Young victims
Has the rhetoric of international agencies skirted the real causes for the anguish of Iraq's children? Hala Sakr considers the issues
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A young girl suffers at an Iraqi hospital; collateral damage of the young in Iraq;
a child's wish list drawn by 12-year-old Khaled Aziz from Iraq and exhibited this week in Cairo
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This year World Health Day (WHD), 7 April, came two weeks into the American and British invasion of Iraq. It was no surprise that the press was not invited to the regional celebration of the day. According to Hussein Abou-Zaid, adviser to the Supportive Environment for Health of the Eastern Mediterranean Regional Office (EMRO) of the World Health Organisation (WHO), the festivities were postponed in light of the current situation in Iraq.
Ironically, the theme for this year's WHD is "Safe Environments for Children". Yet the message WHO Director General Gro Harlem Bruntland released on the occasion made no mention of the impact of the war on the "safety" of the "environment" in which Iraqi children live today. In fact, the threats facing Iraqis could endanger children in other countries as well given the current US administration's recent aggression in the region.
Even before the invasion, Iraqis endured more than a decade of economic sanctions, two wars and the collapse of social services. Children were not spared the suffering. Apart from constant insecurity and fear, Iraqi children have not received adequate food supplies nor have they had access to clean drinking water or proper medical care.
Surveys conducted in 1999 by the UN Children's Fund (UNICEF) and the Iraqi government showed that the death rate of children under the age of five in southern and central Iraq more than doubled in the decade beginning in 1989.
The report "Situation Analysis of Children and Women in Iraq" issued by UNICEF in 1998 stated that the infant mortality rate (IMR), which had dropped from 31.95 to 25.16 per thousand during a period of economic prosperity from 1980 to 1989, jumped to 92.7 per thousand in 1996 during the sanctions.
Prior to 1990, when the sanctions were imposed, malnutrition was not a major health problem in Iraq. "By 1997, however, it was estimated that about one million children under five were chronically malnourished," stated the UNICEF report.
The report also said that "primary health care reached about 97 per cent of the urban population and 78 per cent of rural residents [before the sanctions]." However, according to WHO, after 1991 the quality of health care has been set back by at least 50 years.
The American and British invasion has made a bad situation worse. In a country in which children comprise approximately half of the population, the humanitarian crisis has escalated dramatically. Prior to the war, the UN Oil-for-Food Programme, which barely met the nutritional needs of Iraqis, was suspended when United Nations staff were evacuated on 17 March.
Throughout the war, the number of civilian casualties has risen. Thousands of families have been displaced. Electric power and water plants have been destroyed. The scarcity of shelter, food, electricity, clean water and medical supplies has opened the door for a myriad of communicable diseases such as pneumonia, diarrhoea and measles.
Before the destruction resulting from the 1991 Gulf War, Iraq's water and sewage infrastructure had provided both urban and rural areas with clean water. After the sanctions, however, water treatment plants lacked proper equipment, treatment chemicals and adequate maintenance by a qualified staff. Leaky or broken pipes disrupted the water distribution network. Moreover, no new infrastructure could be erected to meet the needs of the burgeoning population. According to UNICEF, more than 90 per cent of the urban population and 70 per cent of rural population enjoyed adequate safe water supply before sanctions. After 1991, the per capita share of water in Baghdad plummeted from 330 to 180 litres per day, from 270 to 135 litres per day in other urban areas and from 180 to 60 litres per day in rural areas.
A special brochure issued by the International Committee of the Red Cross (ICRC) published in 1994 entitled "Children and War" stated that "children, not adults, are the first to suffer the effects of rationing or sanctions. They die of hunger if aid cannot get through because convoys are held up by mined roads or airspace is closed to non-military activity."
During its 57th session in April 2001, the UN Commission on Human Rights discussed the adverse impact of sanctions on Iraqi children. The Commission drew attention to "the effect of environmental pollution in Iraq, in particular, of depleted uranium, which is chemically and radiologically toxic". Epidemiological studies have shown that "the increased incidence of congenital abnormalities and defects, [as well as] cancers in all age groups, are directly related to depleted uranium, either by ingestion, inhalation or skin contact."
Commenting on this year's WHD, Carol Bellamy, executive director of UNICEF, stressed the importance of a "protective" environment to keep children out of harm's way. Again, war was not directly addressed. In press releases, UNICEF has called "violence, abuse and exploitation...[the] silent dangers that lurk in every society in the world". These statements ignore the dangers resulting directly from international action, such as the invasion of Iraq.
EMRO Director Hussein A Geziary has highlighted the physical and emotional effects of war, conflict, occupation and civil unrest on children. "This has tremendous consequences for their psychosocial development and, subsequently, for national health and economic development," he said.
"While acknowledging the six environmental priorities designated in the Johannesburg World Summit on Sustainable Development in 2000, including safe water supply, sanitation and hygiene, chemical safety, vector disease, indoor air pollution and unintentional injuries (physical accidents), we have our own considerations," said EMRO's Abou-Zaid. In response to the situation in the Eastern Mediterranean region, which includes countries such as Iraq, Palestine, Afghanistan, Somalia and Sudan, EMRO underlined the need for peace, security and stability in attaining the aforementioned priorities. "War and displacement of populations seem to be the fashion worldwide, yet they are definitely more intense in our region. Things have to be tackled in a way that is in harmony with this setup," Abou-Zaid noted.
Nevertheless, despite the intense global attention directed towards Iraq in recent months, the situation of Iraqi children has not been addressed directly within the framework of WHD's "Safe Environments for Children" theme.
Rita Giacaman, director of the Community Health Programme at Bir Zeit University in Palestine, defines the environment as the context in which children live, including physical, socioeconomic, political, cultural and psychological aspects. "I think the physical aspects are only part of the total environment in which children live. [The] 'physical' is necessary, but certainly not sufficient. The main issue with children's environments in our context [in the Middle East] is the right to live, the right to education, the right to be free of fear and the right to hope for a free future," she told Al-Ahram Weekly.
Lyla Berlemot Shtewi, chief of ICRC's regional Support Centre for Communication, agrees that physical safety is crucial but added that "dignity is just as important".
"International humanitarian law underlines both protection and respect. No one should suffer humiliation, torture, ill-treatment and imposed physical work," she urged. Protocol I of Article 77 of the Fourth Geneva Convention states: "Children shall be the object of special respect and shall be protected against any form of indecent assault. The parties to the conflict shall provide them with the care and aid they require, whether because of their age or for any other reason."
"If WHO fixates on the physical, it is quite problematic, as even with the physical we have problems. Take a look at what Israel is doing in Palestine in terms of destruction of the physical environment, the ecosystem, the system of basic sanitation services, uprooting trees and controlling our water sources. This is only the tip of the iceberg. These are only a manifestation of a deeper bondage, that of a lack of justice and a lack of freedom and basic rights," argued Giacaman.
In 1989, the United Nations issued the Convention on the Rights of the Child (CRC). "It is the height of hypocrisy that the very organisation which developed CRC has itself violated the statutes of this convention by imposing the sanctions on Iraq with all the consequent suffering it has generated," Soheir Morsi, professor of medical anthropology, told the Weekly.
"Throughout its history, the United Nations has produced a series of overlapping and mutually reinforcing legal instruments in support of human rights," Morsi said. She went on to explain that CRC is one such instrument which is crucial for protecting basic rights. Yet, economic sanctions on Iraq have resulted in drastic reductions in the food supply, compromising child welfare and violating children's rights.
UNICEF's 1998 report on women and children in Iraq asserted that the situation in Iraq is one in which children's rights, particularly regarding health care, that are guaranteed under the CRC continue to be infringed.
Reports from the 57th session of the UN Commission on Human Rights state that "the economic sanctions have a devastating effect not only on the survival of children but also on their moral, social and psychological development in violation of the CRC."
Children's rights are not only linked with access to food but also to a number of other basic services, Morsi explained. These include a sanitary environment, a clean water supply, preventive health care, maternal health, education, safe birthing practices and the availability of medical supplies. All of these basic services have been compromised by 12 years of sanctions and by the recent military aggression.
According to the 1998 UNICEF report, even the Oil-for- Food Programme failed to protect Iraq's children from malnutrition and disease. The report stated that "children spared from death continue to be deprived of essential rights addressed in CRC."
Another serious problem is long-term development. "The problem with the Oil-for-Food arrangement is that the operation is merely meant to be humanitarian, supporting essential commodities. It provides no resources for the rehabilitation and further development of the health system and the basic infrastructure for water and sanitation," Abdel-Aziz Saleh, former deputy regional director and consultant to EMRO, told the Weekly in a previous interview.
The ICRC brochure "Children and War" indicates that "there is considerable discrepancy... between the detailed provisions worked out by experts and the daily life of children caught up in the maelstrom of war."
"The so-called targetted attacks by Americans and Israelis in Iraq and Palestine have affected first and foremost civilians, and on the top of the list we have children. Children are denied the right to go to school every day, to plan their lives, and above all, [particularly for] the older children, to hope for a better future," said Giacaman.
"In the Palestinian case," she continued, "the physical environment is being destroyed. The social fabric is being destroyed, and the psychological environment is nothing less than problematic. Children live in fear of the army and the checkpoints they have to cross to get to school and to their homes. They fear for their parents and siblings. Injustice is so severe that it is difficult to see how children here could ever learn, let alone engage in transformative learning."
ICRC's Shtewi says that armed conflicts cause living conditions to deteriorate by disrupting access to education and medical care, among other things. "We see children enrolled as soldiers beyond their own will. They take part in military activities out of fear. Sometimes they have been taken as hostages and separated from their families. What makes things worse is that they are ignored by society and other adults when they should be looked after and protected."
The "Children and War" brochure states that while "warlords murder children with the aim of conquering the future, the world turns a blind eye... In reality, children have never before been so poorly protected."
After the fall of the major Iraqi cities, the situation has worsened for Iraqi citizens. The problem of a lack of security persists. Lawlessness and looting have prevailed in the absence of any central authority, and the victorious "liberating" American and British forces have watched carelessly. Amidst the anarchy, a UNICEF briefing dated 8 April said, "The situation is chaotic [but] it is still manageable."
The UN agency also voiced deep concern regarding the looting of schools. "Schools and any other location where intense fighting took place have become places of curiosity for children," said UNICEF. After the fighting stopped and children could move more freely, they have a "natural curiosity" to visit such places and take potentially lethal remnants of war as souvenirs.
"Children in essence are explorers. They are eager to experiment with everything around them. They are great risk- takers, which can sometimes be life threatening," said EMRO's Abou-Zaid.
On 3 April, UNICEF reported that three Iraqi children, two brothers and a cousin, were injured while playing with a landmine in northern Iraq. The hands of the older brother, aged six, had to be amputated and he suffered severe facial injuries and chest burns. The eye of the five-year-old brother was severely injured and the other child suffered wounds to his right leg and arm.
UNICEF described the incident as "a stark and disturbing reminder of the impact of war on children". UNICEF has said that there are between 15 and 20 landmine incidents every month in the three governorates of northern Iraq.
As the invasion of Iraq proceeded, a team affiliated with Save the Children, an international NGO working in Iraq, entered the Gulf seaport of Umm Qasr, the only place the military deemed safe for humanitarian groups. Arriving on 7 April, the team reported that water and security were critical concerns for local residents. The police were no longer operating and inhabitants complained that roving gangs posed a threat to home owners and medical centres.
After the fall of Baghdad, UNICEF noted that the "absence of any real improvement in the security situation in Baghdad and other Iraqi cities continues to cause great alarm. When chaos and lawlessness rule, the most vulnerable segment of the population -- the country's children -- are certain to suffer."
In Kirkuk, WHO assessments have shown that health facilities have been looted. All medicine, medical supplies and equipment have been stolen or destroyed, the organisation said. Staff and patients are either afraid or unable to travel to hospitals. This situation seems to have been repeated across much of Iraq.
According to WHO, the poor state of health facilities combined with the damage that has been done to water and electricity systems make the task of rehabilitation and reconstruction of the Iraqi health system harder than ever.
To address the crisis in Iraq, Save the Children listed the needs of Iraqi children as health care, protection, food and nutrition, water and sanitation, shelter and basic needs.
In 2000, UN Secretary-General Kofi Annan told the Security Council that the humanitarian situation in Iraq posed a serious moral dilemma for the UN. "The UN has been on the side of the vulnerable and the weak and has always sought to relieve suffering, and yet we are accused of causing the suffering of an entire population." At the time, he was commenting on the sanctions. One cannot help but wonder if this is still the case.
