Reprinted March 2003 with updated Malnutrition Information · Reprinted March 2003 with updated...

Reprinted March 2003with updated

Malnutrition Information

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This Situation Analysis is producedin accordance with UNICEF proce-dures, which mandate such anassessment prior to the preparationof a new country programme. Itsconceptual framework draws on theprinciples of human rights, and inparticular the Convention on theRights of the Child. It adopts thecausal analysis approach that exam-ines the immediate, underlying andbasic causes for specific outcomes.

The report begins by describing thepolitical and socio-economic con-text of Iraq, a country which, after adecade of conflict in the 1980s andearly 1990s, has been under compre-hensive United Nations sanctionsfor 11 years, and the the variousarrangements put in place since1996 to mitigate the impact of sanc-tions on the population. Overall,these efforts appear to have arrestedthe deterioration of the situation, butnot to have greatly improved condi-tions for the majority of the popula-tion, which is now close to 25 mil-lion.

In terms of children's rights to lifeand survival the report notes thatinfant mortality today is 107 per1,000 live births, over double what itwas at the end of the 1980s (47), andthat under-five mortality is 131deaths per 1,000 live births, two-and-a-half times what it was adecade ago (56). It also notes that15.9% of children suffer from beingmoderately to severely underweightor from general malnutrition; 22.1%

suffer from moderate to severe stunt-ing or chronic malnutrition; and5.9% suffer from moderate-severe. The immediate causes for this situa-tion include disease and malnutri-tion, with preventable illnesses suchas diarrhea and respiratory infectionsaccounting for 70% of the mortality.In 1998, 22.8% of children - morethan one in five - suffered from mal-nutrition. Nearly a quarter of babieswere low birth weight, indicatingmalnutrition in mothers. Micro-nutrient deficiencies also affect thepopulation.

The underlying causes include thepaucity of resources to rehabilitateservice sectors, including health,water and sanitation, and electricity,as well as in education. Iraq's elec-tricity "deficit" is estimated to be over2,300 megawatts, and power cutsaffect the majority of the population,with knock-on effects on the provi-sion of clean water and treatment ofsewage. Between 1990 and 2000, thedaily per capita share of potablewater went from 330 litres to 150litres in Baghdad, 270 to 110 in otherurban areas, and 180 to 65 in ruralareas. Some 500,000 tons of rawsewage are dumped into fresh waterbodies each day. At the householdlevel, causes include poverty, withmany Iraqis living on as little as $3 to$6 a month, as well as behaviourssuch as early marriage, insufficientbirth spacing, and the low rate ofexclusive breast-feeding.

Basic causes include systems-relatedas well as crises and sanctions-relat-

ed causes. As regards systems, linksbetween different sectors are weak;human resources are insufficient;very low user fees do not encourageconservation of scarce resources;government policies equate univer-sal and uniform coverage with equi-ty; and there is insufficient data foranalysis and planning. The cumula-tive effects of two major wars andmore than a decade of economicsanctions have resulted, amongother things, in the non-availabilityof sufficient financial resources toprovide and support effective servic-es; ad hoc, intermittent, and insuffi-cient supplies; restrictions on pur-chase of local goods, and an increasein the number of female headedhouseholds.

Interventions have addressed theimmediate and underlying causes,but not the basic causes.Interventions include screening ofchildren to detect malnutrition andaddress it through therapeutic feed-ing; Vitamin A and other supple-ments; iodization of salt; an intensiveimmunization campaign; and somerehabilitation of services and utili-ties.

In terms of children's education, theMultiple Indicator Cluster Surveys(MICS) undertaken in the year 2000revealed that as many as 23.7% ofchildren are not attending primaryschool, with nearly twice as manygirls staying out of school as boys -31.2% of girls and 17.5% of boys.Other worrying trends include thesharp decline in adult female literacy.

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Executive Summary

Immediate causes include thedecline in coverage and quality, withtwo and sometimes three shifts inschools due to the shortage of build-ings and teachers; few books andsupplies; and little revision of thecurriculum in recent years.Underlying causes include the factthat some 8,613 school buildings arestill in a deteriorated state, and 5,132additional buildings are needed, andthat sanitation and other services arelacking. Underlying causes at thehousehold level include poverty;family attitudes to education in gen-eral given that highly educated grad-uates are earning a living drivingtaxis; attitudes to girls' education;and early marriage.

Systems-related basic causes includea need for more emphasis on quality;weak linkages between sectors;insufficient community involve-ment; weak management informa-tion systems and the need for reformof key policies that inhibit effectivetargeting of assistance for the mostvulnerable. Crises and sanctions-related basic causes include insuffi-cient resources to rehabilitate andrebuild facilities and to meet newgrowth; the stagnant economyaffects household incomes anddrives teachers out of the system;and there is a difficulty in securingsupplies and spare parts. Again,interventions have focused onimmediate and underlying causes.These include partial or full rehabili-tation of 1,000 schools, and some in-service teacher training.

As regards the right of vulnerablechildren to protection, perhaps themost striking aspect is the lack of suf-ficient information. There is clearlyan increase in the number of chil-dren working on the street, as well asin the number of orphans needingstate assistance, together with aninability of existing institutions tomeet the need of these children or ofchildren with disabilities. The situa-tion has improved a little during2001, although more resources arenecessary together with more socialawareness of the issues.

In terms of women's human rights,there is a sharp increase in maternalmortality, which means that womenare not getting emergency obstetriccare when they suffer complicationsduring pregnancy and childbirth.There is also a lower rate of girls'attendance in primary school, and adramatic rise in female illiteracy.The discrepancy between femalesand males in this area can be attrib-uted to poverty compounded by lin-gering negative attitudes to girls'education. Economic need is drivinglow and middle income women intothe work force, but opportunities areconstrained by the overall economicsituation.

The main conclusion from theanalysis is that unless basic causesare addressed, the best that can behoped for from programme interven-tions is a mitigation of the situation.To date, programme interventionshave not addressed basic causes.Given this situation, the report con-

cludes that, while programme inter-ventions are important, rights-basedadvocacy should be top of the list ofpriorities so as to ensure that basiccauses are addressed. Rights-basedadvocacy could promote the under-standing necessary to secure achange in the present conditions andpolicies, and, in particular, to securethe resources necessary to rehabili-tate key service sectors in a sustainedand sustainable manner, to support ashift from humanitarian efforts tocomprehensive long-term develop-ment planning and to review policiesthat inhibit the effectiveness of pro-gramme interventions - such as theinclusion of breastmilk substitutes inthe universal food ration. Thereport's recommendations for rights-based advocacy, research and pro-gramme interventions include:

Advocacy and Research

1. Advocacy should highlight theimportance of securing the requisiteresources to rehabilitate each of thewater and sanitation, electricity,health, and education sectors bothfor present users and to meet popu-lation growth. Further research isnecessary on the plans and resourcesfor each sector, the inter-relationsamongst these sectors, the obstaclesto rehabilitation, the gaps in skillsand capacities and the impact thishas on the rights of children.Capacity for data collection andanalysis should be supported in therelevant institutions to produce thisresearch.

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2. Another key issue for advocacy isthe need to shift from a humanitari-an approach, which by definitionconsists of discrete and standaloneactivities, to a comprehensive medi-um- to long-term developmentapproach.

3. A further issue for advocacy isthat Iraq should be able to use itsfinancial resources to purchase local-ly supplied goods and services inorder to ignite the economy and givefamilies more opportunities to earn aliving wage.

4. Advocacy to promote policyreform is needed in several areasincluding the composition of thefood basket/ration (i.e. withdrawal ofinfant formula and inclusion of morefood for pregnant and lactatingwomen) and the promotion of tar-geted assistance to the most vulner-able groups (i.e. female headedhouseholds, out of school children)and communities.

5. The existence of vulnerablegroups of children and women, andthe need for resources to promotethe human rights of these groupsand their special needs, is an impor-tant point to highlight.

6. Advocacy for behavioural changeis necessary on issues like girls' edu-cation and the use of scarceresources such as water and electric-ity.

Programme Interventions1. More focus is required on reduc-tion of neo-natal mortality(improved feeding and anemia pre-

vention among pregnant and lactat-ing women, prevention of low birthweight, withdrawal of infant formulafrom food ration, promotion ofbreastfeeding).

2. Programme interventions thatsupport stronger links between theeducation, health and nutrition, andwater and sanitation sectors wouldenable optimum use of scarceresources.

3. A better understanding of howthe systems function in each of thesectors and where the national andlocal bottlenecks and capacity gapsare would greatly assist future devel-opment in general, and effective andtimely co-ordination and decisionmaking on cross-sectoral issues inparticular.

4. A more comprehensive plan forhealth information campaigns wouldmake better use of scarce resources,factoring in a range of health, nutri-tion, environmental, and behavioralissues, including family planning,birth spacing, early marriage, exclu-sive breast-feeding, as well as diseasecontrol, water quality, personalhygiene, and disposal of sanitation.

5. The quality of education emergesas a major issue, in particular therevision of the curriculum andinvestment in teacher and manage-ment salaries, capacities and skills.

6. Girls' education and relatedhousehold factors need to beaddressed through targeted support,as well as public awareness cam-paigns.

7. Further investment is necessary inmanagement information systems,and data is needed in several areas,for example, what are children nolonger enrolled in schools doing withtheir time?

8. More popular awareness of andcommunity involvement in resourceuse, along with modest user feeswould assist in conserving and reha-bilitating the water and sanitationand electricity sectors and in protec-tion of the environment.

9. More comprehensive planningwould assist the rehabilitation of thewater and sanitation sector.

10. Collaboration between theMinistry of Labour and Social Affairsand the Ministry of Health couldhelp to address the issue of avoidabledisability during delivery.

11. For orphans and street/workingchildren, it would be useful to putmechanisms in place to detect fami-lies and children at risk, who couldthen be given special support.

12. Introducing emergency obstetriccare as part of regular services inclinics and at hospitals will savepregnant women's lives.

13. Support is necessary to expandthe business and employment oppor-tunities available to women, particu-larly female heads of household.

14. Special support for women's edu-cation and eradication of illiteracy isneeded.

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This Situation Analysis has beenprepared by the United NationsChildren's Fund (UNICEF).UNICEF programme proceduresmandate such an assessment prior tothe preparation of a new CountryProgramme. 1 The aim of a SituationAnalysis is to:

- Better understand the causes andlinkages between problems affectingwomen and children in a country,and how national resources can helpto address these problems;- Identify necessary action to realizethe rights of women and children;and- Contribute to Country Programmestrategy for priority interventions,future research, and rights focusedadvocacy.2

This introductory chapter sets outthe conceptual framework andmethodology used in the SituationAnalysis. Chapter 2 describes thenational context, while Chapters 3,4, and 5 review issues related to sur-vival and education, as well as tochildren in need of special protec-tion. Chapter 6 addresses thehuman rights of women. Chapter 7recommends priority interventions,and suggests areas for future researchas well as advocacy.

a.Conceptual Framework

The conceptual framework of thisreport has two main pillars: the prin-ciples of human rights, and thecausal analysis approach.

Human RightsKey to the first pillar are the humanrights principles contained in theConvention on the Rights of theChild (CRC) and the Conventionon the Elimination of all Forms ofDiscrimination Against Women(CEDAW), in line with the adop-tion by UNICEF of the human rightsframework.

The four core principles of the CRCare: non-discrimination; the bestinterests of the child; the right to life,survival and development; andrespect for the views of the child.They are covered by Articles 2, 3, 6,and 12 in the CRC (these and otherrelevant articles are excerpted inappropriate sections of this report).Given the context of Iraq which isdescribed in Chapter 2, thisSituation Analysis focuses in partic-ular on the right to life and survival(Chapter 3), development (Chapter4), and protection (Chapter 5).

The analysis will establish the extentto which the rights of children aswell as those of women are respect-ed, protected, promoted, and ful-filled by those in a position to do so,within the means at their disposal."Duty bearers" responsible for theprogressive realization of these rightsare generally held to include parentsand the extended family, the com-munity, and national as well as localgovernment.

In the case of Iraq, it is necessary toadd the international community, in

the form of the United Nations, tothis list of duty bearers, given thatUnited Nations resolutions haveplaced the country under compre-hensive sanctions since August1990. The Situation Analysis willexamine the role played by each setof duty bearers regarding the fulfil-ment of the rights of children as wellas those of women.

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1The Situation Analysis was researched and written by an independent international consultant. Itcovers 15 governorates of the south and centre of Iraq, where UNICEF's Programme of Cooperationwith the Government of Iraq is implemented.

2 Aims extracted from UNICEF Programme Manual.

1. Introduction

Non-DiscriminationCRC Article 2

1. States Parties shall respect andensure the rights set forth in thepresent Convention to each childwithin their jurisdiction withoutdiscrimination of any kind, irre-spective of the child's or his or herparent's or legal guardian's race,colour, sex, language, religion,political or other opinion, nation-al, ethnic or social origin, proper-ty, disability, birth or other status.

2. States Parties shall take allappropriate measures to ensurethat the child is protected againstall forms of discrimination orpunishment on the basis of thestatus, activities, expressed opin-ions, or beliefs of the child's par-ents, legal guardians, or familymembers.

Three more aspects of the interna-tional human rights framework areimportant to note with regard to thisreport's conceptual framework. Thefirst relates to the inclusion of therights of women in a SituationAnalysis that deals with children,when both parents are equal dutybearers. First, women's human rights

are a good in themselves. Second,the status of women's nutrition,health, and education has beenshown to be directly related to thesurvival and development of theirchildren, particularly during preg-nancy and breast-feeding, that is, atthe beginning of the child's life-

cycle3. Women who do not enjoytheir human rights - throughouttheir own life-cycle - are not in aposition to effectively provide for thesurvival and development of theirchildren.

This report addresses the rights ofwomen in two ways. First, wherepossible, it disaggregates the datapresented in Chapters 3, 4, and 5 toexamine not just the overall status ofchildren but also the status of girlsvis-à-vis that of boys, at differentstages of their life-cycle. Second, itincludes a chapter dedicated to thehuman rights of women.

However, the inclusion of the rightsof women should not be interpretedto mean that women's roles arerestricted to motherhood, or thatmen's roles as fathers are not criticalto their children's survival, well-being and development. Both par-ents are considered to be equal dutybearers in terms of ensuring, withinthe resources available to them, asocial and economic environmentthat promotes their children's devel-opment.

By the same token, women haverights and responsibilities to them-selves and to society that are sepa-rate from those of their children.This report does not use the phrase"women and children", in order toavoid the tendency to think ofwomen only in connection withtheir children, and not to think ofmen in connection with their chil-dren.

The second aspect to note regardingthe human rights framework is theimportance of the right to develop-ment. The right to development isnot embodied in a separate conven-tion, but after a decade of debate itwas recognized as a right by the con-sensus of the international commu-nity at the World Conference onHuman Rights held in Vienna in1993. Without impinging on theprinciple of indivisibility of allhuman rights - civil, political, eco-nomic, social, and cultural - the rightto development brings economic,social and cultural rights to the fore,and shows how these can beachieved in tandem with civil andpolitical rights. This was a majorstep forward for human rights,because the content of economic,social and cultural rights had previ-ously been far less fully developedthan that of civil and political rights.

The challenges of fulfilling econom-ic, social and cultural rights havelong been recognized. Many civiland political rights can be secured byacts of political will, whereas eco-nomic and social rights require theavailability of resources, as well asthe capacity to manage and the com-mitment to use those resources togood effect. Moreover, it has beendifficult to "measure" the fulfilmentof economic and social rights. In thisrespect, the development of targetsand indicators during the world con-ferences of the 1990s has been veryhelpful in setting standards for theinternational community, and indeveloping the content of economic

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3UNICEF adopts a life-cycle approach in its assessment and analysis

Parents as equal dutybearersCRC Article 18 (extract)

1. States Parties shall use theirbest efforts to ensure recognitionof the principle that both parentshave common responsibilities forthe upbringing and developmentof the child. Parents or, as thecase may be, legal guardians, havethe primary responsibility for theupbringing and development ofthe child. The best interests ofthe child will be their basic con-cern. . . .

and social rights. The UNICEFEnd-of-Decade goals provide a wayto assess the fulfilment of children'srights within and across countries.

The right to development is particu-larly important to consider in thecase of Iraq, which, it can be argued,constitutes a unique case of "de-development". This will be dis-cussed in Chapter 2 dealing with thenational context.

Finally, the third aspect to noteregarding the human rights frame-work, is what could be considered asthe "rights of future generations".The question of the needs of futuregenerations was first addressed in thecontext of environmental sustain-ability by the international commu-nity at the United NationsConference on Environment andDevelopment in Rio de Janeiro. TheRio Declaration on Environmentand Development adopted by con-sensus on 14 June 1992 proclaims, inPrinciple 3, "The right to develop-ment must be fulfilled so as to equi-tably meet developmental and envi-ronmental needs of present andfuture generations".

In the 1994 Human DevelopmentReport, the concept of the "univer-salism of life claims" is put forward asthe "common thread that binds thedemands of human developmenttoday with the exigencies of devel-opment tomorrow…. The strongestargument for protecting the environ-ment is the ethical need to guaran-

tee to future generations opportuni-ties similar to the ones previous gen-erations have enjoyed".

While the "rights" of future genera-tions have not been captured in aconvention, serious thought is clear-ly being given to the subject. Thisconcept is especially relevant to chil-dren, who are the next generation,as well as the parents of generationsto come. The importance of such aconcept in the case of Iraq cannot beoverstated. Whatever is visited onthe children of Iraq today will affectthe development of many futuregenerations. This issue will be keptin view as the analysis unfolds.

Causal Analysis

The second pillar for the conceptualframework of this report is the causalanalysis. There are three levels ofinter-linked causes that can lead tothe non-fulfilment of rights:

- Immediate causes, such as diseaseand inadequate nutrition, whichdirectly relate to life, survival anddevelopment rights;

- Underlying causes, such as the sta-tus of household food and nutrition,as well as social services like waterand sanitation, health, and educa-tion, which promote or prevent well-being and development;

- Basic causes, which relate to issuessuch as control and distribution ofnational resources, institutional

arrangements, and social organiza-tion (including the status of women)- which provide the environment inwhich rights may or may not be ful-filled.

The causal analysis approach is par-ticularly helpful in the case of Iraq,where it is important to be able todistinguish those basic causes attrib-utable to the sanctions regime fromother basic causes, as well as fromunderlying and immediate causes.Sanctions-related basic causes canonly be addressed in the context ofan international political resolutionof the present situation, and, as such,are not under the control of nation-al authorities responsible, for exam-ple, for social services. However,other basic causes related, forinstance, to institutional arrange-ments can be addressed by nationalauthorities if a convincing case ismade that these are relevant to chil-dren's survival and development.

In addressing the rights of childrento life, survival and education, thisreport will first assess the situation,and then examine the immediate,underlying, and basic causes for cur-rent conditions.

b. Methodology

The Situation Analysis is based onprimary and secondary data, as fol-lows.

- Desk Review This was greatlyfacilitated by the fact that, in theyear 2000, the Government of Iraq

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and UNICEF jointly conducted acomprehensive programme reviewof the past decade of technical coop-eration. The review processinvolved about 400 counterpartsand stakeholders over a period ofnine months, with the technical sup-port of a team of 12 internationaladvisers. Five sectoral workshopswere conducted, and findings werediscussed at a plenary conferencechaired by the ministers of educationand health. The resulting documen-tation was reviewed, as was theGovernment of Iraq's NationalReport on Follow-Up to the WorldSummit for Children, the report of aFuture Search conference bringingtogether 86 stakeholders, and otherdocuments (see References).

- Interviews Structured discussionswere held with UNICEF staff as wellas with civil servants, members ofinstitutions such as Beitul Hikma,and non-governmental organiza-tions such as the General Federationof Iraqi Women.

- Visits Schools, orphanages andhealth centres were visited, to form afirsthand view of both progress andobstacles in addressing the situationof children.4

- Brainstorming Workshop A two-day brainstorming workshop washeld under the auspices of thePlanning Commission to discuss the

proposed outline of the SituationAnalysis. Some 50 representatives ofministries and institutions participat-ed, and the discussion generatednew insights into the existing materi-al.

Information gathered as a resultmade it possible to form an assess-ment of the situation and then toanalyze causes with a view to recom-mending priority interventions.

However, it should be pointed outthat it is very difficult to form a clearpicture of the situation in Iraq basedon accurate data. Political factorsmake the release of data sensitive inthe country. In addition, the capac-ity of national authorities to captureand analyze data has been adverselyaffected over the past decade.Therefore, some of the findings drawon observation and even anecdoterather than on comprehensive data.

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4 Due to time constraints and the fact that the programme review teams had conducted extensive sitevisits, the visits conducted during the Situation Analysis took place only in Baghdad.

Iraq covers an area of 435,052 sqkm; it shares borders with Turkey,Syria, Iran, Jordan, Saudi Arabia,and Kuwait. Some 25% of the landis arable, and about half of this landis cultivated. There are four majorphysiographic regions: mountains(21%), alluvial plain (30%), desertplateau (39%), and upper plains(10%). The climate ranges fromcool to cold winters and hot toextremely hot summers.

Rainfall is irregular; the country suf-fered a prolonged drought at the endof the decade, which severely affect-ed cereal production. The 2000 har-vest was 47% below the 1999 har-vest level and 64% lower than theaverage of the previous five years.5

The drought also reduced waterresources in rivers, dams, lakes andcanals. The Tigris was reported to beflowing at just 40 % of its normal lev-els and the situation of theEuphrates was said to be no better.In 2001, the rains were plentiful.

a. Political Context

Iraq has been a republic since themonarchy was overthrown in 1958.It has been ruled since 1968 by theBa’ath Party. The RevolutionaryCommand Council is the highestauthority, and its resolutions havethe force of law. Executive responsi-bilities are assumed by a cabinet.The President of the Republic,

Saddam Hussein, who has ruledsince 1979, also serves as prime min-ister. A National Assembly wasformed in 1980.

The main administrative structure isthe governorate, of which there are18, five northern, nine central, andfour southern. Each governorate isdivided into districts (qada'a) andsub-districts (nahiya). The gover-nors are responsible for implementa-tion of policies, plans and develop-ment projects. Local government ismade up of the qaimmakam, the

administrator of the district level,and mudeer al-nahiya, at the sub-district level. Villages are run by themukhtar. Local People's Councilsare an additional forum for popularmobilization. There are also profes-sional and cultural organizations,such as the General Federation ofIraqi Women and the GeneralFederation of Iraqi youth.

The past two decades have beenextremely difficult for the Iraqi peo-ple. War broke out between Iraqand Iran in 1980 and lasted until1988. Relations between the two

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5UNICEF Iraq Annual Report 2000.

2. National Context: Development in Iraq

countries have recently improved.The Iraqi war with Kuwait in August1990 resulted in the imposition ofcomprehensive sanctions on Iraq bythe United Nations, which continueto this day. 6

In order to improve the situation ofthe population under sanctions, aMemorandum of Understanding(MOU) was agreed between theGovernment of Iraq and the UnitedNations.7 This became known as theOil for Food Programme, and hasbeen renewed by the SecurityCouncil on a six-monthly basis. Atthe inception of the Programme,Iraq was enabled to export $2 billionworth of oil every 180 days, and touse the funds to procure essentialhumanitarian supplies.8 Restrictionsof the value of oil that could beexported were later eased and thenlifted.

Applications for supplies had to besubmitted to the Secretariat of the661 Committee. It took somemonths for the MOU to becomeoperational; the first applications forexports of humanitarian supplieswere approved by the Secretariat ofthe 661 Committee in January1997; commodities began arriving inthe country in March 1997.

The MOU was restricted to suppliesin the first seven phases, and com-plementary cash resources had to begenerated from other sources for thesouth and centre of Iraq, unlike thenorth where a cash component was

made available in the MOU. Thelack of a cash component for thesouth and centre of Iraq imposedserious constraints on national abili-ty to use the supplies in an effectiveand efficient manner. Local costssuch as transportation, storage andinventory, installation of equipment,and training to ensure proper opera-tion and maintenance of equipment,could not be covered through theprogramme. It is also worth notingthat funds from oil sales generatedunder the MOU could not be usedto purchase locally produced sup-plies, which would have helpedmove the weak domestic economy.

A proportion of local costs were metfrom funds made available byhumanitarian agencies working inIraq, and the Government also cov-ered part from its own resources.However, this was not sufficient torepair and maintain water and sani-tation, health, and education sec-tors, let alone to invest in meetingthe needs of the growing population.For example, the electricity deficit inIraq is estimated to be over 2,300megawatts, with the prolongeddrought causing a dramatic reduc-tion in hydro-generation9. As aresult, long power cuts still affect themajority of the population, althoughthe situation has improved inBaghdad in 2001. The power cutsare especially damaging during thehot summer months, and have avery negative knock-on effect on thecapacity of water and sewage treat-ment plants as well as primary health

care centers and other vital facilities. The serious limitations caused by theabsence of a cash component wereeventually recognized, and SCR1330, which took effect on 6December 2000, allowed for a cashcomponent within the SCR 986 pro-gramme. The resolution provided for600 million Euros to be allocated incash to the oil sector, and allocated5% of the oil revenues (from theamount previously allocated to theKuwait Compensation Fund) tomeet the needs of the most vulnera-ble groups. However, by November2001 there was still no agreement onthe modalities for the cash compo-nent, and the constraints on nation-al capacity to implement the Oil forFood Programme remained in place.

Other weaknesses of the Oil forFood Programme stem from longdelays in submissions and contractapproval procedures. This wasaddressed in SCR 1284, whichincluded provisions for acceleratedapprovals of contracts pertaining tofood, health, agriculture, and educa-tion supplies. A "green list" ofauthorized supplies was drawn up tospeed up the slow approval process.Nevertheless, the number of con-tracts on hold with the 661Committee remained very high. Asof 31 October 2001, contracts onhold and inoperative for the Waterand Sanitation sector reached 123,worth over US$537 million; theEducation sector also had 98 con-tracts on hold or inoperative, worthUS$181 million.

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6SCR 661 of August 1990 imposed economic sanctions including a full trade embargo, except medicalsupplies, foodstuffs and humanitarian items as determined by the Security Council SanctionsCommittee.7The MOU was signed on 20 May 1996 to implement the provisions of SCR 986 of 14 April 1995.8Of the oil revenues, 30% or $600mn were set aside as Gulf War reparations; 13% ($260mn) for thethree autonomous governorates of the north, 2.2% ($44mn) for UN operational costs, and 1% ($20mn)for payments to escrow. The remaining 53% ($1.06bn) were for humanitarian supplies for 15 gover-norates. For comparison, Iraq's civilian imports in 1989 cost $5bn9UNICEF Annual Report 2000.

Although the Oil for FoodProgramme has ameliorated the situ-ation, it is not an adequate replace-ment for national developmentplanning, which would overhaul allsectors in a comprehensive manner.Nutrition surveys carried out byUNICEF, as well as an FAO/WFPnutrition assessment mission in May2000, showed that since the intro-duction of the Oil for FoodProgramme, the nutritional status ofchildren has not improved. One infive children in the south and centreof Iraq remain so malnourished thatthey need special therapeutic feed-ing, and child sickness rates contin-ue to be alarmingly high.10Subsequent parts of this report willpoint to the close linkages betweenhealth, nutrition, water and sanita-tion, and electricity, which need tobe addressed in an integrated way soas to overcome disease and physicalunder-development.

In February 2000, the Governmentdecided to reintroduce nationaldevelopment planning, which hadbeen suspended over the pastdecade due to the country's circum-stances and lack of control overnational resources. Work is nowcomplete on a five-year plan, forwhich national accounts and datasets were reportedly thoroughlyrevised and updated (a national cen-sus was concluded in 1997).11 ThePlan's contents have not beenreleased; it is to be managed in tan-dem with preparations for a 2006-2010 national development plan.

b. Socio-EconomicDevelopment

The modern Iraqi economy has beenlargely dependent on oil exports, aswell as on extensive imports ofmachinery and other inputs for eco-nomic growth. The dependence onimports has of course increased overthe past decade, given that fundsmade available through the Oil forFood Programme have been restrict-ed to imports since 1997. Importedequipment and supplies havebecome especially visible over thepast year: shiny new garbage trucks,high-protein biscuits, air condition-ers.

In 1989, the oil sector comprised61% of GDP, services came secondwith 22% of GDP, then industry with12%, and agriculture with 5%. It isdifficult to form a clear quantitativepicture of the Iraqi economy today.12Clearly, oil is even more of an eco-nomic mainstay than in the past,given sanctions-related restrictionson trade, since it is the major sourceof foreign exchange and govern-ment revenue. However, analystspoint out that the oil sector does nothave strong horizontal and verticallinkages with the rest of the econo-my, and that the scale of oil produc-tion does not exert significant directinfluence on other sectors.

Other sources of Government rev-enue include organized "religioustourism" with Iran, which reportedlybrings in around $2.7mn in hard cur-

rency each month, and oil-for-goodsand services barter trade with Turkeyand Jordan. In addition, theGovernment has recently intro-duced service fees to cover costs.For example, hospitals are now sup-posed to cover half their budget fromfees, and to pay for maintenance andnew construction themselves.Government continues to beresponsible for providing equipmentand supplies. A separate fee struc-ture applies to low income groups.

In recent months, the Governmenthas reportedly distributed 300,000plots of land to citizens, which arenow being registered. Constructionof homes on this land would help tojump-start the economy, given thatthis is a sector that uses local materi-als and skills.

In 1989, GNP was about 14bn Iraqidinars at constant 1980 prices. Thisthen declined at a rate of approxi-mately 23% until it reached 2.9bndinars in 1995.13 After fluctuating,GNP rose to $4.3bn in 1996, in thewake of a redirection of economicpolicy, including reduction of non-essential spending, and inflation wasbrought under control.

The Economist Intelligence Unitforecasts that Iraq's GDP will grow atrates ranging from 15% to 18%between 2000 and 2004 (see Table1). It notes that although GDPgrowth appears high, it is takingplace from a very low base, and inreal terms the economy will besmaller than it was in 1989 despite asignificant increase in population.

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10 Ibid.11Interview with Minister of Planning.12As noted earlier, in many cases, figures are simply unavailable due to both technical and political fac-tors. 13National Report on Follow-up to the World Summit for Children, May 2001.

Furthermore, any growth is likely tobe almost entirely oil-dependent.

A worrying issue for the population'sfuture well-being is that Iraq's pre-Gulf War debts are now said, accord-ing to various estimates, to totalbetween $130 and $180bn, whichwill burden the economy even in theabsence of sanctions unless the debtsare renegotiated and rescheduled.Moreover, no figure has been set onthe ultimate amount of reparationsIraq is expected to pay; since theMOU was signed, 30% of the oil rev-

enue was set aside for reparations,however in SCR 1330 this wasreduced to 25%.

Unemployment in 1987 was estimat-ed at 4.49%, with female unemploy-ment of 7.28% higher than maleunemployment of 4.13%. By 1997,female unemployment was reportedto have doubled, reaching17.6%;reasons included the drop in GNPand the pressing need for more fam-ily income, which led to an increasein the number of women looking for

work. In any case, even those whoare employed seek second and thirdjobs. Teachers, whose salaries are aslow as $3 a month, doctors, and civilservants seek income where they canfind it, driving taxis, giving speciallessons, or opening private practice.Studies quoted in the NationalReport estimated that as many as81% of the population was livingbeneath the poverty line in 1993,although this had improved to 55%by 1997.

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Children are also being forced intothe workforce due to family need.The last data on children's workdates to 1987, when 442,349 chil-dren aged 7 - 19 were estimated tobe in the workforce, of whom themajority - 389,429 - were in the in 15- 19 age range. Even though figuresare hard to come by today, there is avisible rise in the number of childrenselling goods on streets, and in thenumber of child beggars, a recentphenomenon.

For most Iraqis, household foodsecurity has been dependent on therations they receive fromGovernment, a system put in placeafter the Gulf crisis. Prior to theMOU and after sanctions were putin place, the Government providedrations of some 1,093 calories perperson, approximately 40% of dailyrequirements. After the MOU,rations were increased to 2,030 calo-ries in Phase 1, and further improvedto 2,472 calories in Phase VIII.However, the proportion of incomespent on food is still around 72% ofthe average household income,because monthly food rations onlylast two thirds of the month accord-ing to an FAO/WFP mission in April2000 and because of low personalincomes. Average salaries only rangebetween $3 and $6 a month.14

Sectors critical to the population'swell-being - electricity, water andsanitation, health, and education -have yet to recover from the damageof two wars both in terms of physicalplant and human capacity. Roads arestill of high quality, and bridges andmany Government buildings havebeen repaired. There is some new

construction of schools, mosquesand other facilities.

However, the overall trends are ofsteep decline. It is important to keepin mind that the sanctions wereimposed on a country that had justhad its infrastructure seriously dam-aged in a devastating war in 1991. Itwas only after 1996, five years later,that some mitigation of the effects ofsanctions took place. Efforts to alle-viate the effect of sanctions concen-trated on the humanitarian needs ofthe population, and did not addressthe massive investment necessary tooverhaul the country's infrastruc-ture.

The evidence points to the impact ofsanctions on the population's well-being and on the national economy.By all accounts, even during the 8years of war with Iran, the country'soverall development was not dra-matically affected, and theGovernment continued to investheavily in social services. By 1990,primary health care reached about97% of the urban population and78% of the rural population; primaryschool attendance reached about83%. 15

Even after the war with Iran, Iraqwas ranked 50th out of 130 coun-tries on the 1990 UNDP HumanDevelopment Index, which meas-ures national achievements inhealth, education, and per capitaGDP. It was close to the top of the"medium human development" cat-egory, a reflection of Government'scontinued investment in basic socialservices. By 1995, Iraq had slippedto 106th out of 174 countries, and by

2000 it had plummeted to 126th,behind Bolivia, Mongolia, Egypt,and Gabon, close to the bottom ofthe medium human developmentcategory. 16

According to the HDI, an Iraqi bornin 1987 could expect to live 65 years.But whereas citizens in neighbouringJordan saw their life expectancyimprove from 67 years in 1987 to70.4 years in 1998, life expectancy inIraq dropped to 63.8. WhereasJordan saw its literacy rate rise from75% in 1985 to 88.6% in 1998, Iraq'sdropped from 89% to 73.5%. In the1990 HDI, Iraq ranked three placesabove Jordan. By 2000, it ranked 34places below.

Medical specialists note that a coun-try which had infant mortality in therange of 40 to 60 per 1,000 livebirths, as Iraq did in 1990, should bynow have an infant mortality rate ofbetween 20 and 30 per 1,000 livebirths. However, infant mortality inSouth/Centre Iraq rose to 107 per1,000 live births between 1995-99.As for under-five child mortality, thisrose from 56 deaths per 1,000 livebirths in 1985-89 to 131 deaths per1,000 live births in 1995-99. Figure2 compares the situation regardinginfant mortality in Iraq to that ofother countries over the past decade.

As there has been no major changein government in Iraq since 1978,one can only conclude that if theGovernment had had the resources,it would have invested in social serv-ices, as in the past. This erosion ofhuman development - which onecan effectively term "de-develop-

1313

14GOI-UNICEF 2000a.15 Situation Analysis, 199816 In fact, the HDI ranking for 1995 and 2000, poor as it is, is likely to be more positive than the reality,

because the GDP per capita was estimated to be $3,197.

1414

Figure 2 Under-Five Mortality Rate - Cross-Country Comparisons (Estimates)

ment" - therefore appears attributa-ble to the lasting effects of the crisesof 1990/91 including the resultingsanctions regim attempts by the Sec-urity Council to alleviate the impacton the population. De-developmenton such a scale is unprecedented,and it will require decades of invest-ment for the people of Iraq to reachthe point at which they were in1989. Figure 2 is one of the moststriking evidences of the deteriora-

tion of the situation of children inIraq. It shows that the mortality rateof under-five year old children hasincreased by 160 per cent over thelast decade. This is on average tentimes more than civil strife(Rwanda) or HIV/AIDS (South

Africa) affected countries in east andsouthern Africa.

Given the recognition of a right todevelopment by the 1993 ViennaConference, as well as of the right ofchildren to development as set outin the CRC, and the right of womento development as set out inCEDAW, the international commu-nity may wish to review the contri-bution of sanctions to de-develop-

ment in Iraq, so as to ensure that theUnited Nations is not supporting aviolation of the human rights of theIraqi people, and in particular therights of children to survival, healthand education.

c. Demographic Profile

According to the 1997 national cen-sus, the Iraqi population hadreached almost 22 million, with anaverage annual growth rate of 2.95between 1987 and 1997. TheNational Report on Follow-up to theWorld Summit for Children notedthat the total had reached 23.9 mil-lion by the year 2000, with males

accounting for 11,925,000 of thetotal, and females for 12,046,000. Itestimated the rate of growth at 2.94.

The population is marked by itsyouth, with some 45% of the totalbeing under 14 years of age. Over-

1515

65s account for just 3.5% of thetotal. This is a high dependency rateon income-earners. The rate ofurbanization was high between 1957and 1980, but stabilized thereafter.According to the National Report,68% of the population now lives inurban areas, a drop from 70.2% in1987. It attributes return migrationto the country side to the attractionof the agricultural sector due to stag-nation in other sectors.

Data on the demographic profile ofchildren in Iraq are provided in Table2. Over the past decade, children'sproportion of the population hasdeclined from 53.5% to 49.6%. TheNational Report attributed the dropin the proportion of children to thetotal population to a lower birth rate,on the one hand, and to the increasein infant and child mortality, on theother.

However, other sources believe thatthe population growth rate is higherthan previously thought, and has notdropped as much as had beenexpected as a result of conditions ofpoverty and deprivation. TheMortality Survey found a high totalmarital fertility rate of 7.7 in thethree years before the survey. A highbirth rate puts great pressure on thehousehold to provide for its mem-bers, and on the state to providebasic services for a rapidly growingpopulation.

Family planning methods are freelyavailable, but the Iraqi FamilyPlanning Society has only 136 cen-

tres throughout the country, andclinics are understaffed. Some 20%of women who visit PHC Centres forother purposes do ask about familyplanning methods, according to staff.

A Multiple Indicator Cluster Survey(MICS) conducted in 2000 providesnew insights into the populationstructure and dynamics.17 This isthe second such survey; the firstMICS was conducted in 1995.

MICS 2000 covered all 18 gover-norates in Iraq. The sample was setat 13,430 households; 13,011 house-holds actually participated in thesurvey, of which 61% were urbanand 39% rural. Of the femalerespondents, 43.8% had never mar-ried and 26% had never attendedschools. The survey revealed astrong correlation between women'seducation and fertility rates.Women with no education account-ed for 26% of the total, while thechildren of mothers with no educa-tion accounted for 31.8% of thetotal; women with primary schooleducation were 38% of the total,while their children accounted for41.1% of the total; and women withsecondary education were 34.7% ofthe total while their childrenaccounted for 25.3%.

d. Psychosocial Profile

According to a report commissionedby UNICEF, current conditions haveseriously affected the psychosocialconditions of Iraqis.18

1616

17The survey was conducted by the Central Statistical Office (CSO) in the Government's PlanningCommission, with support from UNICEF and in collaboration with several ministries and departments,medical personnel, educators, and water and sanitation experts in the field. MICS surveys aredesigned to monitor the global goals adopted at the World Summit for Children in 1990 (see Table 9).UNICEF, together with its partners WHO, UNESCO and others, identified a set of 75 indicators to moni-tor the status of children in different aspects. A total of 381 experts and field researchers were involvedin conducting the survey, and they received training on the methodology at 15 workshops. A carefulsystem of data entry, editing and checking was established, and was continuously evaluated by aninternational consultant. 18Assessment of the Implementation of the Humanitarian Programme (SCR 986): The PsychosocialWell-Being of Children in Iraq", UNICEF, March 1999.

Box 1 Snapshot of FamilyPlanning

The family planning clinic at Al NurHospital in a low income area ofBaghdad has been open since 1996.The initial response was slow, thenurse recalled in the small, cleanoffice, but now there are sometimes asmany as 400 clients a day. ThatSaturday in May 2001, the clinic hadserved 172 women.

Birth control pills are the most pop-ular form of family planning, and areoffered on Saturday and Tuesdays,with condoms offered on Thursdays.The clinic charges for supplies, forexample 200 dinars for a monthlycycle of pills. The price is lower thanthe private sector because supplies aresubsidized by the Iraqi Family PlanningSociety.

The Society has been running 136reproductive health clinics all over thecountry. These clinics are locatedmainly in GFIW centres, but some arelocated in primary health centres. Theclinics are run with the active involve-ment of the members of GFIW, teach-ers, and other civil servants. TheSociety also provides referral servicesto beneficiaries, and conducts trainingin reproductive health.

Regarding early childhood (ages 0 -6), the Report stated: "The numberof persons attending outpatient clin-ics for mental/psychological disor-ders has risen from 200,000 in 1990to 220,000 in 1994 and 510,000 in1998 (Work Group AssessmentReport on Health)…. NGOsobserve an increase of family con-flicts, divorce and polygamy".

Regarding young children, theReport pointed out that "Exhaustedparents who can hardly meet thefamily's basic needs are naturally lesssensitive and caring towards theirchildren, and deprived childrenoften add through their consequentdifficult behavior to parents' distress.Families whose resources for lovingcare are depleted through long-termmultiple distress can no longer pro-vide their children with a sense ofbelonging, which is necessary to pro-mote young children's curiosity,exploratory activities and tolerancefor unfamiliar situations. Finally, thehome environment of many youngchildren has become depleted ofessential commodities, toys, booksand other opportunities for self-directed learning and achievement".

Regarding adolescents, it found that"many adolescents of both sexes suf-fer from malnutrition and relatedhealth problems, but also fromdepression as they see very littlehope for their future".

The Report noted the dearth ofinformation on children in need ofspecial protection, which imposes

1717

reliance on observation. It made tworecommendations: "An expansion ofpresent humanitarian programmesto respond in an exhaustive mannerto Iraqi children's psychosocial anddevelopment needs, and the estab-lishment of a comprehensive moni-toring system that allows to docu-ment changes of their psychosocialand development status throughvalid and reliable data".

e. Legislative Framework

Iraqi Civil law defines a child as anyperson who is under the age of eight-een. The law for Juvenile Care No.(76) of 1983 uses the following termsto designate children in various agegroupings: a minor, if the child isolder than nine and younger than18; a juvenile, if older than nine andyounger than 11; a boy, if older than11 and younger then 15; and an ado-lescent if older than 15 and youngerthan 18.

The National Pact of 1971 ensuredthat all Iraqi citizens have a right tofree education at all levels. In 1976,legislation made primary school edu-cation compulsory. It was plannedthat this law would be reinforced in1991, by making school attendancemandatory through the intermediatelevel, but this has not been accom-plished. Centres aimed at eliminat-ing illiteracy were also establishedsoon after enactment of the"Illiteracy Education Law" of 1978(GOI-UNICEF, 2000d).

Iraq ratified the CRC with a reserva-tion to article 14.1 concerning theright of the child to choose a religion,as this clashed with the IslamicSharia. It embodied the CRC intoexisting legislation by law No 3 of1994, issued in the Official GazetteNo 3500 on 7 March 1994.

CSO established a mother and childunit in 1990. It prepared a NationalPlan of Action for Children, andbecame responsible for monitoringand following up the Summit goals.The National Plan was finalized in1995, but due to the circumstancesin the country it was not implement-ed. A Child Welfare Commissionwas established, bringing togetherseveral ministries and bodies. Thefirst conference on children was heldin Iraq 11 - 13 May 1993, and organ-ized by CSO in coordination withUNICEF and the Child WelfareCommission.

During the year 2000, the CWC wasbrought under the chairmanship ofthe Minister of Labour and SocialAffairs, but still linked to the office of

the Vice President, in accordancewith an RCC decree. One of themajor tasks of the CWC is to ensurethe implementation of the provisionsof the CRC.19 However the ChildWelfare Commission has not taken aleadership role in this area and theMinistry of Education was givenresponsibility for the Iraq nationalreport on the follow-up to the WorldSummit for Children.

More significantly, the new amend-ment has authorized resources forthe CWC: allocations within theannual and the investment budgets;resources and revenues generatedfrom CWC facilities; and donationsand grants from within the country.External donations are subject topresidential approval.

It is worth noting that birth registra-tion of children aged 0-59 months atofficial bureaus is very high. TheMultiple Indicator Cluster Surveyconducted in 2000 indicates that98.1% of children under five yearshave been registered, 98.7% urbanand 97.2% rural.

1818

19The CWC now includes representatives from the following ministries and offices, at the director gen-eral level, as well as two experts to be chosen by the CWC: Ministry of Foreign Affairs, Ministry ofLabour and Social Affairs, Ministry of Culture and Information, Ministry of Education, Ministry of Health,Planning Commission, the General Federation of Iraqi Women, and the General Federation of IraqiYouth.

This Chapter provides an assess-ment and analysis of the situationconcerning children's right to lifeand survival, and particularly theiraccess to adequate nutrition andhealth care.

a. The Situation: Mortalityand Physical Under-Development

After falling between 1975-79 and1985-89, infant mortality rates inSouth/Centre Iraq jumped from 47deaths per 1,000 live births between

1985-89 to 79 deaths between 1990-94, and to 107 between 1995-99.The infant mortality rate is 102.1 inurban areas and 116.4 in rural areas.Figure 3 illustrates the dramatic andcontinuous rise in mortality.Similarly, under-five mortality ratesgradually fell until 1985-89, andthen rose sharply from 56 deaths per1,000 live births to 131 deaths per1,000 live births in 1995-99.20

Under-five mortality rates are 120.9in urban areas and 144.9 in ruralareas. Neo-natal mortality accountsfor two-thirds of under-five mortali-ty.

1919

20Salman, Khawla Naji and Al-Dulaymi, Aiayd, Child and Maternal Mortality Survey Iraq 1999, Ministryof Health Iraq and UNICEF, mimeograph.

3. Children's Right to Life and Survival

Life and Survival

CRC Article 6

1. States Parties recognize thatevery child has the inherent rightto life.

2. States Parties shall ensure tothe maximum extent possible thesurvival and development of thechild.

As for the physical development ofchildren under five years of age,MICS 2000 shows that 15.9% ofthese children suffer from beingmoderately to severely underweightor from general malnutrition(Weight/Age); 22.1% suffer frommoderate to severe stunting orchronic malnutrition(Height /Age );and 5.9% suffer from moderate-severe wasting or acute malnutrition(Weight/Height). In particular, therate of stunting shows a steep risefrom 18.7% in 1991 to 32% in 1996,decreasing to 20.4% in 1999.

The MICS reveals that boys and girlsunder five years of age are equallyaffected by being underweight,stunted or wasted. If anything, boys

are more affected: 16.1% of the boysand 15.6% of the girls suffer frombeing underweight ; 22.2% of theboys and 22.1% of the girls sufferfrom stunting; and 6.1% of the boys,and 5.7% of the girls suffer fromwasting. This is an indication thatone sex is not being favoured aboveanother in terms of access to nutri-tion.

Overall, the situation is that infantmortality has more than doubled inIraq over the past decade, whileunder-five mortality increased bytwo-and-a-half times. In spite ofsome improvement, over a fifth ofchildren still experience stuntedgrowth. For these children, thehuman rights to life and survival are

not being fulfilled. The causes willbe described over the next few pages.

b. Immediate Causes:Disease and Malnutrition

The immediate causes of mortalityand physical under-development aredisease and malnutrition. Tragically,most of the children who are dyingin Iraq are dying from preventableillness. Diarrhea leading to deathfrom dehydration, and acute respira-tory infections (ARI) togetheraccount for 70% percent of childmortality in Iraq. In 1999, the casefatality rate due to diarrhea in chil-dren under five years stood at 2.4%,

2020

while the rate of case fatality due toARI for the same age group was1.4%. This is a tenfold increase overthe past decade.21 A study carriedout in May 2000 showed that closeto half of children under five sufferedfrom diarrhea within two weeks ofthat month; over a third of the chil-dren suffered from acute respiratoryinfections; and nearly half suffered

from fever.22 The child suffers as anaverage 14.4 diarrhea spells whichrepresents an increase of about threetimes the 1990 average of 3.8.

Moreover, many diseases which arelocally endemic, such as malaria,cholera, visceral leishmaniasis, intes-tinal parasitic infestations and hepa-titis have been reported to be re-

emerging.23 An outbreak of polioaffected the country in 1999, but wasquickly dealt with (see Section 3/e).

The prevalence of malnutrition hasshown a sharp increase since 1991and has remained at an unaccept-ably high level since 1996. AMultiple Indicator Cluster Survey

2121

21 2000c.22 GOI-UNICEF 2000c. 23 Ibid.

(MICS) in 1996 showed that 23.4per cent of children below five yearsof age suffered from underweight.The 2000 MICS (provisional fig-ures) revealed that the prevalence ofunderweight is 19.6 per cent, whichmeans that one in five Iraqi childrenis underweight. Figure 4 shows mal-nutrition trends during the1990s forsouthern and central governorates.

The already reduced protein andenergy intake of food has been fur-ther aggravated by major deficienciesof micro-nutrients such as VitaminA (necessary for functioningimmune systems and the preventionof eye damage and blindness), iron,the B group of vitamins, and iodine.While these deficiencies manifestthemselves slowly, they have severeconsequences for growing children,and increase the prevalence of ane-mia among pregnant women andchildren below 5 years of age (esti-mated to have reached 51% and61%, respectively, in the years 1994-96). 24

Malnutrition amongst mothers hasled to an increase in the number oflow birth weight babies from 4.5% in1990 to 23.8 % in 1998.25 In otherwords, this phenomenon affectsnearly a quarter of Iraqi children.Low birth weight babies are 40 timesmore likely to die in the first monthof life as compared to babies withnormal weight. Those who surviveare more likely to be stunted for therest of their life. MICS 2000revealed that malnutrition indicatorsvary inversely with the educational

level of the mother. Children ofmothers with secondary educationhave a lower level of under nutritionthan other children.

It is worth noting that malnutritionnot only prevents children fromachieving the full potential of theirphysical and mental developmentbut also leads to high mortality, sinceit increases the susceptibility to com-mon childhood sicknesses like diar-rhea, ARI, and measles. Thus,according to the UNICEF-GOIProgramme Review on Health andNutrition, malnutrition needs to beviewed as an important pubic healthissue.

c. Underlying Causes:Services and HouseholdFactors

The underlying causes that lead tomalnutrition and disease can betraced to the services and utilitiesresponsible for good public healthand a safe environment, such as asafe water supply/sanitation system,as well as to household factors,including the family's economic situ-ation and level of awareness ofhealth and nutrition risk issues.

i. Services: Water and Sanitation,Electricity, Health, Education

Water and Sanitation These servicesare often referred to as the first lineof defense against disease. In thecase of Iraq, deterioration in waterquality is one of the key causes for

the increase in childhood disease.Most of the water distributed isdrawn from the Tigris, theEuphrates, and their tributaries andirrigation canals. These are all sur-face water sources and are, therefore,susceptible to both pollution andinfestation. Water needs to be puri-fied, and chlorine is critical for thispurpose.

There has been both a drop in cov-erage since 1990 as well as a seriouserosion of water quality. Before 1991,the potable water coverage for urbanand rural areas was 95% and 75%respectively. This was achievedthrough an advanced water systemcomposed of 218 fixed water treat-ment plants, 1,191 mobile compactwater treatment plants, 51 boostingstations and hundreds of thousandsof kilometers of water conveyancepipes. There was little differencebetween urban and rural water sup-plies in the central and southernparts of the country, the main onebeing that the first secured high per-centages of water via fixed treatmentplants, while the second dependedmainly on mobile plants. Urban cov-erage declined to 94% in 1997 and92.4% in 1999, while rural coveragedropped to 41% in 1997 andimproved to 45.7% in 1999.Between 1990 and 2000, the dailyper capita share of potable waterwent from 330 litres to 150 litres inBaghdad, 270 to 110 in other urbanareas, and 180 to 65 in rural areas(see Table 4).

2222

24 GOI-UNICEF 2000c.25 GOI-UNICEF 2000c.

2323

26 GOI-UNICEF 2000b.27 GOI-UNICEF 2000b.28 Ibid.

Water quality has been heavily com-promised during the 1990s and whilerestoration work is underway, chil-dren and women are exposed towater-related health hazards. WaterQuality results reported by theMinistry of Health and WHO, showhigh contamination of water sam-ples, sometimes beyond 40%. Thesituation is especially serious in thesouthern governorates. According toIraq Standards, the turbidity of waterreaching the population should notexceed 1 Nephelometric TurbidityUnit (NTU). However more than70% of water currently distributed isof a turbidity exceeding 10NTU. Insome places the turbidity has evenexceeded 25NTU. In a number ofinstances, especially in the southerngovernorates, treated water is blend-ed with raw water (directly from thesource) to cope with the increasingdemand, particularly during thesummer.

About 40,000 km of pipes form thewater conveyance network. Waterpipe breaks and leaks are causingwater losses and water contamina-tion; water losses through inefficien-cy in the network are estimated at35% of treated water.26 Waterschemes are currently operating atabout 60% of their normal efficiency.

As for sanitation, about 25% of thepopulation, all in urban areas, use

piped sewerage systems; about 50%use household cesspools, septictanks and pit latrines; the rest of thepopulation dispose of their seweragedirectly into rivers, streets or openareas, forming ponds of stagnantwater and causing contaminationand environmental hazards in bothurban and rural areas. It is estimat-ed that 500,000 tons of raw sewerageare dumped directly into fresh waterbodies every day. Most treatmentplants are malfunctioning due tolack of spares, equipment, propermaintenance and skilled manpower.Many tanker trucks for cesspool pitshave broken down because of lack ofspares, tires and batteries. 27

Garbage collection vehicles face asimilar problem to that of cesspooltankers lacking spares, tyres, batter-ies, etc. In 1990, in Baghdad Cityalone, there were 800 garbage col-lection trucks with a capacity of8m3/collector (about 4 tons each)making two trips per day serving4.25 million with an average garbagedisposal of 1.5kg per capita per day.Now, with a population of 5.6 mil-lion inhabitants disposing of 0.5kgper person per day, there are only 80garbage collectors with much lowercapacity, assisted by 400 hiredgarbage collectors. As a result, moregarbage accumulates between resi-dences (about two thirds is not beingremoved) and the garbage disposalareas are getting nearer to the city ascollectors carry less and travel short-er distances.

Auxiliary machinery and equipmentsuch as garbage collectors, tractors,

loaders, lorries excavators, water andsewerage tankers, jetting vehicles,personnel and transport vehicles,have dropped from an estimated6,500 units to 700 in 1996. By 2001services have improved with approx-imately 3000 vehicles in service.The number of operational work-shops has also dropped from morethan 60 to less than 20. Foreignlabour and maintenance staff in thesector, who previously formed about20% of the total, left the country in1991. As in the other sectors, expe-rienced local staff, including engi-neers, technicians and operators,also left in search of more rewardingjobs. This reduced the number ofpersonnel working for the GeneralCorporation for Water and Seweragefrom 20,000 to only 11,000. Theestimated average number of years ofexperience dropped from 20 to only9 years. 28

As a result, safe drinking water isnow a nation-wide problem. Asnoted earlier, cases of diarrhea have

increased from an average of 3.8episodes per child/year in 1990 to 15episodes per child/year in 1996.During the same period, typhoidfever increased from 2,240 to over27,000 cases. The drop in coveragecompared to the rise in water-relateddisease like typhoid is shown inTable 4.

Electricity As noted above, the elec-tricity deficit in Iraq is estimated tobe over 2,300 megawatts, with longpower cuts affecting the majority ofthe population. The impact ofpower cuts on the water and sanita-tion sector is considerable. At least70% of the standby generators in

water projects are out of order forlack of batteries and spares, so formany water projects a power cutnow means the total shut-down ofthe plant.

According to a water and sanitationsurvey conducted by UNICEF in1999/2000, the ripple effects ofpower cuts include: reduced waterpressure; no water reaching commu-nities; increased likelihood of waterbecoming contaminated; and dis-ease. The survey noted, "The effectsof power cuts are even longer andmore widespread than the actualduration of the power outage, espe-cially in water treatment plants. Re-

commissioning of the plant andrefilling the main pipes of the net-work usually take a lot more timethan the outage time". 29

Because of the lack of supplies, poormaintenance and long power cuts,sewers are frequently clogged withsediments of the sewerage solid par-ticles causing back flow of sewerageinto living quarters and residences.In Baghdad city for example, thelong-duration of power cuts causedsevere damage to the piping networkresulting in 18,000 pipes' settlementsand breaks during 1990 - 1997 com-pared to only 18 during the period1985 to 1990. The formation of

2424

29 The study is "Water and sanitation Services Coverage Survey", UNICEF/CARE, 1999-2000.

hydrogen sulphide with its aggressiveacidic action results in the corrosionand disintegration of pipes, disinte-gration of soil below and eventuallythe collapse of the pipes.30

Another aspect that is worth notingis that the cold chain system hasbeen adversely affected by frequentelectricity failures. Owing to thisproblem, the system had to bechanged from electricity supportedequipment to kerosene refrigeratorsat the primary health care level.

Health Services The health servicesystem has been badly eroded overthe past decade. The Ministry ofHealth had an annual budget before1990 of $450mn to cater for a popu-lation of less than 20 million. Thisdropped to a current level of approx-imately $22mn, or approximately5% of the original budget for a pop-ulation increased by 10 to 15 percent. According to the ProgrammeReview on the Health and NutritionSector, the effects of the drop inresources "are easy to see. Staffsalaries are poor (due to hyperinfla-tion) and motivation has sunk tovery low levels". Prior to 1990, 97%of the population in urban areas and79% of the population in rural areashad access to health care. Currently,there are just 929 primary healthcare (PHC) centres remaining out ofa network of 1,800 prior to 1990.Many skilled personnel have emi-grated, and the remaining personnelhave experienced technical isola-tion. There is shortage of supplies,including medical equipment.31

User fees were introduced in 1999,

under a plan whereby hospitalswould "auto-finance" and be respon-sible for half their budget, coveringfurniture, maintenance, and con-struction, while the Ministry wouldprovide equipment, supplies andmedicines. User fees were due tostart at PHCs in May 2001. A twotier fee structure is in place with lowincome groups paying about a quar-ter of what middle to higher incomegroups pay. For example, an exami-nation is ID100, as is a laboratorytest. While it was not possible toascertain the extent to which theintroduction of user fees has imped-ed the population's access to health,there is evidence in some areas ofreduced demand for health services after fees were implemented.

It must be noted however that feesdo not affect preventive mother andchild health care. The auto-financesystem does appear to be working asregards hospital funding and man-agement (see Box 2).

Education The state of many of theschools in Iraq is not just a disincen-tive to education but also a publichealth hazard for children (seeChapter 4, in particular Box 4). Thelack of electricity means somehowcoping with the extreme heat insummer and cold in winter. Brokendown and backed up sanitation sys-tems mean there are no toilet facili-ties to use, and children are releasedto go home when they need to usetoilet facilities.

ii. Household Factors

Several factors at the householdlevel contribute to child mortalityand under-development. The mostimportant is poverty, which makes itdifficult for parents to provide ade-quate nutrition for their childrenand care for their health and well-being. As regards nutrition, forexample, the 1,093 caloriesGovernment was able to providepre-MOU was raised to 2,030 inPhase I and to 2,472 in Phase VIII(based on the UN SecretaryGeneral's recommendation inFebruary 1998 that the nutritionaltarget value be increased, given itsinadequacy).

However, the food basket, even ifdistributed fully, does not fulfill themonthly food requirements for themajority of the population. As notedearlier, the May 2000 FAO/WFPreport confirmed that supplies fromthe food ration were not sufficientfor the whole month. It revealedthat wheat flour lasted for 21 daysand milk powder 12 days. Moreover,the food basket has a very low veg-etable protein and does not includeany animal protein, and the need toachieve a balanced intake of foodsmeans that families have to buyadditional food items. The amountspent by families each month is esti-mated at almost ID21,966, and isalmost double the estimated marketprice of the food in the ration(ID10,086). This means consider-able hardship for families, especiallysince income for most public ser-

2525

30 Ibid.31 GOI-UNICEF 2000c.

2626

Box 2 Health System: The Long Road Back to Service

Dozens of women clad in long black abayas crowd around the door to the office of the Director of Al Nur PHC Centrein Al Shula area of Baghdad, waving pieces of paper and demanding attention. Across the hall, both men and womenclutching their infants, press into a room where vaccination is underway The Centre Director estimates that she andthe remaining four doctors see about 800 patients a day; the number of patients served by the Centre can go up to 1,500a day during immunization campaigns. In normal times, a PHC with the catchment area of Al Nur has 17 doctorsassigned to it.

Most of the wage-earners in the area are labourers. Amongst some of the health problems faced by the population arehigh anemia during pregnancy, and high rates of child malnutrition, the Director reported. High protein biscuits aredistributed to children and mothers. The distribution of the biscuits causes additional work for the Centre management.Awareness sessions regarding ARI, diarrhea and breast-feeding are given at the Centre, and information on hyperten-sion, an increasing problem for pregnant women, is being introduced. Children experience frequent bouts of diarrhea,as do adults. Open sewers run through the streets, and although the Centre collaborates with the water and sanitationauthorities, the resources simply aren't there to tackle the sewage system.

This Centre is one of the lucky ones, having been rehabilitated three months earlier through the support of the ICRC;this included complete rewiring, repairs, and painting. "Rain used to drip on us all the time", the Director recalled; "Thisis an old building; I came here for my training in the 1960s". Some 60 out of the 800 PHC Centres have been rehabil-itated to date; work is underway on another 20. The renovation costs around $20,000 a centre. Imported air-condi-tioners have been installed in some of the rooms. The Centre is clean in spite of the crowds, and last year it acquired amodern conference room which is used for medical graduates. However, it is difficult to provide services, not justbecause of the numbers but because doctors are leaving the profession due to low pay, or to set up their own privateclinics. Some offices in an adjoining building, which is yet to be rehabilitated, are used for private "popular" clinics inthe afternoon, based on a reduced fee structure for lower income groups.

Six Community Child Care Units are attached to the Al Nur PHC. The CCCU in Othmaniya is based in the People'sCouncil Offices. Some 100 children had been screened that day, and their charts completed. Four children suffered fromsevere malnourishment; on average 35% are suffer moderate to severe malnourishment. Boxes of high protein biscuitssit in a corner. The volunteer, who has been coming to the Unit for five years, notes that lack of storage is a problem.To date, she has covered her own transport costs to come to the Unit. Talks are given on the importance of breast-feeding; some women ask about family planning services and are referred to the Al Nur PHC clinic.

At Al Nur Hospital, which is located in the same low-income area, the overall impression is of a clean and well-main-tained outfit. The hospital has been "auto-financed" since the decision was passed in September 1999. The children'soutpatient department sees around 150 patients a day, of whom 80% have gastroenteritis. There are 25 patients in res-idence. Families that can afford it pay about ID4,000 per day of hospital stay, whereas low income families payID1,000/day, which includes the cost of treatment, and food for the child and caretaker. Apart from the number of peo-ple to a room, there was little visible difference between the private ward and the low-income ward.

vants ranges from 5,000 - 10,000ID/month ($3-6) per month. 32

The education of the mother is animportant factor in children's healthand well-being. All three indicatorsof nutrition status (underweight,stunting or wasting) vary inverselywith the educational level of themother. Children of mothers with atleast secondary education havelower level of malnutrition thanother children according to all threeindicators.

Moreover, many mothers are mal-nourished themselves: more thanhalf of pregnant mothers are anemic,due to inadequate food intake interms of both quality and quantity.Poor quality of care during pregnan-cy and delivery leads to a large pro-portion of babies born in hospitalswith low birth weight. As noted ear-lier, this affects nearly a quarter ofbabies born in Iraq; low birth weightbabies are 40 times more at risk ofunder-development during the restof their lives. Hence, it is importantthat care be improved for the moth-er and the new born to ensure theirsurvival.33

Other factors at the household levelinclude early marriage and shortbirth spacing. The Mortality Surveyrevealed that some 40% of womenin Iraq were married before 18 yearsof age and only 14% were married at24 years or later. Birth intervals werealso too short: 41% births werespaced less than 2 years and 20% lessthan 18 months. Only one-third of

births were spaced by more thanthree years. There was also a hightotal marital fertility rate of 7.7 in thethree years before the survey.

MICS 2000 revealed that only17.1% of mothers of infants less than4 months of age exclusively breast-fed their infants. There was notmuch difference between breast-feeding of boys (17.8%) and girls(16.4%) of less than four months ofage. Rural mothers were almosttwice as likely to exclusively breast-feed their infants (24.6%) thanurban mothers (13.1%) during thisperiod. Some 51% of mothers con-tinue to breast-feed their infantsaged six to nine months, togetherwith complementary food, and58.6% continued to breast-feedbetween 12 and 15 months.

An earlier survey (MOH/WHO1998) had revealed that 61.7% ofmothers gave their children waterduring the first month of life, 31.7%of these children being givenunboiled water. Mothers' decision tostop breast-feeding or to use comple-mentary foods is facilitated by theinclusion of infant formula in thefood basket of rations providedunder the MOU, which has beenidentified as an area of concern interms of children's survival and well-being, in normal times but particu-larly in the conditions that currentlyprevail with regard to water, sanita-tion, and probably inappropriatehygiene practices.

The national authorities and inter-

national organizations support com-munity awareness campaigns target-ed at specific issues - ARI, breast-feeding, vaccinations, family plan-ning, and so on. However, theseappear to be managed in an isolatedand vertical fashion, rather thanthrough a comprehensive approachthat covers a range of critical issues,and which would better use scarcehuman and financial resources.34

d. Basic Causes:

Most major basic causes are directlyrelated to the management of theservices themselves. Perhaps themost important are the weak link-ages between the water and sanita-tion sector and the various levels ofthe health system, as well as weaklinkages between these two sectorsand the education sector.

In addition, the absence of a coher-

2727

32 2000c.33 Ibid.34 Observation during site visits for the preparation of this Situation Analysis.

ent policy, legal and institutionalframework has been identified as abasic cause in the case of the waterand sanitation sector.35 Indeed, thedifficulty of moving beyond ad hocpatchwork arrangements and on tomore comprehensive planning hasaffected all sectors over the pastdecade, due in large part to loss ofstaff and resources. This is an issuethat may be addressed through therecent resumption of five- yeardevelopment planning.

The fact that user fees in the waterand sanitation sector are modest andare far from covering costs has beenidentified as a systems issue. At theircurrent level, the fees do not reflectscarcity, and hence are not con-ducive to efficient and rational useby the community to preserve scarcewater resources. A more steeplyescalating user fee system could beconsidered. The same could be saidfor electricity, where use of newlyavailable air conditioners and gener-ators appears in some cases to bewithout regard to real energy costs. 36

As noted above, user fees have beenintroduced in the health sector withsome success. Although the possibleimpact upon the fall in demand forservices must be assessed. It has alsobeen noted that there is limited com-munity involvement in the waterand sanitation sector.

A point to note is that while data onsome service systems - for example,water and sanitation - seems to beplentiful, information on others suchas health and education - is more

sparse. This makes it difficult toaddress the question of how the sys-tems themselves function and howthey have coped with the impact ofsanctions.

The deteriorated physical infrastruc-ture of the social sectors can also beseen as a basic cause. In November2001 the numbers of primary healthcare centers, primary schools, watertreatment plants, and sewage treat-ment plants still in need of rehabili-tation respectively amounted to 500,4,500, 960 (including 880 compactunits) and 17. Up until the end ofthe 1980s, the abundance of foreignexchange and public revenue com-bined with a scarcity of labour drovethis sector, in particular, to rely

almost exclusively on labour saving,capital intensive infrastructure. Nowwith a scarcity of foreign exchangeand public revenue the ability ofauthorities to maintain, let alone fur-ther develop this infrastructure hasbeen severely diminished. The con-tinuing isolation of Iraq has limitedthe authorities' ability to explore andintroduce more appropriate low costtechnologies. The disparity inurban/rural infant and child mortali-ty rates highlights both an institu-tional bias in focus towards bothurban areas and towards to capitalintensive infrastructure which isoften not appropriate for servingwidely scattered and sparsely popu-lated rural areas.

2828

35GOI-UNICEF 2000b.36Observation during site visits for the preparation of this Situation Analysis.

Causes that reflect the impact ofcrises and sanctions on systemsinclude inadequate capacity for effi-cient and effective management ofhealth, nutrition, water and sanita-tion, and education systems andservices. The erosion in numbersand skills staffing in the public sectoris due to low levels of pay due to theabsence of resources. This has beendocumented particularly well in thewater and sanitation sector, wherethe number of staff at theCorporation for Water and Seweragedropped from 20,000 to 11,000,eroding the average number of yearsof experience from 20 to only 9years. The government has tried tomake up for low salaries by introduc-ing allowances and incentives, butthis does not raise wages sufficientlyto meet needs. Lack of resourcesalso means less opportunities fortraining and career development.

A basic cause for non-fulfilment ofthe rights to survival and develop-ment cuts across all sectors: the lackof financial resources available tonational authorities, whether overallresources to overhaul a sector to itspre-1990 capacity and to develop itto meet growing population needs,or to simply distribute and install thesupplies and equipment providedthrough MOU arrangements.

As noted above, the Ministry ofHealth annual budget dropped from$450mn in 1990 to less than $20mn,affecting staff levels and services. Inthe case of water and sanitation,implementation of activities underthe SCR986 programme started in

early 1997 with a view to rehabilitat-ing existing systems. However, whilethe requirements of the sector stoodat more than $700 million, the sec-tor allocation in the first four phases(two years) provided only about $50million. It is estimated that full reha-bilitation of the water and sanitationsystems would require around $1 bil-lion. Meeting the demand ofunserved and under-served popula-tions, and putting systems in placefor future population growth, wouldrequire several billions more.

Moreover, the absence of a cashcomponent within the SCR 986 Oilfor Food Programme made it difficultto support activities like transporta-

tion of supplies, timely delivery ofcommodities at end user level withinthe country, training and capacitybuilding, maintenance, repair ofwarehouses and institutions, andother areas. In other words, the sup-plies and equipment arrive, and aseverely depleted and under-resourced public sector then has tofigure out ways to install and distrib-ute them. The cash necessary todeal with issues of delivery, training,installation, maintenance and so onhas been estimated to be $12.8mnfor primary health care and $13.8mnfor nutrition. International and non-governmental organizations havebeen helping to defray some of thesecosts through their regular pro-

2929

grammes, but these ad hoc arrange-ments cannot substitute for plannedand reliable expenditures.

As of the 19th November 2001,1544 contracts valued at overUS$4billion remain on hold at theSCR 661 Sanctions Committee inspite of efforts to establish a fast-track list of goods. The absence offunding, and the irregularity of suchfunding that becomes available aswell as the irregularity of equipmentand supplies, means that authoritiescannot plan and implement a com-prehensive strategy. In the waterand sanitation sector, for example,there is no Master Plan for the reha-bilitation of the sector. The authori-ties followed a "shock therapy strate-gy" that only anticipated reducedrates of deterioration in servicesthroughout the country. Phase IIfocused on auxiliary equipment toimprove the networks; phase III onwater system spares and power,phase IV more emphasis on auxiliaryequipment and compact units.37

ARI diseases, in particular, can beattributed to the inability to plan andmanage health resources due to thead hoc arrangements in force as aresult of sanctions. The GOI-UNICEF Programme Review of thehealth and nutrition sector notedthat this was "a multi-factorial issue,as irregularity of medicines supple-mentation and frequent drug short-ages combined with 'weak' and inef-fective training courses has led toincreases in ARI cases especially inthe winter. The problem is exacer-

bated by lack of follow-up".Sanctions-related causes for malnu-trition and disease also include theavailability of calories in the foodration, as noted in 3/b/ii.

e. Interventions to Date

Nutrition To address the popula-tion's nutrition needs, theGovernment has put in place pro-grammes to screen children and pro-vide the necessary nutrition supportand health care to those in need. Itintroduced Community Child CareUnits (CCCUs) in 1996 as part of aTargeted Nutrition Programme, withthe objective of screening at least75% of children less than five yearsold for malnutrition, with a specialemphasis on children in high-risk

areas. From Phase IV onward, theGovernment included high proteinbiscuit as part of the supplies pro-cured under MOU.38 The CCCUsrefer moderately and severely mal-nourished children who need care toprimary health care clinics, whileseverely malnourished children suf-fering from associated illnesses aretreated at Nutrition RehabilitationCentres (NRCs) based in hospitals.The centres also provide health edu-cation regarding proper hygiene andfeeding practices and care of chil-dren during common childhood ill-nesses.

By the end of 2000, there were 2,531CCCUs in the country, screeningsome 60% of children. The numberof under-5 children screened formalnutrition rose from 200,000 in

3030

37GOI-UNICEF 2000b.38 A problem occurred with the first delivery of therapeutic milk, and this has not yet been made avail-able.

1997 to 1.5mn during the first threemonths of 2000. During the firstthree months of the year some 16%of screened children received nutri-tion supplements in the form of highprotein biscuits. These were alsoprovided to over 138,000 pregnantand lactating mothers (27.1%) dur-ing the same period. 39

The CCCUs are established inschools or in People's LocalCouncils, and have drawn in otherministries and NGOs. They arestaffed by volunteers, most of whomare teachers, and are the firstattempt by the social services systemto create an extension system at thecommunity level. In addition to thepositive sides of this experience,described above, there have beensome difficulties. Volunteers lack suf-ficient skills and support to managethemselves as independent and selfsustaining local institutions. They donot receive funds to cover their per-sonal expenses, and have beenforced to cover these out of pocket.The actual number of under-fivechildren who would need to bescreened is estimated to be 3.5mnout of whom the estimated numberof malnourished is 750,000 and thenumber needing rehabilitation isestimated to be 350,000. In order tobe able to cover 100% of under-fivechildren, a total of 4,000 CCCUswould be required.

The NRCs are established at hospi-tal paediatric wards and at paediatrichospitals to provide medical andnutritional treatment to severelymalnourished children under five.

3131

39 GOI-UNICEF 2000a and UNICEF Annual Report

The centres also provide health edu-cation and advice on nutrition to thechildren's family. A key link thatexists between NRCs and CCCUs isthat on discharge from the centre,after recovery, the rehabilitated chil-dren are referred to a suitable CCCUfor growth monitoring and furthersupport and advice. The total num-ber of NRCs currently is 63, locatedin all governorates and in sectoralhospitals. The number of rehabili-tated children rose from 6,000 in1996 to over 1.2mn by December1999.

Again, in addition to the positiveaspects, some difficulties have beenfaced. The numbers of NRCs arethinly spread, and they require caregivers to stay at the hospital whilethe child is there, which is often dif-ficult for mothers with other com-mitments. All NRCs put togetherhave a monthly admission capacityof 2,000 and can rehabilitate onlyabout 24,000 severely malnourishedchildren in a year. This covers only20% of severely malnourished chil-dren. Some of these issues are beingaddressed by using oral rehydrationtherapy corners in hospitals for nutri-tion rehabilitation With inclusion ofall 929 PHCs in the effort to rehabil-itate malnourished children, the pro-gramme will be able to cover 80% ofthe malnourished children.40

Interventions are also addressing theneed for micro-nutrients. Vitamin Asupplements are being given to chil-dren together with their measles

vaccine. However, MICS 2000revealed that less progress has beenmade in this area than previouslybelieved, with 12.7% of childrenreceiving Vitamin A supplements.

Over the past few years, determinedsteps were take as regards salt iodiza-tion, given iodine's importance inpreventing mental retardation.Legislation was adopted in 1996, andan action plan reviewed in 1998.Currently, only iodized salt is distrib-uted in food rations and householduse of iodized salt has risen. Again,the MICS 2000 revealed thatprogress is less than had beenthought, with 40% of householdsconsuming iodized salt. One of thereasons given is that the salt suppliedin the food ration is not enough tocover household needs, and familiesthen buy non-iodized salt from themarket.

Health Ongoing immunizationcampaigns are amongst the inter-ventions to redress the adversehealth conditions experienced bychildren. The Ministry of HealthExpanded Programme onImmunization (EPI) has beenresumed and reactivated, and immu-nization coverage rates improvedgreatly during 2000 (see Table 5). 41

Efforts to eradicate polio from Iraqwere intensified during 2000 toaddress the 1999 outbreak (see Box3). These were successful due inlarge part to the use of micro-plan-ning and full Government commit-ment. The Ministry of Health hasreported only 4 polio cases - all dur-ing January 2000 - compared to 77cases in 1999.

There was also a considerable reduc-tion in the number of cases ofmeasles - from almost 10,000 in

3232

40 GOI-UNICEF 2000c.41 UNICEF Annual Report 2000.

1999 to only 678 cases by October2000. The number of tetanus caseswas also reduced to just 26 cases in2000, compared to 49 in 1999.Indeed, Iraq has achieved the globalgoal the elimination of neonataltetanus goal (0.5 per 1000 livebirths) although when disaggregatedby district there are some districtsstill to attain this level. The MICS2000 survey showed that 63.2% ofpregnant women had receivedneonatal tetanus protection.Nevertheless, all immunization cam-

paigns were delayed to some extentduring 2000 by the late or non-arrival of supplies procured underthe Oil for Food Programme.42

International organizations active inthe health and nutrition sector inIraq include UNICEF, WHO, ICRC,CARE International, PremiereUrgence, and the InternationalFederation of Red Cross and RedCrescent. UNICEF focuses on reha-bilitation of primary health centres,nutrition rehabilitation, immuniza-

tion, social mobilization, cold chainequipment and provision of incen-tives for personnel. WHO focuseson surveillance, laboratory activities,and transportation. The two organi-zations collaborate in the conduct ofsurveys. ICRC helps to rehabilitatePHC centres, among other things.The International Federation of RedCross and Crescent helps distributefood rations to malnourished chil-dren and their families.

3333

42 Ibid.

3434

Box 3 Campaign Against Polio

In the spring of 1999 drought brought animal herders and nomadic people fur-ther south along the Tigris River valley in search of water and good grazingland. The first indication of a serious problem came in the Sinjar district inNinewah governorate in May 1999. A normally healthy child developed alight fever, her limbs became floppy and weak. Doctors suspected polio andthe case was quickly confirmed. By the year-end, there were 76 more cases asthe virus moved south.

National Immunization Days for polio were started in 1995. The outbreak sug-gests that coverage during routine immunization and National Days had beensub-optimal. In response to the outbreak, Polio National Immunization Dayswere conducted during October and November 1999, while in 2000 an addi-tional Immunization Day of two rounds was also carried out. The 2000 Dayswere reported successful due to good micro-planning and social mobilization.

This included house-to-house campaigns, monitoring and supervision. Healthworkers prepared maps of their areas and plotted every under-five child on themap. These were used to plan the campaign and to ensure every child wasvaccinated. About 9,500 volunteers (teachers, NGO members, communityleaders and local council and Ba'ath party members) participated in the cam-paign, helping to ensure 100% coverage. A pocket calculator or a diary and acertificate was given to them in recognition of their contribution. Supervisorsfrom central, governorate, sector and primary health care centres supportedthe teams through regular monitoring and supervision. TV spots and radiomessages were produced to raise public health awareness. Loudspeakers wereused for making announcements to educate the community and to ask themto bring their children for vaccination, and banners were displayed at publicplaces to mobilize the community before and during the campaign.

Water and Sanitation In 1995, theWater and EnvironmentalSanitation authorities and CSOconducted, with UNICEF support,the first ever services survey at thesub-district level. This was followedby other more refined surveys withsupport from UNICEF and CARE.In addition to defining the level ofservice coverage, the survey definedthe system through which the waterservice was provided. Two othermajor surveys were conducted in1997 and 1999, enhancing the clari-ty of problem definition and theeffectiveness of planned solutions.The surveys provided a solid basis fora monitoring and evaluation system,and support is currently being givento establishment of a managementinformation system.

Between 1991 and 1996, interven-tions in the sector were perforce lim-ited due to the sophistication of thesystems and the absence of financialresources. For example, it was esti-mated that $100mn a year wouldhave been needed to repair the sys-tem, whereas only $8mn were avail-able.

Through the Oil for FoodProgramme, the Iraqi authoritieshave been able to procure some ofthe hardware equipment, spares andpurification chemicals necessary torepair, maintain and run the existingsystems. However, no funding wasavailable through the Programme forinstallation, costs of local labour,materials, training, maintenance,and research.

Rehabilitation works have helpedincrease the efficiency of targetedschemes by 25% - 35%. This hasresulted in better quality and largerquantities of water in case of watertreatment plants and less frequent ofsewerage flooding and better qualitytreated sewerage effluent in the caseof rehabilitated sewer lines and treat-ment plants.

f. Conclusions

The causal analysis set out in Figure5 reveals both the basic causes fornon-fulfilment of children's rights tolife and survival in Iraq, as well as theinter-linkages between causes.

In particular, the lack of sufficientfinancial resources to rehabilitateand develop the health, water andsanitation, electricity and educationsectors has been particularly devas-tating. Water and sanitationrequires some $1bn to rehabilitatethe sector and several billion dollarsto meet the need of unserved andunder-served populations andaddress new population growth. Ad-hoc and patchwork arrangementsare a mark of efforts in this area,whereas comprehensive planningand management is necessary, forwhich intensive capacity buildingwill be an essential precursor.

The potential of householdeconomies to grow beyond thepoverty threshold is limited by astagnant economy, which in turn isdue to the very small amount of

3535

resources moving through the econ-omy, and the almost completereliance on imported supplies at theexpense of national productivity.

Against this backdrop, interventionsto provide a food basket, to screenand rehabilitate malnourished chil-dren, and to promote full immuniza-tion coverage, while laudable, simplymitigate the situation and do notgive the population the opportunityto recover and move forward.

Figure 5 shows clearly how the bulkof interventions target the immedi-ate causes. Efforts to address theunderlying causes are remedial,while efforts to address basic causesare non-existent. Even as regardsimmediate causes, the efforts to mit-igate the situation are impeded byslow and irregular delivery of sup-plies, due to the complex system forimports now in place. Perhaps themost telling indicator is that evenafter three years of such measures,the proportion of malnourished chil-dren has not greatly declined.

The attempts to ameliorate theimpact of economic sanctions hasnot addressed the basic or underly-ing causes for infant and child mor-tality and under-development. Onlysufficient and reliable resources andcomprehensive management andplanning will promote children'srights to life and survival. This wouldinclude not just repair and overhaulof the physical systems providingservices to the population, but alsothe necessary capacity building andstaff remuneration.

3636

Several major areas, such as inade-quate resources, insufficient andintermittent supplies, do not fallwithin the control of social sectorauthorities or of families, and theycannot be held accountable as dutybearers for the violation of children'srights that ensues.

Among the factors that do fall with-in the control of social sector author-ities, it is important to considerstronger planning and implementa-tion linkages between the health,water and sanitation, and educationsectors to ensure best use of scarceresources and effective targeting ofthe problems. There are clearlystrong inter-relationships betweenhealth and water services, and elec-tricity and water services, all ofwhich in turn impact strongly ondisease and malnutrition.

A positive factor in this otherwisegrim situation is the improvement ofinformation on the status of childrenand the population, through theMICS and other surveys (such aswater and sanitation), which enablesbetter planning and monitoring ofinterventions. More must be doneto collect and analyze informationon the state of the systems them-selves, in order to support capacitybuilding and organizational reform.

A more comprehensive plan for edu-cation and information campaigns isnecessary, so as to make best use ofscarce resources. Such a plan wouldfactor in a range of health, nutrition,environmental, and behavioral

issues, including family planning,birth spacing, early marriage, andbreast-feeding, as well as disease con-trol, water quality and sanitation dis-posal. Breast-feeding and otherissues relating to the survival of new-borns is particularly important, giventhat neonatal mortality accounts fortwo-thirds of infant and child mor-tality.

More popular awareness of and com-munity involvement in resource use,along with a review of user fees in away that is both equitable and yetreflects the scarcity of resourceswould assist in conserving and reha-bilitating the water and electricitysectors.

3737

3838

Primary education has been compul-sory in Iraq since 1976, and Iraq is asignatory of the Education for AllDeclaration. The Government hasadopted the global goals establishedat the World Summit for Children.Two separate ministries deal witheducation in Iraq: the Ministry ofEducation deals with pre-schools,primary, intermediate, and prepara-tory education (both academic andvocational), while the Ministry ofHigher Education and ScientificResearch deals with university edu-cation.

a. The Situation: LowAttendance, ParticularlyAmong Girls

Gross enrolment rate in kinder-gartens declined from 8.2% in 1991to 6.8% in 1998. This means thesystem serves less than 10% of thepopulation in the 4 - 5 age group.

The Education for All report indi-cates that from 1990 to 1998,approximately 22.6% of children didnot enroll in school, of which 10.6%did not enroll in primary schools in1998. The enrolment decline wasgreater in rural than urban areas andhigher among girls. 43

Data on primary school attendancegenerated by the MICS 2000 surveyconfirms the serious and ongoingerosion in education. According tothe survey, 76.3% of children of pri-mary school age (6-11) in Iraq areattending primary school. In other

words, as many as 23.7% of childrenare not in primary school, with near-ly twice as many girls staying out ofschool as boys - 31.2% of girls and17.5% of boys (see Table 6). The ero-sion in attendance has affected therural areas more than urban areas,with 39% of children out of primaryschool in rural areas compared to16.2% in urban areas. In rural areas,the female attendance rate of 49.2%is lower than that of males (72.1%);in other words, half of rural girls arenot going to school. In urban areas,male-female attendance rates arecloser to each other at 87.4% formales and 80% for females.

The percent of overall primaryschool entrants who reach grade fiveis relatively high, at 88.3%. Again,as Table 6 shows, there are differ-ences between boys and girls andurban and rural children. As regardsgirls, the data shows that they aremore likely to drop out or be pulledout of school than boys.

The average repetition rate in pri-mary grades has been reduced by21.1% in 1991-2, to 17.6% in 1995-6 and 17 % in 1997-8. The highestrepetition rate was reached in Grade5 in 1997-8; it stood at 23% of which26% were males and 16% females.44

According to the National Report,drop-out rates have increased at theintermediate and preparatory levelsof education (ages 12 - 17, and levelsone through six). Boys enroled inthe third intermediate level in 1997-98 were only 68.0% of those whohad enroled in the first intermediate

level; the percentage of girls was62.0%. As for the preparatory stage(academic), the percentage of malestudents enroled in the sixth level in1997-98 was 115.3% of those whohad been enroled in the fourth level,whereas girls enroled in the sixthlevel were 96.1% of those enroled inthe fourth level. The Report notedthat the reason for the high level ofmale enrolment was the high rate offailure leading to repetition in the1996-97 school year.

The successive national literacycampaigns of the 1970s and early1980s resulted in substantialimprovements in the adult literacyrate, estimated at 52% in 1977, andgrowing to 72% in 1987. Howeverthere has been a sharp decline inadult female literacy rates since themid 1980s, from 87 % in 1985 to49% in 1990 and 45% in 1995. 45

In terms of recreation, the Children'sCultural House organizes on average39 events a year, including drawingcompetitions, book exhibitions, andfestivals. Children's plays are per-formed, and there are programmesfor children on radio and TV. Thereis a General Federation of IraqiYouth, a National Federation of IraqiStudents, a Commission for Youthand Sports, and a National OlympicCommittee, as well as several sportsclubs and federations. Middle-income families complain of chil-dren's easy access to electronic toysand billiards. Overall, not muchinformation appears to be availableon children's right to recreation.

3939

43 GOI-UNICEF 2000a.44 GOI-UNICEF 2000d.45 GOI-UNICEF 2000d.

4. Children's Right to Education

b. Immediate Causes:Erosion in Coverage andQuality

By the mid-1990s, the educationsector was in deep crisis: the physicalinfrastructure was dilapidated,requests for supplies went unmet,and the teaching personnel wascompletely dissipated in the face ofshrinking funding. As the GOI-UNICEF Programme Review put it,"Unable to cope with high costs inthe face of shrinking real incomes,many teachers in schools developedsurvival mechanisms that directlyimpinge on the capacity to providequality education. Individual teach-ers resorted to providing extra les-sons, to those who could afford to.Other teachers took on a second oreven third job, while others simplyabandoned teaching to engage in'other income generating activities'.The results for students was thatmany became self-taught or nottaught at all and education stan-dards deteriorated sharply. In a num-ber of instances, pupils themselvesstarted leaving school to do 'otherthings'". 46

In most primary schools, the schoolday has been reduced to cater fortwo shifts, and sometimes three, ofchildren a day. Estimates by theMinistry of Education reveal thatthere was a decrease in the numberof Ministry staff between 1990 and1998 of 26,394 persons (approxi-mately 10%), of whom 16,337 (or6.5%) were teachers. At present,

approximately 15,798 of staff(including teachers) are not attend-ing work regularly. This aggravatesan already poor situation wherepupil numbers have increased due topopulation growth.

Prior to 1995, concerted teachertraining resulted in increased num-bers of primary and secondary schoolteachers. A shortage of resourcesforced the government to cut backthe number of trainees in regularteachers' training programme in1995.

There are severe shortages of basicschool supplies, classroom furniture,textbooks and teaching aids.Estimates provided by the Ministryof Education indicate that schoolslack approximately 500,000 teachingaid units, 2 million desks, 68 milliontextbooks, and 15,000 computers.The Ministry also adds that theyused to distribute free of charge awide range of stationery items(i.e.150 million pencils, 23 millionerasers, 5 million rulers, 5 milliongeometrical kits, etc), but that theseare no longer being distributed.

4040

46 Ibid.

EducationCRC Article 281. States Parties recognize the right of the child to education, and with a viewto achieving this right progressively and on the basis of equal opportunity, theyshall, in particular: (a) Make primary education compulsory and available free to all; (b) Encourage the development of different forms of secondary education,including general and vocational education, make them available and acces-sible to every child, and take appropriate measures such as the introduction offree education and offering financial assistance in case of need; (c) Make higher education accessible to all on the basis of capacity by everyappropriate means; (d) Make educational and vocational information and guidance available andaccessible to all children; (e) Take measures to encourage regular attendance at schools and the reduc-tion of drop-out rates.

2. States Parties shall take all appropriate measures to ensure that school dis-cipline is administered in a manner consistent with the child's human dignityand in conformity with the present Convention.

3. States Parties shall promote and encourage international cooperation inmatters relating to education, in particular with a view to contributing to theelimination of ignorance and illiteracy throughout the world and facilitatingaccess to scientific and technical knowledge and modern teaching methods.In this regard, particular account shall be taken of the needs of developingcountries.

4141

The curriculum has remained basi-cally unchanged for 20 years, anissue which is now being addressedby the Ministry of Education.

c. Underlying Causes:Household Factors, SchoolEnvironmentPoverty is a major factor in lowenrolment and high dropout rates.Although primary education is free,many teachers are now insisting onand charging for private lessons inorder to survive, something poorfamilies cannot afford. Families inneed also pull their boys out ofschool to go to work, and their girlsto help at home or get married. The

phenomenon of early marriage stillprevails. The data show an insuffi-ciently positive attitude towardsfemale education, given that asmany as 30.2% of girls are notattending primary schools.

More worrying, there is a reportedattitude that some people no longerview education as useful or necessaryfor either sex, given the number ofengineers and other highly qualifiedgraduates driving taxis or working atodd jobs.

There is also a direct link betweendropout rates and families' unwilling-ness to send their children to schoolsthat are unfit for purposes of educa-

tion. The absence of sanitation is amajor factor, as are the other hazardsassociated with non-rehabilitatedbuildings. The large class sizes andthe shift system do not inspire confi-dence in the quality of education.

The Ministry of Education estimatesthat about 4,500 educational build-ings, representing about 53% of thetotal existing building stock in the 15Central and Southern governoratesare in extremely deteriorated condi-tion and do not provide a safe learn-ing and teaching environment forstudents and teachers. This deterio-ration is evident in all areas: buildingstructures, water provision, sanita-tion, playgrounds, classrooms, and

electrical installations. The Ministryfurther estimates that about 5,132additional buildings would berequired to meet the growing needfor school accommodation. TheMinistry had previously outlinedplans for the construction of neweducational buildings and to replacedestroyed and damaged buildings.These plans came to a halt in theearly 1990s. 47

d. Basic Causes: Basic causes impact on both thequality and quantity of education. Interms of quality it is generally agreedthat the curriculum needs compre-hensive review after little changeover the past two decades.Although it is difficult to do so giventhe great pressures for delivery interms of quantity, there is a pressingneed to pay more attention to thequality of education, includingteacher skills and incentives. Theministry's management informationsystems are said to need more invest-ment in capacity building and soft-ware.

There is also room for furtherinvolvement of the community inschool development and service pro-vision, although this is difficult toachieve amongst low income groups.

This demands focused capacitybuilding, advocacy and social mobi-lization. The weak linkages betweenplanning for education in tandemwith the water and sanitation andelectricity sectors have been noted inSection 3.

According to official sources,$230mn was allocated to the sectorin the 1988-89 school year, repre-senting approximately 6.7% of totalgovernment expenditure.Investment in education under thefirst four phases of SCR 986 aver-aged just $23 million a year, or atenth of the previous amount.Starting with Phase V, there was anincrease in SCR 986 Programmeallocations to the education sector,which culminated with an allocationof $351 million in Phase VIII.48

These resources have yet to impacton the sector.

The stagnant economy is reflected inpoverty both of families who nolonger have the resources to keeptheir children in school, and in thelow wages of teachers, who take onsecond or third jobs, or leave the sys-tem altogether. The resources madeavailable through the SCR 986 Oilfor Food Programme do not help torevive the economy, given that theymust be used for imported suppliesand not for locally produced goods;the cash component agreed inDecember 2000 had not yet goneinto operation by November 2001.

In addition, the intermittent arrivalof supplies has affected the sector,perhaps the most telling examplebeing the case of the printing presson which the production of schoolbooks depends. Attempts to secureboth the spare parts necessary andthe expertise at one and the sametime have not yet borne fruit.

e. Interventions to Date:Rebuilding Schools, YouthActivitiesWith support from UNICEF, theMinistry has rehabilitated andreconstructed 402 schools in bothurban and rural areas benefiting atotal of 305,000 children and 11,460teachers in the Baghdad, Ninevah,Basrah and Thiqar governorates. Inaddition, in collaboration with theinternational NGO, OXFAM, waterand sanitation facilities in 1,050schools were rehabilitated for thebenefit of 840,000 children. Thiswork was undertaken throughoutthe 1990-2001 period, though thebulk of it took place after 1996.

Rehabilitation work is presentlyongoing in the Basrah, Thiqar andMissan governorates. In urban areas,priority is being given to schools inareas of high population concentra-tion, or to schools running two ormore shifts a day. Schools that wereeither partially or totally closed dueto unsafe and/or poor conditions ofthe facilities (flooded, structurallydamaged, etc.) are also being consid-ered. In rural areas, priority is beinggiven to areas where school buildingswere destroyed or damaged beyondrepair, especially in the southerngovernorates. 49

The Ministry of Education is cur-rently upgrading its ManagementInformation System to improve theschool data collection system and tobetter facilitate planning capacities

4242

47 GOI-UNICEF 2000d.48 Ibid.49 Ibid.

at the central and peripheral levels.Essential computer equipment hasbeen provided and staff have beentrained, although the number is stillinsufficient.

Intensive efforts have been made forover a year to bring the chalk facto-ry and the printing press back intoproduction through repair of themachinery and training of staff. Thechalk factory is now back in produc-tion, but the printing press is still notfully operational. This is due to thefact that it has proven extremely dif-ficult to secure the spare parts neces-sary at the same time as internation-al expertise to supervise installationand training. 50 Both spare partsand international experts have beensecured, only to discover after theinvestment of considerable time andresources, that the parts were notsufficient to rehabilitate the press.Most school books are currentlyprinted in Jordan.

In 1998, the Ministry of Educationresumed some regular in-servicetraining for teachers. The pro-gramme continued in 1999 and2000 to cover a total of 1,600 super-visors and teachers from all gover-norates. The support included cours-es in math, English, reading forbeginners, hygiene and environmen-tal education.

Education kits were provided to750,000 students in 1,200 primaryschools, as well as supplies andequipment for teacher training insti-tutes with supplies and equipment,which are now being procuredthrough the MOU.

A non-formal education project wasstarted in 1994 for 7,768 girls aged10-14 to address the dropout prob-lem of girls. A further 7,322 girlsaged more than 14 were also trainedin 1995. The project was implement-ed by the General Federation of IraqiWomen under the supervision of theMinistry of Education.Approximately 598 of the girls wereable to rejoin the formal primaryschool system. The same projecttrained 1,350 teachers of the firstand second grades of primaryschools, mainly women teachers,and provided supplies and equip-ment, as well as food. A TV cam-paign promoting girls' educationaccompanied the effort. A study wasconducted by the Ministry ofEducation on "Factors AffectingFemale Dropout from PrimaryEducation", and the Ministry isworking on a proposal to address theproblem of dropout girls and boys inthe age range 10-14 years.51

Recently, some initiatives have beenlaunched to engage children in plan-ning their future. For example, dur-ing 26 - 28 February 2001, theMinistry of Labour and Social Affairsin collaboration with UNICEForganized "A Youth of Iraq" work-shop, which brought together 53youths, including 24 females, towork on articles in the conventionon the rights of the child. One daywas dedicated to children with spe-cial needs; there were 15 such par-ticipants, children with physical dis-ability, hearing or visual impairment,and orphans. All groups met on the

last day, and shared recommenda-tions. They established a creativegallery of recommendations, includ-ing drawings and sketches, to visi-tors. The workshop was widelyviewed as a success. One of theyouth commented, "We feel respect-ed; we have a say".

This workshop also helped to givechildren the skills to engage withother stakeholders in a broaderworkshop organized by the ChildWelfare Commission and theMinistry of Labour and SocialAffairs, a "Future Search Conferenceon the Implementation of ChildRights in Iraq" (27-29 March2001).52 A total of 86 people partici-pated; they represented 10 "stake-holder" groups, including childrenbetween 8-12 and adolescentsbetween 13-18; health, education,and media professionals; justice andlaw enforcement agencies; parlia-mentarians; and others.

Together they analyzed past andpresent global and national trends asthese related to children, and creat-ed future scenarios. The commondreams identified by the groupincluded: "Development and stabili-ty of health, social and educationalstate of the family, and the environ-ment; child participation in discus-sions and decision-making; schoolhealth and nutrition programmeintroduced; ending of negative socialphenomena; establishment of radioand TV channels for children".Groups then worked on action plansto fulfil their dreams.

4343

50 Discussions by the author with personnel concerned.51 GOI-UNICEF 2000d.52 The Future Search methodology involves "an interactive process of exploring the past, reviewing thepresent and dreaming for a common future by all the stakeholders of a system/issue to design strate-gies and actions for improving it in a coordinated manner by themselves under a supportive leader-ship", from Proceedings of the Future Search Conference on Implementation of Child Rights in Iraq.

4444

Box 4 A Tale of Two Schools

In the Rassafa Directorate in Baghdad, 575 schools and 15,000 teachers serve half a million pupils. The Directorateincludes some of the poorest areas, such as Saddam City, where 2.5mn people live and 350 of Rassafa's schools arelocated. The schools have deteriorated badly over the past 10 years, their condition made worse by the fact that thisis an easily flooded low lying area. "When it rains, the schools drown", the Ministry of Education's planning managerfor that Directorate, a woman engineer, explained.

The schools are badly overcrowded, with 3,000 children per school, on average, and 120 per class. Ten schools runthree shifts a day, while many others run two shifts a day. Only 30 of the schools have computers. Each school has acommunity board of trustees, and when this is active - and where the community has the resources - the schools arein better condition. State-supplied equipment is far from meeting the need. For example, 30 toilets have been madeavailable for the Directorate, whereas the need is eight per school. To date, 61 schools have been rehabilitated throughcollaboration between the Ministry and international organizations. They were selected on the basis of size and num-ber of shifts.

At Al Ishtirakiya Primary School for Girls, the walls gleam a freshly painted white, and the doors and window framesare picked out in bright blue. This is, the headmistress explains, in sharp contrast to the situation that had prevailedjust two months earlier, with broken windows, blocked up toilets, ripped and exposed metal, and no fans. The yardhad completely flooded due to the heavy rains. The school foundations have been raised to make it higher than thesewage system, and as a result the windows are visibly closer to the ground and the ceilings are lower; the main thingis that the toilets are now functioning again. The light fixtures have been repaired, although, like other parts of Baghdadthe school experiences five hours of power cuts a day. The plain wooden desks are imported, since MOU funds arenot released for local supplies. The renovation cost about $20,000.

The school caters for 950 students in two shifts. Many of the students had stopped coming - as had two of the 25teachers. "But now that they see what the school looks like they've come back, so we have 200 students to a classinstead of 150," the headmistress explained. " One teacher even cut her maternity leave to come back and teach". Theheadmistress earns ID15,000/month ($15) which includes her transport allowance, incentives and awards. Teachersget ID3,000 plus another ID1,000 for transport.

No renovation has yet taken place at the Fao Primary School for Boys, which was built in 1963. The Headmasterpleads with his visitors for support, pointing to the exposed electrical wires, broken window panes, and blocked up toi-lets. Recently, pieces of ceiling fell on a student at the edge of the yard. One of the headmaster's biggest concern isthe damaged wall surrounding the school, which can easily be penetrated by pranksters, thieves and animals. "Anescaped cow came crashing through one day", he recalled. Books are neatly piled up on the floor of one of the class-rooms, though exposed to dust from the pane-less window. Half of the school books necessary are provided new bythe Ministry each year, while the other half is recycled from one year to the next.

The school caters for 936 children in two shifts, and has 28 male and female teachers. During the heavy rains earli-er in the year, they had to move the students to other premises as the courtyard was completely flooded. Some schoolsallow children to go home when they need to use the bathroom. Most of the teachers have second jobs. The head-master, who earns ID3,200 and has to travel 60 kilometres to get to the school, works as an electrician in his sparetime, and some of the teachers work as drivers.

f. ConclusionsThe causal analysis presented inFigure 6 suggests that the violationof children's right to education inIraq is being affected by the low qual-ity and quantity of service provisionas well as household incomes. Themost crucial element is the paucityof resources available to both plan-ners and families, which means thatschools have remained in a deterio-rated condition for over a decadeand that teachers' salaries are on thepoverty line, even when all incen-tives are factored in. Meanwhiledemand for resulting low qualityeducation services continues to dropas children, especially girls, are madewithdrawn from school to work athome or assist in the provision offamily income.

Children are getting less educationin terms of both quantity and quality- the school day is shorter to allowfor two or three shifts - and less sup-port in terms of supplies. The ero-sion in skills and knowledge, and inthe capacity to manage the sectorare a less tangible but equally impor-tant effect of the stranglehold onresources. Household incomes andattitudes are negatively influencingchildren's access to education, andthere is a clear link between the stateof services and household attitudes.The immensity of the task of physi-cal rehabilitation appears to havemade it difficult for policy makers togive attention to the qualitativeaspects.

As in the case of children's right tolife and survival, the interventions todate have barely scratched the sur-face of this sector, and have as yetnot been able to stop deterioration ofthe problem. In addition to beingmodest in the face of the problemfew interventions address the basiccauses. The most urgent interven-tion is access to resources of suffi-cient volume for the physical reha-bilitation of the sector.

However, while education authori-ties do not have control over the fac-tors that could lead to the physicalrehabilitation of the sector, they dohave some control over some of theissues related to quality, such as therevision of the curriculum, which isclearly a priority given the interven-ing passage of time since the last

revision. Another important area isinvestment in teacher capacities andskills, and the capacity of the educa-tion authorities to manage the sys-tem. Information systems are anoth-er area of concern.

Although they cannot at themoment offer financial or other sup-port to parents, national authorities,with the support of internationalorganizations, need to find ways toaddress the issue of attitudes to edu-cation, and in particular the attitudeto girls' education, which is an obli-gation in both the culture and tradi-tions of the region, as well as ininternational human rights.Stronger links between education,health and nutrition, and water andsanitation sectors would enablemaximum use of scarce resources.

4545

4646

a.The Situation of DisabledChildren, Orphans, andWorking Children

The Iraqi Social Welfare Law (126)of 1980 was the first of its kind in theArab world to recognize the medical,educational and economic rights ofthe disabled. The law established theright of all disabled persons in Iraq torehabilitation services. Provisionswere made to provide financial sup-port to those who needed it.Integration of disabled children intonormal schools was declared an edu-cational policy. Legally all businessesare required to reserve 10% of theiremployment positions for disabledindividuals. While the law is clear onrights and entitlements the realiza-tion of these rights, including inte-gration, remains a formidable chal-lenge. The government makes astrong effort to place disabled gradu-ates of vocational schools in the pub-lic and private sector, but no extrameasures have been taken to makeimprovements to the environmentso that it is suitable for the develop-ment of persons with disabilities. Asa consequence, very few finish sec-ondary school and only rarely dosome attend university.53

The Social Welfare Law, Law No.126 of 1980 defines all legal aspectsrelating to orphaned children. Thisalso defines the role of state-runhouses and stipulates conditions ofacceptance and residence in govern-ment houses. Those who apply for

admission to government houses,including orphanages, must be Iraqior Palestinian with residence in Iraq;have "lost" one or both parentsbecause of death, handicap, arrest,or imprisonment, and have no othercaretakers; have family problems; or,may have no identity.54

The matter of working children isregulated by Law Number 76 of1983 (Law of Care for the Juvenile)and the labour law. Law 76 statesthat children under 15 years of agewho are found begging, selling orcarrying out any other type of workin the streets, are considered to bevagrants and can be taken to courtfor cautionary action or be placed ina guardian's custody, or referred to arehabilitation centre. Children whohave left their homes or any otherplace where they have been placed,without authorization, or those whowork without authorization also fallin this category. Article 25 of thesame law considers a child or adoles-cent to be deviant if they work inprostitution, gambling, or in a bar,have contacts with vagrants, or havedisobeyed the authority of their par-ents.55 Law No. 38/1973 prohibitschild labour in Iraq, setting the min-imum working age at 15 years.

According to a 1998 report by theGovernment of Iraq on the imple-mentation of the Convention on theRights of the Child, Juvenile CareLaw ensures that detention of chil-dren is activated only when all pre-ventive and rehabilitation measureshave been exhausted. Juvenile

courts are composed of a medicaldoctor, a psychologist and/or pedia-trician as needed and a team ofsocial workers. They are responsiblefor conducting a medical and psy-chological evaluation of the minorand assessing his/her living/familyconditions and environment. Theresults of the evaluation are present-ed to the court that instructs on asystem of periodic follow-up of thejuvenile. In this case the court hastwo main functions, cautionary andjudiciary. Trials of juveniles are con-ducted in the presence of guardians,custodians and/or any of the child'srelatives in closed sessions. A juve-nile accused of a felony can only bedetained if he/she is above 14 yearsand placed at a rehabilitation institu-tion. Juvenile law also includes pro-visions for deferred and favourablesentencing, sentence and placementrevision, and conditional dischargeof sentenced juveniles.56

WHO estimates that in any popula-tion the number of people with dis-abilities is approximately 10%.57

However surveys carried out in somecountries do not identify more than3 to 5% of the total population of acountry as being disabled. Evenassuming a low disability prevalencerate of 3%, with a population ofapproximately 25 million, therewould be some 750,000 disabled per-sons in Iraq, 50% of whom (or375,000) would be children underthe age of 15 years. Given that Iraqhas been through two wars from1980 up to 1991 and under econom-ic sanctions throughout the 1990s,

4747

53 GOI-UNICEF 2000e.54 Guidelines for Services in Government Houses quoted in GOI0-UNICEF 2000e.55 GOI-UNICEF 2000e.56 Ibid.57 United Nations (1988): Development of Statistical Concepts and Methods on Disability forHousehold Surveys. Department of International Economic and Social Affairs, Series F. No. 38.

5. The Right of Vulnerable Children to Protection

the figures may well be higher.Increased malnutrition, challengesin health service delivery, and psy-chological trauma resulting from warand hardship all contribute to theproblem.58

As well as limited data on totalnumbers, the distribution by type ofdisability is also little known.Anecdotal information, especiallythat coming from health care serviceproviders, suggests that in terms ofmagnitude (number of children withdisability) mental disability is mostprominent. This is followed by phys-ical disability, hearing impairment,and visual impairment. Some evi-dence also exists to suggest thatthere are a number of children withmultiple disabilities. Studies alsoreveal an increase in the incidence ofdisability among infants. A sizeableproportion of these disabilities arecaused by generally preventablecomplications during delivery.59

In 1990 it was estimated that only5,000 children were being served byschools for disabled children, namelythose with visual and hearing impair-ment and those who are mentallychallenged. This leaves a large num-ber of children not catered for.Access to institutional care hasdeclined in the last 10 years: thenumber of students in special educa-tion institutions decreased from5,000 children in 1990, to 3,286 in1995, and to 3,284 in 1999, a reduc-tion of 34 % since 1991. This is inspite of an increase in the number ofschools for children with disabilities

4848

58 GOI-UNICEF 2000e.59 Ibid

Children with DisabilitiesCRC Article 23

1. States Parties recognize that a mentally or physically disabled child shouldenjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate the child's active participation in the community.

2. States Parties recognize the right of the disabled child to special care andshall encourage and ensure the extension, subject to available resources, to theeligible child and those responsible for his or her care, of assistance for whichapplication is made and which is appropriate to the child's condition and tothe circumstances of the parents or others caring for the child.

3. Recognizing the special needs of a disabled child, assistance extended inaccordance with paragraph 2 of the present article shall be provided free ofcharge, whenever possible, taking into account the financial resources of theparents or others caring for the child, and shall be designed to ensure that thedisabled child has effective access to and receives education, training, healthcare services, rehabilitation services, preparation for employment and recre-ation opportunities in a manner conducive to the child's achieving the fullestpossible social integration and individual development, including his or hercultural and spiritual development.

4. States Parties shall promote, in the spirit of international cooperation, theexchange of appropriate information in the field of preventive health care andof medical, psychological and functional treatment of disabled children,including dissemination of and access to information concerning methods ofrehabilitation, education and vocational services, with the aim of enablingStates Parties to improve their capabilities and skills and to widen their expe-rience in these areas. In this regard, particular account shall be taken of theneeds of developing countries.

increased from 43 in 1990 to 50 in1999, thanks to the efforts of theMinistry of Labour and SocialAffairs. Specialized training institu-tions for special education teachershave remained closed since 1991, sono new teachers have been trainedsince that time.

Rural-urban differences are alsoprominent. Of all the institutions inthe country that provide treatmentfor disabled children, 26 are locatedin Baghdad and 36 in other cities.Thus with only 23% of the popula-tion Baghdad has 42% of the facili-ties.

The number of state homes fororphans in the whole of Iraq in 1990was 25, serving 1,190 children. Sincethen, both the number of homes andthe number of beneficiaries havesteadily declined due to the lack ofresources from the Government ofIraq to rehabilitate homes, lack ofstaffing, lack of educational equip-ment, material and programmes andlack of food supply and health care.On the other hand the number ofchildren in need of this service hasbeen rising, partly due to the naturalphenomenon of population growthand also because of the continueddecline in the social and economicwell being of ordinary Iraqis.60 Asenior public official in this sectorestimated that the number oforphans had doubled over the pastdecade.

Available information reveals thatthere has been an increase in juve-

nile court cases from 2,600 in 1991to 4,420 in 1996. Until 1999, streetand working children have beenplaced in the Houses for theRehabilitation and Supervision ofJuveniles, together with sentencedand convicted older children andjuveniles in conflict with the law.The number of street and workingchildren referred to these centres isreported to have increased at leastfive-fold since 1990. Unfortunately,during the same period the quality ofrehabilitation programmes for streetand working children in these cen-tres has declined. Food and healthcare are the main areas that havebeen particularly affected.Rehabilitation programmes had tobe cut back, except for school atten-dance. Other problems over theyears have included lack of staff,poor or no transport facilities, lack ofmaterials and equipment, etc. Lackof transportation has made it virtual-ly impossible to trace the families ofchildren and/or to arrange for theirrelease and reunion.61

A useful study was conducted on theservices, institutions and conditionsof working children and children inorphanages in late 1999, based uponsite visits to six institutions inBaghdad, Nejef and Kerbala, andinterviews with national authori-ties.62 The report concluded:

"All institutions suffer from signifi-cant shortages of food and clothes.Protection from cold through ade-quate building conditions, heatingand blankets is partly deficient.

Basic health services are provided bythe Ministry of Health, yet first aidkits, emergency medicine and resi-dent medical assistants are missingin several cases. Lack of transporta-tion provides a problem for someinstitutions if more specialized treat-ment is required (Kerbala and thetransit home for boys). Most institu-tions are spacious and have outdoorplaygrounds, with the exception ofthe transit home for boys, yet equip-ment for activities is minimal. Staffnumber and qualification minimizethe conditions for reliable and sensi-tive caregiving".

b. Causes for CurrentConditions

In the case of children with disabili-ty, the immediate causes for the con-ditions they face include, for some,avoidable problems during delivery,which makes their disability a viola-tion of their right to survival anddevelopment. In addition, substan-tial needs remain for building main-tenance and renovation and thesupply of specialized material andaids. According to the GOI-UNICEF Programme Review,underlying causes in terms of theservices available include:

· weaknesses in the application ofcommunity based rehabilitationactivities;· insufficient integration of children

with disabilities in the normalschooling system;

· few appropriate education pro-

4949

60 Ibid.61 Ibid.62 See Josi Salem-Pickartz, report submitted to UNICEF.

grammes for children with disabili-ties; · the lack of an alternative care sys-

tem for children with disabilities whoare without family support;· the area of early detection of dis-

abilities is considered still largelyunderdeveloped; and· Insufficient national capacity to

deal with the issue, partly due to lackof education and training in thisarea.

Underlying causes at the householdlevel include an attitude of sympathyin the family and community, ratherthan an attitude of empathy thatcould encourage the disabled to fulfiltheir potential. There is also insuffi-cient guidance and counseling forthe affected families, to enable themto recognize and cope with disability.

In the case of orphans, immediatecauses include the loss of one or bothparents, and/or the absence of acaretaker. In the case of childrenworking on the street, or abandonedchildren, the circumstances varyfrom one family to another, or fromone street child to another. Thecommon underlying cause for mostchildren or families is poverty. Somechildren are compelled to work tobring home income for the purchaseof food. But some parents simplyabandon their children - unable tofeed or clothe them, or support themto go to school.63

The Salem-Pickartz Report identi-fied four sets of causes for the situa-tion of orphans and street/workingchildren:

5050

63 Ibid

Best Interests, Protection, Respect for Views

CRC Article 3

1. In all actions concerning children, whether undertaken by public orprivate social welfare institutions, courts of law, administrative authoritiesor legislative bodies, the best interests of the child shall be a primary con-sideration.

2. States Parties undertake to ensure the child such protection and careas is necessary for his or her well-being, taking into account the rights andduties of his or her parents, legal guardians, or other individuals legallyresponsible for him or her, and, to this end, shall take all appropriate leg-islative and administrative measures.

3. States Parties shall ensure that the institutions, services and facilitiesresponsible for the care or protection of children shall conform with thestandards established by competent authorities, particularly in the areasof safety, health, in the number and suitability of their staff, as well ascompetent supervision.

Article 12

1. States Parties shall assure to the child who is capable of forming his orher own views the right to express those views freely in all matters affect-ing the child, the views of the child being given due weight in accordancewith the age and maturity of the child.

2. For this purpose, the child shall in particular be provided the opportu-nity to be heard in any judicial and administrative proceedings affectingthe child, either directly, or through a representative or an appropriatebody, in a manner consistent with the procedural rules of national law.

· The child's immediate environ-ment: material resources need to besubstantially upgraded; the numberof staff needs to be increased andtheir qualifications upgraded; lawenforcement authorities need train-ing on dealing with children; admin-istrative rules and regulations shouldbe revisited with children's rehabili-tation needs in view; and a system offamily-like care should be intro-duced into orphanages.

· The relationship between institu-tions, home, school, health services,and NGOs: there is a pressing needfor more transportation; more socialworkers are necessary to reach out tofamilies, as is training for staff in thisarea; and mechanisms should beestablished to exchange experienceamongst institutions.

· Social structures: there is a needfor mechanisms for prevention andearly detection for families and chil-dren at risk; and alternatives shouldbe introduced in the present systemof care, such as rehabilitation fami-lies, open houses and mobile facili-ties.

· Legislative and cultural environ-ment: better public awareness con-cerning orphans and street childrenis necessary; and it is important toreview of the present legal status ofstreet children.

Overall, the paucity of resourcescombined with the multiplicity ofproblems in other sectors appear tobe the main basic causes for the con-ditions facing the spectrum of vul-nerable children. There was nocomponent in the MOU to address

children in vulnerable conditions,and an amount was only recently setaside in Phase VIII. However, thiswas allocated to vulnerable groupsindirectly through the water andsanitation, health and housing sec-tors. The dearth of resources clearlyaffects the ability of authorities torehabilitate institutions, plan forexisting and newly emerging prob-lems and build the capacity to dealwith them, and provide support tofamilies in need beyond the food bas-ket.

Given the range of problems in othersectors, it has proven difficult tomake this area a priority. Cultureand tradition also make it difficultfor the state to acknowledge prob-lems in this area or to admit, forinstance, that families may abandonor abuse their children. This, inturn, makes it hard to collect theinformation necessary to underpinthe search for solutions.

c. Interventions to Date

The Government collaborated withUNICEF and the NGO Enfants duMonde, libraries were established in34 schools and institutions for thedeaf, physically handicapped chil-dren, and in the Al Rahma Centrefor working children on the street inBaghdad. Training was conductedfor librarians in these 34 institutions,including technical information onbooks and registration as well asmethods to encourage children toread. Between 1997 and 2001, 254special teachers and workers

received training.64 CARE Australiahas also supported training for dis-abled, deaf and mute children.

Fifteen schools and centres wererehabilitated for children of primaryschool age with disabilities, with pri-ority was given to the Al-Hanan res-idential centre for abandoned chil-dren with severe and multiple dis-abilities. This included all requiredspecial measures and standards forfacilitating the daily life of the chil-dren. Essential equipment and basicfurniture were also provided. As aresult of the success of the rehabili-tation programme, approval wasgranted by the Ministry of Labourand Social Affairs for the transfer of100 disabled children 5 - 14 years,from the outskirts of Baghdad to AlHanan in Al Ataifiya in a more cen-tral location of town.

Over the past two years, theGovernment has refocused atten-tion on the need to care for orphans,and has engaged the private sectorin this area.

In 1998 the Government embarkedon the physical rehabilitation of Al-Rahma Centre for street and work-ing children, with the support ofUNICEF and Enfants du Monde.This was designed to separate 6-14year old children, previously placedwith sentenced and convicted olderchildren and juveniles in conflictwith the law, in a caring environ-ment, while at the same time pro-moting their reunification with theirfamilies. The institution opened in

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64 Ibid.

5252

Box 5 The 28 Nissan Orphanage

The 28 Nissan (April) Orphanage in central Baghdad houses 60 children, girls aged 6 - 18.They come to the Orphanage if have lost one of both parents or if parents have divorced. Theyare placed in the Orphanage by members of the extended family, by the police or the courts. Forexample, seven-year-old Narmeen lost both parents in a car crash; she survived, but spent twoyears in hospital where she came to believe that the doctor and nurse were her father and moth-er. Like many other children, she creates her own story about her parents. None of the chil-dren acknowledge they have no parents, the Director reports. Now Narmeen has settled downand her grades have improved.

The Orphanage consists of three interlinked buildings. It is spotless, and there are large lounges,smaller study rooms, and two eating halls for older and younger girls. Conditions have greatlyimproved over the past year, when the Orphanage acquired a generator secured from theMinistry of Foreign Affairs. "Before that, we had no electricity like the rest of the Iraqi people.We used grease-based neon lights", the Director recalled. The Orphanage has also benefitedfrom a presidential order to facilitate formalities for such institutions. And it now receives moregoods and services thanks to the intervention of the Minister of Labour and Social Affairs. Heconvened a meeting of the business community, and pointed out that the State could not doeverything, and that they had to pitch in and support such welfare services, which they did.

Children at the Orphanage go to school. A doctor visits once a week, and a dentist lives onthe premises; there are two social workers. The staff registers children who do not have identi-ty cards. Those children who have family members visit on a regular basis. Those with no fam-ilies are taken on trips on visiting days, "but it's hard on them". Once they complete their edu-cation, some of the young women find work, mostly in the public sector. Due to cultural factors,women do not live on their own, and often will women remain at the Orphanage and take onassignments there. A few get married.

1999, and is the only one of its kindin Iraq. It can accommodate up to150 boys and girls.

d. Conclusions

Even though the information aboutthe scale of the problems of disabili-ty, orphans, and working children isscarce, it is possible to conclude thatthe interventions to date do not suf-ficiently address the needs of vulner-able children. An important reasonis the scarcity of resources withoutwhich it is difficult to rehabilitate, orbuild, institutions on the scale neces-sary, procure the requisite equip-ment and supplies, and invest in thespecialized staff capacity required.

However, there are areas within thecontrol of national authorities. Thepriority appears to be to gather andto continuously update informationon the scale of the problem in eacharea in order to pinpoint resourceneeds and priorities, and to enableconsideration of non-traditionalsolutions.

For children with disabilities, collab-oration between the Ministry ofLabour and Social Affairs and theMinistry of Health could help toaddress the issue of avoidable disabil-ity during delivery. Collaborationbetween the Ministry of Labour andSocial Affairs and the Ministry ofEducation is also needed to findways to integrate children with dis-abilities into the education system.

Awareness campaigns for the com-munity and guidance for the familyare also areas where investment isneeded.

For orphans and street/working chil-dren, an important area of interven-tion appears to be mechanisms fordetection of families and children atrisk, who could then be given specialsupport. In the case of street/work-ing children, a review of laws, proce-dures and the skills of law enforce-ment agencies could help to ensurethat these children's difficulties arenot inadvertently compounded.

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5454

The Convention on the Eliminationof All Forms of DiscriminationAgainst Women (CEDAW) wasadopted by the United Nations in1979. It requires states parties totake "all appropriate measures,including legislation, to ensure thefull development and advancementof women, for the purpose of guar-anteeing them the exercise andenjoyment of human rights and fun-damental freedoms on a basis ofequality with men" (Article 3).CEDAW covers three dimensions ofthe situation of women: civil rightsand the legal status of women; issuesrelating to production and reproduc-tion; as well as the impact of cultur-al factors on gender relations.Articles 10, 11 and 13, respectively,affirm women's rights to non-dis-crimination in education, employ-ment and economic and social activ-ities. Article 16 asserts the equalrights and obligations of women andmen with regard to choice of spouse,parenthood, personal rights andcommand over property.

The implementation of theConvention is monitored by theCommittee on the Elimination ofDiscrimination against Women. Atleast every four years, the States par-ties are expected to submit a nation-al report to the Committee, indicat-ing the measures they have adoptedto give effect to the provisions of theConvention. Iraq submitted its sec-ond and third reports to theCommittee in August 1998.

a. Survival andDevelopment

Women's right to survival has beenimpacted over the past decade. TheChild and Maternal MortalitySurvey 1999 has shown a very highmaternal mortality ratio of 294 per100,000 live births for the period1989 - 1998.65 This accounts forone third of all deaths amongwomen aged 15 to 49 years of age.Before 1990, the maternal mortalityratio was 117 deaths for every100,000 births, according to theNational Report.

The prevalence of malnutritionamongst pregnant women is indicat-ed by the fact that nearly a quarter ofbabies are low birth weight. TheSurvey highlighted the problem ofearly marriage: 40% of women inIraq were married before 18 years ofage and only 14% were married at 24years or later. Birth intervals werealso too short: 41% of births werespaced less than 2 years and 20% lessthan 18 months. Only one-third ofbirths were spaced more than threeyears.

There was also a high total maritalfertility rate. This was 7.7 during thethree years preceding the survey, 6.9for urban and 9.2 for rural areas.Education was a factor in the fertili-ty rate, since this was 8.9 for illiteratewomen and 6.2 for those who hadreceived education to intermediatelevel. Indeed, the Survey results

5555

65 Salman and Al-Dulaymi.

6. Women's Human Rights

revealed a positive correlationbetween birth interval, education,and maternal age at childbirth onthe one hand and child survival onthe other, as is shown in Table 7.

Currently, the percentage of birthsattended by trained health personnelis 72.0%, according to MICS 2000,79.0% in urban areas and 60.2% inrural areas.

b. Education and Work

As has been noted in Chapter 4, theright of females to education hasbeen more adversely affected overthe past decade than that of males,with nearly 30% of girls no longerattending primary schools, accordingto MICS 2000. The MortalitySurvey shows that 29.5% of 23,105women aged 15-49 years never

attended school. Of these women,48% attended primary school, 15.6%attended intermediate/secondaryschool, while only 6.9% attendeduniversity or higher education.Female illiteracy has more thanquadrupled between 1985 and 1995,from 8% to 45%.

As for work, the Labour Code 171987, the Law of Pension and SocialSecurity 1971, and Maternal Law

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1971, guarantee women equalopportunity with men in civil serviceemployment, paid leave for onemonth before delivery and for sixmonths after delivery. Althoughwomen continue to dominate theeducation system, accounting for65.3% of teachers in 1998 at the pri-mary and secondary stages, they arenot as well represented in otherareas. For example, they constituteonly 200 out of 7,150 journalists,that is 5.7%.66 The GeneralFederation of Iraqi Women (GFIW)uses products such as its fortnightlymagazine as a training ground forwomen.

The GFIW, which has 1.2mn mem-bers, notes that since the 1990sthere has been an increase of womenin the work force, not due to anincrease in opportunities butbecause women took the place ofmen in the public sector, who leftlargely because salaries were nolonger enough to cover needs.67 Thepercentage of women in the publicsector rose from 34.% in 1990 to40% in 1998, and in the services sec-tor from 72.2% in 1977 to 79.3% in1998.68 The GFIW notes thatwomen now compete with men forjobs in the private sector, whereas

they had previously gravitated to thepublic sector to secure maternityleave and other benefits.

The GFIW submission to Beijingnoted that women's low contribu-tion to agriculture does not reflectthe reality of their unpaid work inthis sector, which has increased dur-ing the past decade of sanctions.

The GFIW observed that womenwere not just seeking employment inthe private sector, but also setting upbusinesses themselves, in unusualfields, such as merchants, traders,

5757

66 GFIW, "The Iraqi Woman Five Years After the Beijing Conference".67 Information based on author's discussions with the General Secretary of the GFIW and her col-leagues, May 2001.68 GFIW, op cit.

contractors, sub-contractors to thestate, and owners of garages. Asemployees, too, they were venturinginto new areas. It was no longerunusual to see women offering dailyor seasonal labour at the sites wherecontractors went to find malelabourers. As hired labourers,women were taking on tasks likefield work, food processing (eg.plucking chickens), and even onconstruction sites. In addition, theynow produced goods for sale in theirhomes, and some sold their productsin the marketplace, a rare sightbefore 1990.

GFIW conducted a survey of 750female-headed households in 1997in Baghdad to identify needs andcapacities (it is estimated that thereare 10,560 female-headed house-holds in the capital). It found thateven though the number of econom-ically active women was high(48.9%), economic need was forcingwomen to increase their workload orsend their children out to work. Ithelped 136 women establish incomegenerating projects in 1998.

In response to women's pressingneed for income in other parts of thecountry, GFIW now combines voca-tional training, and employment inan innovative initiative. Women arefirst trained on how to conduct a fea-sibility study on the income-generat-ing potential of projects they want toundertake. Then training is offeredto the women to establish the proj-ect, and a loan is extended to helpbuy equipment and supplies.

The initiative was piloted in poorcommunities in the Basra and Dialagovernorates, and 277 projects havesince been launched in areas such asbaking, poultry, livestock, fishing,land rehabilitation and landscapegardening, fodder, weaving andsewing, ceramics, kindergartens, andbeauty salons. The loans, ID250,000on average, are being repaid onschedule, and the experience isbeing extended to four other gover-norates.

Amongst its activities, the GFIWaddresses other aspects of women'srights, such as the legal framework.They conduct weekly courses on thepersonal status code, and on labourlaws, and advocate changes in thelaw in parliament. As in other Arabcountries, while labour laws andcommercial codes do not discrimi-nate against women and containpositive provisions regarding bene-fits, the designation of men as headof household, with responsibility forthe financial support of the family,leads to "equivalent" rather than"equal" treatment within the familyand in areas such as nationality.

c. Conclusions

Women's right to survival emerges asan important issue given the sharprise in the maternal mortality ratio.This is an indication that healthservices are not providing the emer-gency obstetric care that womenexperiencing obstetric complications

need to save their lives, and/or thatwomen do not have access to facili-ties that provide such care.

The education of girls is a major con-cern, given that 30.1% of girls do notattend primary school, with graveimplications for their future and thatof their children. Household factorsplay an important part in securingthe human rights of women, asregards attitudes towards fertility,birth spacing, and education. Here,public information campaigns help.

Economic need is driving low andmiddle income women into the workforce, but the opportunities availableare constrained by the overall eco-nomic situation as well as by tradi-tional views of women's roles ashomemakers who do not have pri-mary responsibility for householdfinances.

5858

Iraq's situation is in many waysunique: following an eight year warwith Iran in the 1980s, comprehen-sive sanctions were imposed in 1990after the Iraq-Kuwait war; subse-quent battles greatly damaged Iraq'sinfrastructure; arrangements forfunds for humanitarian interven-tions to alleviate the impact of sanc-tions on the population did notcome into effect until seven yearsafter sanctions; until recently, thefunds available have not been of amagnitude to undertake compre-hensive rehabilitation, even assum-ing sufficient human resources toundertake the task; and the systemof operation introduced by theMOU has been continuously refinedas problems are addressed.

The past decade has witnessed theemergence of a large body of wasted,stunted and impoverished children,in violation of the right to life andsurvival. A substantial proportion ofboys and girls are not able to exercisetheir rights to learning and recre-ation, as well as opportunities forlife-long learning. These childrenwill be the parents of future genera-tions, and they will not be in a posi-tion to provide their children withrights and opportunities. Girls andwomen in particular are facing alearning gap of major proportions.The longer the present conditionsare in force, the larger the pool of ill-health and illiteracy, the further thedetriment to future generations, andthe compounding of violations ofrights. Securing the rights of children

not only guarantees the well-being ofthe present generation, but also thatof future generations.

Against this background, the causalapproach applied throughout thisSituation Analysis reveals thatunless basic causes leading to thedenial of children's rights to life, sur-vival, and education are addressed,the best that can be hoped for fromprogramme interventions is to arrestdeterioration and to mitigate the sit-uation. To date, programme inter-ventions have addressed some of theimmediate causes and underlyingcauses, but have not addressed basiccauses. Moreover, many programmeactivities are discrete and timebound, whereas comprehensiveplanning based on secure and regu-lar resources is necessary for invest-ment in the sectors concerned.

Given these realities, it would seemthat organizations promoting therights of children as well as ofwomen in Iraq should place rights-based advocacy at the top of their listof priorities. Rights-based advocacycould promote the understandingnecessary to secure a change in thepresent conditions, and, in particu-lar, to secure the resources necessaryto rehabilitate key service sectors ina sustained and sustainable manner,and to support a shift from humani-tarian efforts to comprehensive long-term development planning.

Rights-based advocacy will, in turn,require solid data to support it.Programme interventions are, course, still important, both in terms

5959

7. Conclusions and Recommendations

of mitigating the situation, and byproviding a rich source of data andexperience, but advocacy andresearch are crucial in a situation likethat of Iraq. The recommendationsbelow are made for the considerationof national authorities and interna-tional organizations promoting therights of children as well as those ofwomen in Iraq.69

a. Rights-Based Advocacyand Future Research

1. Advocacy should highlight theimportance of securing the requisiteresources to rehabilitate each of thewater and sanitation, electricity,health, and education sectors bothfor present users and to meet popu-lation growth.

Further research is necessary on theplans and resources for each sector,the inter-relations amongst thesesectors, the obstacles to rehabilita-tion, the gaps in skills and capacitiesand the impact this has on the rightsof children. It is particularly striking,for instance, that 70% of under-fivedeaths are caused by easily preventa-ble diseases like respiratory illnessesand diarrhea, which are not so muchhealth as environmental issues.Capacity for data collection andanalysis would be supported in therelevant institutions.

2. Another key issue for advocacy isthe need to shift from a humanitari-an approach, which by definitionconsists of discrete and standaloneactivities, to a comprehensive medi-um- to long-term developmentapproach. While it is possible to tar-get and overcome a problem likepolio, most other issues require sus-tained development strategies.Moreover, current circumstanceskeep citizens focused on basic needs,and not on the future and on therapid changes taking place worldwide.

3. A further issue for advocacy is thatIraq be able to use its financialresources to purchase locally sup-plied goods and services in order toignite the economy and give familiesmore opportunities to earn a livingwage. The point was frequentlymade during the research for thisreport that teachers, for example,require a living wage and not merelyadditional incentives.

4. The existence of vulnerablegroups of children, and the need forresources to promote the humanrights of these groups, is an impor-tant point to highlight.

5. Advocacy for behavioural changeis necessary on issues like girls' edu-cation and the use of scarceresources such as water and electric-ity.

b. Proposed ProgrammeInterventions

Cross-sectoral6. Programme interventions thatsupport stronger links between theeducation, health and nutrition, andwater and sanitation sectors wouldenable optimum use of scarceresources.

7. A better understanding of howthe systems function in each of thesectors and where the national andlocal bottlenecks and capacity gapsare would greatly assist future devel-opment in general, and effective andtimely co-ordination and decisionmaking on cross-sectoral issues inparticular.

Health and Nutrition8. A more comprehensive plan forhealth information campaigns wouldmake better use of scarce resources,factoring in a range of health, nutri-tion, environmental, and behavioralissues, including family planning,birth spacing, early marriage, exclu-sive breast-feeding, as well as diseasecontrol, water quality, personalhygiene, and disposal of sanitation.

Education

9. The quality of education emergesas a major issue, in particular therevision of the curriculum andinvestment in teacher and manage-ment salaries, capacities and skills.

6060

69 Some of the conclusions and recommendations set out in this Chapter were made at theBrainstorming Workshop convened by the Planning Commission 27-28 May 2001 to discuss an outlineof this Situation Analysis. The Workshop involved 50 experts, civil servants and representatives ofnational and international organizations from different sectors.

10. Girls' education and relatedhousehold factors need to beaddressed through targeted support,as well as public awareness cam-paigns.

11. Further involvement of the com-munity in school support and man-agement is necessary, and the valueof education and of the role playedby teachers needs to be part ofawareness campaigns.

12. Further investment is necessaryin management information sys-tems, and data is needed in severalareas, for example, what are childrenno longer enrolled in schools doingwith their time?

Water and Sanitation

13. More popular awareness of andcommunity involvement in resourceuse, along with modest user feeswould assist in conserving and reha-bilitating the water and sanitation,and electricity sectors, and in protec-tion of the environment.

14. More comprehensive planningwould assist the rehabilitation of thesector.

Children with Disabilities,Orphans, and WorkingChildren

15. Collaboration between theMinistry of Labour and Social Affairsand the Ministry of Health could

help to address the issue of avoidabledisability during delivery.Collaboration between the Ministryof Labour and Social Affairs and theMinistry of Education could helpintegrate children with disabilitiesinto the education system.Awareness campaigns for the com-munity and guidance for the familyare needed.

16. For orphans and street/workingchildren, it would be useful to putmechanisms in place to detect fami-lies and children at risk, who couldthen be given special support.

17. In the case of street/working chil-dren, a review of laws, proceduresand the skills of law enforcementagencies could help to avoid com-pounding these children's difficul-ties.

Women

18. Introducing emergency obstetriccare as part of regular services inclinics and at hospitals will savepregnant women's lives.

19. Support is necessary to expandthe business and employment oppor-tunities available to women, particu-larly women in low income house-holds or female heads of household.

20. Special support for women's edu-cation and eradication of illiteracy isneeded.

6161

626270 A total of 75 indicators were developed to monitor progress towards realization of the goals.

71It should be noted that these percentages reflect access to water as defined by the indicator - ie.whether water is piped, from a public pipe/tap, bore hole, protected well, etc - and not the quality of thewater

72These percentages reflect the sanitation system in use (toilet, latrine, etc) and not its quality.

Child Welfare Commission and Ministry of Labour and Social Affairs, Proceedings of the Future Search Conference onImplementation of Child Rights in Iraq, 27 - 29 March 2001, mimeograph

General Federation of Iraqi Women, The Iraqi Woman Five Years After Beijing Conference, June 2000

Government of Iraq-UNICEF, 2000a. Joint Government of Iraq-UNICEF, Programme Review, 1990-2000, OverviewReport, mimeograph

GOI-UNICEF, 2000b, Joint Government of Iraq-UNICEF, Programme Review, 1990-2000, Sector Review Report: Waterand Environmental Sanitation, mimeograph

GOI-UNICEF, 2000c, Joint Government of Iraq-UNICEF, Programme Review, 1990-2000, Sector Review Report: Healthand Nutrition, mimeograph

GOI-UNICEF, 2000d, Joint Government of Iraq-UNICEF, Programme Review, 1990-2000, Sector Review Report:Education, mimeograph

GOI-UNICEF, 2000e, Joint Government of Iraq-UNICEF, Programme Review, 1990-2000, Sector Review Report: ChildProtection, mimeograph

GOI-UNICEF, 2000f, Joint Government of Iraq-UNICEF, Programme Review, 1990-2000, Sector Review Report:Communication, mimeograph

Government of Iraq-UNICEF, Multiple Indicator Cluster Survey (MICS) 2000, Baghdad, February 2001

Republic of Iraq, National Report on Follow-Up to the World Summit for Children, Ministry of Education, NationalCommittee for the Preparation of the National Report on Follow-up to the World Summit for Children, May 2001, Arabicmimeograph

Republic of Iraq, National Report on Follow-Up to the World Summit for Children (Summary), Ministry of Education,National Committee for the Preparation of the National Report on Follow-up to the World Summit for Children, February2000, English mimeograph

Salem-Pickartz, Josi, "Analysis of Existing Services, Institutions and Conditions of Street/Working Children and Children inOrphanages in Iraq", report submitted to UNICEF Baghdad 22/11/1999, mimeograph

Salman, Khawla Naji and Al-Dulaymi, Aiayd, Child and Maternal Mortality Survey Iraq 1999, Ministry of Health Iraq andUNICEF, mimeograph

UNDP and Oxford University Press, Human Development Report, 1994

UNICEF and Ministry of Health Iraq, Child and Maternal Mortality Survey 1999: Preliminary Report

6363

References

UNICEF Iraq, "The Youth of Iraq Workshop Report", 26, 27, 28 February 2001, mimeograph

UNICEF Iraq, Annual Report 2000 (draft and published versions)

UNICEF, "Assessment of the Implementation of the Humanitarian Programme (SCR 986): The Psychosocial Well-Being ofChildren in Iraqi", March 1999

UNICEF Iraq, Situation Analysis of Children and Women in Iraq - 1997, mimeograph, 30 April 1998

United Nations, Committee on the Rights of the Child, Concluding Observations of the Committee on the Rights of theChild: Iraq, CRC/C/15/Add.94, October 1998

United Nations, Committee on the Elimination of All Forms of Discrimination Against Women, Second and Third Reports,Iraq, CEDAW/C/IRQ/2-3, 19 October 1998

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