, Kirkuk (400 beds), and Hilla General Surgical Hospital, Babil (306 beds) – renovation of roofs, overhaul of water and sewage systems, repairs to operating theatres.
In Mosul a new sewage treatment plant was built to serve a complex of three hospitals with a total of 1,250 beds, making sure that effluent waters could be used for agricultural purposes.
In northern Iraq, comprehensive rehabilitation was carried out in two regional hospitals in Rania (Suleymaniyah governorate) and in Soran (Arbil governorate).
Enhancing basic health care
The ICRC's primary health care project aims to relieve hardship among the population by improving access to high quality preventive and curative medical services, in three governorates.
The project provides training and permanent technical support. Refresher courses are held for health workers at the rehabilitated centres, focusing on specific topics such as pre-natal care, vaccination and health education.
Supporting psychiatric care : in mid-2000, a programme was launched for the staff of Iraq's main psychiatric facility, Al-Rashad Hospital in Baghdad, to improve the quality of care available for its 1,200 inpatients by providing better drug treatment and occupational therapy services. ICRC's input ensured the provision of equipment and professional supervision that allowed more than 100 patients to take part in a variety of activities such as painting, handicraft and gardening.
Upgrading professional knowledge : over the past ten years, health professionals have been unable to keep up with the latest developments because no funds were available to subscribe to medical journals. The ICRC agreed to supply the health ministry's central library with twenty periodicals. Up-to-date psychiatry manuals are also provided to the six hospitals that have psychiatric departments.
Orthopaedic programmes – a step towards dignity for war-disabled
With the benefit of more than twenty years of experience worldwide, the ICRC has developed its own cost-effective technology to manufacture artificial limbs for Iraqi war-wounded and victims of landmines.
Based on the use of polypropylene - a recyclable raw material - this new approach was introduced to Iraq when the ICRC launched its first workshop there in 1994. Orthopaedic components are produced in the ICRC's workshop in Baghdad, mainly by recycling the polypropylene scrap collected from other production centres around the country.
The ICRC centre is currently supplying all the components required for the production of artificial limb parts. In the past three years, it has also produced 6,000 polypropylene elbow-crutches and taken over the repair of beds and troll eys for two hospitals.
Training programmes are organized regularly for staff at all the orthopaedic centres as well as for Iraqi health professionals working in physical rehabilitation. Along with its Iraqi partners, the ICRC has drawn up treatment guidelines and recommendations to establish national quality standards for the production of artificial limbs.
The ICRC is currently working in partnership with centres in Basra, Najaf, Baghdad, Erbil and Mosul. Over the years, cooperation has been developed with the Iraqi Red Crescent and support for the programme has come from the Red Cross societies of Sweden, Norway and France.
Nearly 18,000 artificial limbs and more than 9,000 artificial joints have been produced since 1994. In 2002 alone more than 2,000 limbs were produced – almost half of them for mine victims. Some 1,400 joints were produced, more than 70% of them for children suffering from congenital deformities.
Physiotherapy helps to achieve optimum physical rehabilitation, improving the quality of life, independence and self-respect of the amputees.
In the past two years the physiotherapy services of seven orthopaedic centres in Iraq have been equipped with indoor and outdoor facilities and equipment for re-training people to walk. Continuous training programmes are organized for Iraqi physiotherapists in eight centres.
Water – keeping the system afloat
In January 1991, life in the modern city of Baghdad became a struggle for survival for four million inhabitants suddenly deprived of electricity and fuel by the outbreak of the Gulf war. Access to water soon became crucial, as pumping stations and water treatment plants virtually stopped operating. The ICRC imported water-bagging machines capable of producing 60 one-litre bags of drinking water per minute.
Since then, the ICRC's water and sanitation programme in Iraq has become one of its biggest worldwide. The strategy is to halt the slow collapse of the water services: dozens of ICRC engineers and their Iraqi counterparts monitor the situation and help identify and design appropriate technical solutions for solving new and recurring problems.
Before the oil-for-food programme was put in place the ICRC had to import all spare parts and equipment needed to ensure basic maintenance of water stations. Since 1996, the ICRC has focused its efforts on supplying expertise to assess needs and designing plans for rehabilitation work. During periods of severe drought, notably in 1999, the ICRC had to intervene urgently to keep plants operational.
The ICRC is still carrying out major repair and renovation work in various parts of the country. So far it has been involved in rehabilitating 38 water treatment plants and 16 sewage stations. Basic equipment, such as pumps and pipes, are obtained under the oil-for-food programme while spare parts are purchased from the local market.
One current major project of the ICRC is in the city of Kirkuk (650,000 inhabitants), in Ta'mim governorate, where leaky pipes caused two ground storage tanks - of 8000 cubic metres each - to subside. The ICRC set about stopping the leaks and stabilizing the tanks; the intervention started in 2001 and is still underway.
Supplying drinking water to small rural communities, through an easily manageable system and without the use of chemicals, is a technical challe nge that has been met by the introduction of a process known as roughing filtration. In Iraq, ICRC engineers adapted this technique to local conditions and have implemented five village projects so far, in the governorates of Wasit, Muthanna, Missan, Basrah and Anbar. For a long time these communities had no direct access to drinking water - now villagers enjoy a permanent flow of it.
But for most of the Iraqi population, living outside big cities, water shortages are a fact of life – and what exists is usually of poor quality. While individual projects can improve things or even help avert a disaster, they are - like so much else in Iraq's ravaged society - only stopgap solutions.