Information within this issue may be outdated. Click here to view the most recent issue.
Issue 7.2, August 2003
Victim Assistance in Iraq
Large amounts of UXO and mines left behind from the continuing conflict in Iraq have resulted in a dramatic increase in the number of victims. This article was written while the coalition forces were still engaged in conventional combat prior to the fall of Saddam Hussein.
|An Iraqi schoolboy walks past a pile of unexploded mortar rounds in a field in Basra, Iraq. The field, which lies next to a field where children play soccer, is filled with the rounds left behind by the fleeing Iraqi army. c\o AP|
Toward the end of 2002, civilian landmine casualty rates in Iraq were believed to be about 32 per month. Since conflict began in March of 2003, however, no one knows for certain exactly how many Iraqi civilians have been injured or killed. “The number of civilian victims is very high but cannot be counted,” writes Beatrice Cami of Handicap International (HI).1 During the first few weeks of conflict, the International Committee of the Red Cross (ICRC) reported that overtaxed hospitals in Baghdad gave up counting the number of injured and dead.2 Within a single week in April, the Mines Advisory Group (MAG) reported 52 killed and 63 injured by landmines and UXO at the hospital in Kirkuk.3
Before the conflict, a handful of NGOs had been working in cooperation with the United Nations Office for Project Services (UNOPS) through the Oil-For-Food Program to provide various forms of victim assistance. Now they are not only faced with the immediate needs of a nation torn by war, but they must also reestablish an independent Iraqi health care system, provide drinkable water and restore damaged sewage facilities. In addition to dealing with major shortages in food, medicine and medical care, NGOs are working hard to continue the provision of aid amidst political instability and civil turmoil. Looters and criminal gangs frustrate daily efforts to deliver essential supplies to hospitals and civilians in various parts of the country. The following is a short description of what some established NGOs and the United Nations are doing to help victims in Iraq.
UNOPS Mine Action Program and EMERGENCY
The UNOPS centers have fared relatively well during the recent conflict. They continued to run without interruption during the entire war. The only alteration they made to normal operations was the implementation of a contingency plan to help meet the needs of prospective victims. In addition to making preparations for a new influx of medical patients, the plan stipulates the need for an assessment of borders between the three northern governorates of Iraq and newly liberated areas in southern and central Iraq. The purpose for this assessment is to estimate the number of victims from conflict and to find a means of victim referral to special EMERGENCY surgical centers in Erbil and Sulaimaniya.
Since the conflict started in March, UNOPS estimates that the average number of victims during the first five months of 2003 is approximately 58 per month. From March 18–May 31 2003, mine/UXO victims represent approximately 40 percent of the total number of war victims. Around 48 percent of these victims are adult male and two percent are adult female. The other half of the victims are children under the age of 18. Most of the war victims were referred from liberated areas around Kirkuk and Mosul.
The UNOPS victim assistance program in northern Iraq is currently fully functional and operational. It was unaffected by recent looting because of its northern location. Its goal for the next few months is to complete the implementation of the victim assistance network, raise funds for the program after the termination of Oil-for-Food, make a master plan for victim assistance in northern Iraq, and to expand the program to central and southern Iraq.
In April 2000, UNOPS began a program to provide victim assistance services to northern Iraq and parts of southern and central Iraq. Their vision is to provide general care, to re-integrate victims into society and to establish a sustainable victim assistance capacity. Through this program and with the cooperation of an International NGO named EMERGENCY, UNOPS works from a network of medical facilities that stems from three main prosthetic limb centers in Dohuk, Diana and Halabja. The three main centers fit, produce and maintain prostheses and orthoses for victims in the three northern governorates. They also provide outreach services via seven satellite posts in remoter areas, and rehabilitation and vocational training centers in Diana and prospectively in Dohuk. As a part of this network, EMERGENCY runs 21 first aid posts, two surgical centers, and two Centers for Rehabilitation and Social Reintegration.
Over 60 percent of the employees working in these rehabilitation centers are handicapped. In 2002, the network provided services to over 800 new patients, produced over 1,200 prostheses and orthoses, provided over 5,000 physiotherapy services to patients, and had over 20,000 outpatient visits. All services also regularly provided transportation as required. One important part of the network, the Emergency Surgical Hospital for Civilian War Victims (ESHCWV), is currently implementing rehabilitation and vocational training services in cooperation with the Dohuk and Diana prosthetic limb centers. It also provides medical care services at disbursed first-aid posts and various surgical treatments at sites in Erbil and Sulimania. The UNOPS is also working to include standardized administrative processes, develop standard databases, consolidate training and technology at all funded centers, increase production levels to meet demand, assess requirements for new services and establish a means of coordination with local authorities. They have been working in cooperation with other UN agencies, NGOs, local authorities and community groups to identify needs and service gaps, find solutions, and coordinate needs.
The HI staff in Iraq has encountered several problems providing aid to victims during this conflict. Working in and around Baghdad, HI teams have been providing medical supplies, water, emergency medical care, and artificial limbs to hospitals and individual victims. Slowly, and with the aid of other NGOs, victim assistance under HI in Iraq is improving. Medical staffs in cooperating hospitals are beginning to receive some compensation for long overdue paychecks. Also, aid workers from HI, the ICRC, CARE and other NGOs are addressing major concerns over the lack of proper sewage and waste disposal in medical facilities. Looting and lack of security has been a major concern for HI’s work in Iraq. Beatrice Cami writes, “A large number of victims are not in hospitals anymore because of the lootings and the lack of beds.”
As the number of victims increases every day, HI’s aid workers cannot afford additional problems. “There are lots of victims of landmines and unexploded ordnance (several times a day in Baghdad and more than a dozen a day in the rest of the country),” explains Cami, “In Al Hillah (90 km from Baghdad) there has been heavy American bombing. There are between 450 and 600 victims, among which there are more than 20 amputees. In KiKrit, there will be more than 100 amputees.” HI’s greatest concerns for this growing population of victims are providing clean water, regular electricity and hygienic medical supplies to medical facilities.
In addition to providing support to local hospitals and various other NGO medical centers, HI runs several orthopedic centers in Bassora, Nadiaf and Baghdad. Many of these centers have been looted or closed for security reasons since the end of the war. To help counterbalance the lack of orthopedic aid, HI is establishing an orthopedic center in central Baghdad that will help provide artificial limbs to the entire city. They have also pioneered a new prosthetic technology that allows technicians to assemble a prosthesis in less than an hour.
One of HI’s greatest areas of need is physiotherapy. While every hospital has a physiotherapy department, none of their specialists is trained to deal with immediate post-surgery needs. Little or no physiotherapy is done for amputees in the immediate post-surgery phase, which causes great physical and psychological trauma to the patient. HI sent five therapists, who specialize in post-surgery physiotherapy, to Iraq to train teams of native therapists. The HI therapists will also help train the families of amputees to be proper caretakers when the patient is ready to be sent home. HI is also working to create a database of civilian victims because Iraqi hospitals and medical centers (especially during conflict) have few, if any, records for their patients. With this database, victim assistance workers hope to be able to assess the needs of victims and plan accordingly.
International Committee of the Red Cross
Since conflict began in March, the ICRC has been working almost without interruption at health facilities in Iraq’s main cities (such as al Rashad, Ibn Klatib, Baquba, Baghdad, Qadisiya, Diyala, Babel, Karbala, Najaf, Salah-el-Deen and Wasit). Despite massive looting at many hospitals and continued insecurity that prevents some staff from coming to work, the ICRC (partnered with the Movement), plans to continue its support of hospitals and key health workers by providing supplies for war wounded, distributing massive amounts of drinking water and making emergency repairs to water and sanitation plants.
Most hospitals working with the ICRC suffer from shortages in cooking gas, oxygen and fuel for generators. As with other organizations working in Iraq, the ICRC lists security as another major concern. They write, “Although the Coalition Forces are present in some hospitals, many others are ‘protected’ by armed groups, who interfere with the administration and management of the health structures. Looting still takes place occasionally.”4 In April, one of its logistics managers, Mr. Vatche Arslanian, was tragically killed in crossfire while driving with other ICRC staff members in one of their vehicles.
Currently, the ICRC is working in collaboration with the Iraqi Red Crescent Society (IRCS) to collect data on mine victims and affected villages. Around 300 trained volunteers from 11 IRCS branches are collecting information that will allow danger zones to be mapped and allow proper assessments of victim numbers. IRCS volunteers are also passing out printed mine risk education material and broadcasting public service announcements over the radio. One of the greatest needs in Iraq today is clean water. The ICRC has been working hard to help reestablish water treatment facilities and working sewage systems in Iraqi communities. By sending repair specialists and providing replacement parts for water facilities damaged during the conflict, they have made it possible for donated tanker trucks to temporarily distribute clean water to the community. In the future, the ICRC, supported by the International Federation, will focus on emergency repairs to vital infrastructure, re-furbishing and re-equipping hospitals and other health institutions, and providing health consumables and equipment.
With the collapse of security after the fall of Sadaam Hussein’s regime in April, CARE workers in Baghdad have suffered tragic losses. In May, two of their vehicles were hijacked, and a security guard was shot in the leg when thieves attacked their warehouse. Because of these problems, the organization was forced to move temporarily out of Baghdad. Despite difficulties, CARE continues to distribute clean water to 25,000 people in areas west of Baghdad. They also continue to deliver hygienic goods and lactose-free milk to malnourished children.
A notable characteristic of CARE’s work in Iraq is their concern for the well being of children. Their programs include projects that provide supplementary food and lactose-free milk to children in 97 hospitals in all 14 governorates of central and southern Iraq. This focus on children has never been more apparent than during the conflict. CARE workers chose to remain in Iraq during conflict in order to continue to provide essential assistance to children and other vulnerable groups. In the midst of danger, they delivered hygienic supplies and clean water to hospitals and health centers in Baghdad.
CARE International has been a continuing presence in central and southern Iraq since the first Gulf War in 1991. During their first few years in Iraq, they provided monthly food storage and logistics to over 300,000 people per month. They also provided logistical support and assistance to other UN Agencies. CARE’s work in Iraq began in the northern Kurdish regions of Dahuk, Erbil and Sulaymaniyah and in parts of its central and southern regions such as Anbar, Babel, Diayala and Najaf. As humanitarian need became greater in the central and southern regions during the mid-1990s, CARE’s focus turned more toward providing these areas with basic health care, clean water and proper sanitation.
As expected, the recent conflict brought serious humanitarian concerns to the civilian population of Iraq. Large amounts of explosive remnants of war (ERW) such as artillery shells, grenades, mortar bombs, cluster bombs and other submunitions, rockets, and missiles left in residential areas cause the number of victims to increase daily. Those dedicated to helping these victims must first create a means of keeping track of the number of victims and the nature of their injuries. Their second concern is finding a secure way in which to deliver or administer medical or mental assistance. Finally, they must train Iraqi specialists, medical workers, and civilians in their various areas to help reach the ultimate goal of a self-sufficient Iraqi health care system. Despite these hurdles, the United Nations and NGOs are slowly making progress in their efforts to heal the wounded in Iraq.
Fundraising and Communication Officer
5 Station Hill
UNOPS N. Iraq
Tel: 212-963-4792 ext. 7074