The Status of Children and Women in Iraq: A Situation Report, UNICEF, September 1995

Iraq's population stands today at an estimated total of over 20 million, half of which are under 16 years. The population is predominantly urban at 70 percent with an annual growth rate of 2.7 percent. By early this decade, the country enjoyed a high adult literacy rate of up to 95 percent and the government provided efficient and free health services to the population through a network of hospitals in large cities and towns and primary health car (PHC) centers in semi-urban and rural areas. Consequently, Iraq succeeded in reducing the infant mortality rate (IMR) to about 42 per 1000 live births. After five years of the Gulf War and sustained economic and trade sanctions, the IMR is reported by the Government of Iraq to be at 92 per 1000 live births.

The political situation in and vis-a-vis Iraq over the past two years has witnessed little change and the recent developments of defections by senior government officials has had no immediate tangible effect on the political structure of the government in Baghdad. The situation in Northern Iraq, however, has been widely disturbed by recurrent military confrontation between two rival Kurdish parties, the Kurdistan Democratic Party (KDP) and the Patriotic of Kurdistan (PUK) over the past year. Frequent Turkish military incursions into Northern Iraq during 1995 in pursuit of elements of the Turkish Kurdish Workers' Party, widely known as PKK, has had adverse effects on the political and security situation in the northern region of the country. In contrast, the situation in the South has always been reported calm.

The political scenario in Iraq seems to indicate that the current government is likely to continue its grip on the ruling reigns for some time to come while the situation in the North may continue with its current fragile status until a comprehensive peace accord is signed between the leaders of the KDP and PUK. The basis for this agreement has already been worked out pending the signature of leaders. Although fighting between both parties has stopped since the start of negotiations in Dublin, two bomb explosions has alarmingly undermined the security situation in Erbil during the first week of September 1995. On a different note, power supply to Dohuk governorate from Iraq's national grid was restored on 17 August 1995 after an absence of two years and 17 days. About 20 MW of power supply is now provided to Dohuk from Mosul, sufficient enough to operate water projects and health facilities.

E C O N O M I C
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The current economic situation in government controlled areas has deteriorated at an incredibly rapid pace with soaring hyper-inflation rate and colossal depreciation of the local currency, Iraqi Dinar (ID), vis-a-vis the US Dollar as Iraq remains unable to resume full oil sales due to the five-year old economic and trade sanctions. Oil is the mainstay of Iraq's economy and today only limited sales are carried out to Jordan in comparison to the countries huge oil export capacity of more than 2.5 million barrels per day worth more than US$ 12 billion per annum at a modest price of US$ 14 per barrel. The inflation rate of prices has been persistently increasing by 25-30 percent per month since 1991 and the local currency has lost its value against all hard currencies. Over the last 12 months alone, the Iraqi Dinar has become 400 percent weaker against the US Dollar in the parallel market where all transactions are calculated in Dollar terms and expressed in Dinars. Today, one US$ is worth more than ID 2,000 against ID 500 a year ago. This is a clear reflection of the sad state of the country's economy and its adverse impact on the vast majority of population, particularly children and women.

At the same time household incomes have deteriorated drastically as salaries and wages witness insignificant increments in comparison to the soaring inflation which has led to the total collapse of most household incomes. To maintain survival many families have been forced to sell personal and house effects to buy food and other basic commodities. Most government employees are undertaking part time jobs, either as taxi drivers or venturing into private business after working hours, to generate additional income to make ends meet. The average government civil servant receives a net monthly salary of ID 5,000 which is equivalent to less than US$ 3.

Although the Government is still providing a highly subsidized food basket of five basic items to all its population except in the three autonomous governorate in the North, this food ration covers about 40 percent of nutrition requirements. Subsequently, the rest is sought from the free food market where prices are far beyond the purchasing power of the vast majority. Even a monthly allowance of ID 2,000 to all civil servants, in effect since October 1994, is insufficient to make up for the shortfall. The Government of Iraq has over the past five years accorded utmost attention and priority to the agricultural sector in search for food security and self-reliance. But despite efforts to enormously increase purchase prices of grains and cereals from farmers, Iraq today seems more dependent on food imports than last year or five years ago due to modest harvest and poor performance of the agriculture sector where lack of machinery and spare parts as well as other agri- cultural components are not available.

The poor economic situation in the country has had its adversities on the social sector where social characteristics and behaviour are undergoing a total change in a society once known for its virtual attributes. By contrast, crime rate of theft has been on the rise day by day and even television stations daily telecast advertisements of "missing" private vehicles. Car theft has also included government, UN Agencies and other diplomatic missions operating in the country. House theft and murder cases, driven by economic hardship have significantly risen, although no official statistics are available.

Street children are today widely visible in the country and even in the capital Baghdad. Since beginning of the Gulf crisis, children have been seen selling petty things at traffic lights, but today many more have turned to beggary, one step before delinquency. Child labour is also visible in the streets where small young girls are seen selling a variety of items even drinking water. This situation is unlikely to witness immediate improvement even if the economic and trade sanctions are lifted or eased. Large numbers of boys and girls are still leaving or postponing schooling in order to support their families by working in the market.

H E A L T H
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The situation in the health sector regarding children and women has remained critical over the past five years despite concerted efforts and interventions from various relevant UN Agencies and in particular UNICEF. According to Ministry of Health (MOH) statistics, the number of mortality cases among children under five has been on the rise over the past five years. MOH figures indicated that the monthly average of mortality cases among children of the same age group due to acute respiratory infections, water-borne diseases and malnutrition stood at 4,409 for 1994 against 742 cases in 1990, while the average of monthly mortality cases by end of July 1995 stands at 4,475. (Please see Annexure I)

MOH figures also indicated significant increase of low birth-weight babies of under 2.5 kgs against the total registered births over the past five years. According to these figures the monthly average of low birth weight babies in 1994 was 21.1 percent against 4.5 percent in 1990, while the monthly average by end of July 1995 stands at 21.5. (Annexure II)

There were 1,345 cholera and 24,436 typhoid cases in 1994 against zero and 2,240 cases respectively in 1990, according to MOH figures. Pneumonia cases among children under five have also increased from 11,713 in 1990 to 23,257 in 1994. (Annexure III)

The figures, however, did indicate a steady reduction in the cases of Neo-natal cases from 936 cases in 1991 to 83 in 1994 and 52 cases by end of July in 1995. A similar reduction in polio cases has also been witnessed from 186 in 1991 to 53 cases in 1994 and 27 cases by end of July in 1995. Measles cases have dropped to 10,646 in 1994 from 20,160 cases in 1992. (Annexure IV)

Yet, despite the economic hardship the Govemment of Iraq with sustained UNICEF support stemming from donor contributions has made impressive progress towards achieving the Mid-Decade Goals. Most impressive has been the governments commitment to meet all goals. In April 1995, the highest authority in the country, the Presidential Palace, issued a directive calling on all relevant ministers, governors and other officials to ensure the achievement of the Mid-Decade Goals and to report on measures adopted to reach those goals. Another impressive achievement is in the CDD programme where the Mid-Decade Goal of 80 percent universal application of oral rehydration therapy (ORT) has been achieved.

Immunization coverage of the six anti-gens is over 85 percent. The most impressive achievement has been the success of the Polio National Immunization Days (PNID) campaign where over 3.5 million children under five received two doses of polio vaccines with an interval of one month. The campaign, carried out over two rounds in March and April, proved to be highly successful in terms of planning, organization and implementation. UNICEF played an instrumental role in the provision of 9 million doses of vaccines, cold chain equipment, logistic support and forging a media campaign which was described by a WHO expert as the most effective and provocative witnessed in the region and MOH officials have acknowledged publicly that the media campaign was behind the PNID success. It was the first campaign since 1991 that the entire country including the three Northern governorate were involved simultaneously.

In addition, UNICEF/WHO collaboration in strengthening the polio surveillance is evident through the regular Acute Flaccid Paralysis (AFP) reporting established by MOH.

MOH figures of immunization coverage of children under one for July 1995 showed that DPT dose III was (93.4 %), Measles (92.9 %), OPV dose III (92.2 %), BCG (99.0%). In the North, immunization coverage for Jan-Jul 1995 showed that BCG was (72.29%), DPT dose III (47.5%), OPV dose III (47.5%) and Measles (589.7%). Political instability and continued armed clashes between rival Kurdish parties in the northern region had clear adverse effect on these low coverage figures.

Another significant achievement has been the percentage use of the Oral Rehydration Therapy (ORT) in the treatment and struggle against diarrhoea and the subsequent fatal dehydration, the number one killer among children in Iraq. Results of a Knowledge/Attitude/Practice (KAP) study indicated that 78 % of mothers were applying ORT in the treatment of infantile diarrhoea. This is at threshold of the target of 80 % universal application of ORT in the treatment of all diarrhoea cases in children.

Impressive progress has taken place in the CDD Programme during the first quarter of 1995 in terms of training 2,850 health staff and other supportive groups on the application of ORT in the treatment of children diarrhoea and raising community awareness through advocacy and communication. The ORT day every month, observed by all primary health care centers, has proved instrumental in the dissemination and acceptance of the ORT approach. On such days all activities at health centers are dedicated on household visits and distribution of ORS sachets as well as orientation seminars held at ORT corners. Four diarrhoea training units (DTUs) have been identified in three governorate.

UNICEF played a key role in the reactivation of the government's Control of Acute Respiratory Infection (CARI) project. A nation wide CARI campaign was launched late 1993 till end of 1994 for which drugs, laboratory supplies, IEC material and training modules necessary for facilitating training of health staff and mothers on correct case management were supported by UNICEF. In order to achieve the CARI related MDG, namely the reduction of CARI related mortality by 10% compared to 1992 level, UNICEF's support for the programme continued with the provision of drugs, nebulizers, sound timers and training material necessary for improving correct case management of health staff and home management of mothers. TV spots and messages also continued to be shown on local channels country-wide to raise the level of awareness and to help in changing attitudes and practices at the community level. Activities in 1995 and 1994 have focused on improving CARI case management of physicians, pharmacists and other health staff through extensive training activities country wide. Health education sessions for the community are being carried out by primary health care councils and GFIW at central and district levels. Communication material have been designed to educate mothers on early detection of risk signs for immediate referral to health centers. Training in all medical and nursing colleges are also ensured by inclusion of CARI case management in college curricula. In the North, 102 junior doctors received training on correct case management and 2,000 ARI flip charts in Arabic were provided to primary health care centers.

A KAP ARI survey revealed that 89 percent of 900 mother sample covered recognized that ARI was a risk to child survival and 46 percent could detect the risk signs of ARI related infections. However, on method of treatment 71 percent still believe in antibiotic use and 64 revert to cough medicine. In the North, a survey was undertaken in the three Northern governorate in December 1994 in tandem with the 30 cluster immunization survey. The survey revealed that mothers are not fully aware of earlier sign and symptoms of respiratory infections in their children and when to seek medical advice as evident in their limited knowledge about fast breathing as an indication of ARI. However, their knowledge about difficult breathing as an indicator of acute respiratory infection and correlating that with the prognosis of their children's health was good. Although 74.2 % of mothers reported keeping their children warm, only 17.2% of them had knowledge about using homemade cough preparations. In conclusion, the survey clarifies that health education and especially the role of health personnel in improving mother's awareness is an important issue to be addressed. Insufficient availability of anti-biotic and malnutrition have led to increased cases of respiratory infections.

N U T R I T I O N
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The New Food Ration Basket/Calory Content/Subsidized and Market Prices by April 1995

The above table shows that even the ID 2,000 monthly allowance paid to civil servants by the government is far from sufficient to cover the market costs of these basic food items.

A N N E X U R E I
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MORTALITY OF U5 CHILDREN

A N N E X U R E II
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A N N E X U R E III
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A N N E X U R E IV
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A N N E X U R E V
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                   1990     1991     1992     1993     1994     1995*
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   Kwashiorkor       41    1.066    1.145    1.261    1.748    2.237

   Marasmus         433    8.015    9.289   11.612   16.025   20.549
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   * Covers Jan - July 1995

A N N E X U R E VI
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