Contents

1. Introduction
2. Saddam Paediatric Hospital
3. Fallujah General Hospital
4. Basra Pardiatric And Maternity Hospital
5. Basra Water Treatment Plant
6. Internally Displaced Treatment Camp
7. Farming
8. Conclusion

1) INTRODUCTION Return to top

This was the second joint US/UK delegation to Iraq, and included three members from the UK and two from the US. We aimed to break the sanctions by taking medical supplies - oxygen masks, needles and cannulas - and medical journals into the country without applying for export licences. The day before we left, we visited Downing Street to hand in a letter stating our intention to break the sanctions on Iraq. At the airport, we were searched thoroughly but our supplies were allowed through, and two days later we were able to deliver them to the Red Crescent Society in Baghdad; this was another successful act of civil disobedience against the illegal and inhumane sanctions regime.

First impressions of Baghdad are of a lively city, full of people going about their business with few signs of the devastation which sanctions have wreaked on this once prosperous country. But you don't have to look far to see that all is not well. Leaving our hotel each day, we were met by four shoeshine boys, taken out of school by their families and forced to earn a living on the city streets. In Basrah in particular, hordes of ragged and barefoot children chased us down the road, begging for a few dinars. Begging was unheard of in Iraq before the sanctions, and virtually all children went to school.

Although there are goods in the shops - albeit very little choice - few people can afford to buy more than the absolute essentials. Pre-sanctions, one Iraqi dinar was worth œ2; now, œ2 buys you some 7,000 dinars, about the same as the monthly civil service salary. A kilo of meat costs around 3,500ID, whilst a single egg costs 100ID, beyond the reach of most people. The breakdown of the economy has caused massive unemployment, and many people have turned to driving taxis or selling cigarettes on the streets to bring in a little money.

The effects of sanctions were obvious even in our hotel which provided us with a standard of living far above what most Iraqis experience. There were frequent power outages, and the water went off for hours every day. There were no sheets on the beds. We wondered for several days why there was such a strong smell of petrol in the lobby until we realised that it was being used to clean the floor. Disinfectant is unavailable, but there is of course no shortage of petrol. If only clean water were so freely available.

During our ten days in Iraq, we visited three hospitals, including one in Basrah, a six hour journey south of Baghdad. We also visited the Ameriyah shelter in Baghdad, and the marketplace in Fallujah, both bombed during the Gulf War with huge loss of life. These visits were particularly relevant in the light of the almost daily bombing over the illegal 'no-fly zones' (set up by the US and Britain without UN authorisation) which cover 60% of the country. A few days before we arrived, a Bedouin camp in the north had been hit, killing 14 people, whilst seven people were killed in Mosul in April, and 17 in southern Iraq in January. Whilst we were in Basrah, we heard air raid sirens each day, indicating that US warplanes were in the area. Hans von Sponeck, the UN Humanitarian Coordinator for Iraq (who took over from Dennis Halliday in October) has expressed great concern about these continuing attacks, saying that they "put international law upside down."

2) SADDAM PAEDIATRIC HOSPITAL Return to top

Dr Al-Abdili conducted us around Saddam Paediatric Hospital in Baghdad. He told us that the hospital admits around 130 children each day, many of them brought from towns outside Baghdad by their parents who think that conditions will be better in the city - but in fact, said Dr Abdili, conditions are equally bad everywhere. He talked about the various shortages they experience; not enough oxygen in the winter because of the increased incidence of respiratory disease; insufficient intravenous fluid; not enough syringes or gloves; only a very limited choice of antibiotics. The non-availability of cytotoxic drugs and the lack of facilities for bone marrow transplants mean that 100% of the children who come in with leukaemia will die - in Britain the cure rate is over 70%.

Dr Abdili introduced us to Inas, a 6 year old girl suffering from marasmus. Her growth was so stunted by malnutrition that she looked only three years old. He explained that her family (with seven other children) had been given instructions on what to feed her at home, but it was very unlikely they'd be able to afford it. The hospital used to give children in its care meat and fish; now they get only soup and rice. One of Inas' brothers has learning disabilities as a result of contracting encephalitis, which could not be adequately treated because of the lack of antibiotics.

3) FALLUJAH GENERAL HOSPITAL Return to top

Conditions were similar at Fallujuh Hospital, which has around 100 beds and serves a population of 400,000. The director, Dr Ahmed Karim, told us of the increase in infectious disease, especially typhoid. He also described an increase in cardiac disorders and diabetes which he put down to the stresses of daily life in Iraq. Our tour round the hospital showed a pattern of broken equipment, shortages of medicines and medical supplies, and doctors in despair, knowing how to treat their patients but not being able to do so. The hospital has its own generator which comes on (although not reliably) during the frequent power cuts, as well as its own water sterilising system. The X-ray machine, out of use during the visit of the previous British delegation in August 1998, has not been repaired, so the hospital cannot do chest or abdominal X-rays. The ECG machine is broken, and only one out of four cardiac monitors is functioning. The cooler in the morgue is broken, so bodies have to be taken away immediately because of the intense heat. A quick visit to the casualty department confirmed the state of affairs existing last August: there were virtually no medical supplies to be seen. In the labour ward, the obstetrician pointed out a rack on which disposable latex gloves were drying after being washed between patients. Clearly, this is a recipe for a potentially fatal spread of infection. Such infection, coupled with anaemia in 70% of pregnant women, lack of blood transfusion facilities, and the general poor health of mothers, has contributed to a rise in the maternal mortality rate in Iraq from 117 per 100,000 births in 1990, to 310 in 1996.

Dr Karim explained that the hospital sees 500-700 outpatients and emergency cases each day. He said that many people come straight to the hospital rather than going to primary health care centres, which would previously have been their first port of call, because of the rundown nature of such centres. This was confirmed in a meeting with Hlin Baldvinsdottir, Acting Head of the Iraqi branch of the International Federation of Red Cross and Red Crescent Societies. Her branch is concentrating this year on rehabilitating primary health care centres, setting up supplementary feeding programmes for children, providing spare parts for a water sanitising system at Hillah Hospital south of Baghdad, and on training programmes in nutrition and sewing. But funds are low, and they can afford to rehabilitate only 12 health care centres out of a national total of 850. Like so many people who come to Iraq, she had been taken aback by the all-encompassing effects of sanctions on daily life. "I would never in my wildest fantasies have imagined what the embargo would do," she told us.

4) BASRAH PAEDIATRIC AND MATERNITY HOSPITAL Return to top

As in Baghdad and Fallujah, so in Basrah, except that conditions in the paediatric hospital here were even worse. The director, Dr Feisal-Jawad, explained that the hospital has 465 beds, but that only 340 are in use because of the lack of air conditioning in some areas (due to broken units combined with frequent power cuts). The overcrowding was clear in the casualty unit, where two children shared each bed, all of them lying limply on plastic mattresses (there were no sheets available) in the overwhelming heat. The hospital suffered similar shortages to the others we had visited. Oxygen is always in short supply; they can afford to buy only 12 cylinders a day rather than the 25 they need. They have to use industrial oxygen rather than the purer medical oxygen as the medical oxygen factory in Basrah was destroyed in the Gulf war.

A consultant, Dr Abdul Kerim, took us round the wards. He said that the main illnesses he sees are infectious diseases and leukaemia. Diseases more commonly seen now include typhoid, dysentery and visceral leishmaniasis, a disease carried by sandflies which is now more common because of the ban on insecticides under the sanctions. Dr Kerim estimated that there had been a threefold increase in leukaemia since the end of the Gulf war, mostly amongst children living in areas where there was heavy fighting. He put this down to the use of depleted uranium ammunition by the US and Britain. He told us that when he was doing his residence at the hospital in 1983, he didn't see a single case of leukaemia in three months; now he sees at least one a week, including in a child of only four months old, which was previously unheard of.

Surgery is still carried out at the hospital but under very poor conditions. The power often goes out (and the generator is not reliable due to lack of spare parts), there is no air conditioning in the theatre, no formaldehyde for sterilisation, a shortage of gloves and syringes, and no new surgical instruments since 1990. There are shortages of anaesthetics and not enough antidote to the muscle relaxant given during surgery. The hospital has only one working ECG machine and no cardiac monitor.

We spoke at length about maternal and child health. Dr Kerim said that breastfeeding rates had increased following a campaign to encourage the practice, but many mothers still bottlefeed their babies, either because they themselves are so malnourished, or because they believe that bottle feeding is superior to breastfeeding. This leads to many cases of gastroenteritis as the water supply in Basrah is not safe, and many mothers cannot afford to buy bottled water or to boil the tap water.

We talked about maternal mortality rates. Dr Kerim told us that many women he saw had haemoglobin levels of only 6mg/100ml of blood; the normal level would be 12-14mg. He had seen one woman with a level of only 3mg. Such low iron levels lead to a risk of death from post-partum haemorrhage; a normal blood loss of 500ml could be fatal for such women. Very few women can afford to buy meat which might increase their iron levels - Dr Kerim pointed out that 1kg of meat costs half his monthly salary. Around 60% of women give birth at home, and the lack of ambulances means that they are often unable to get to the hospital if urgent medical intervention is necessary, a further cause of maternal deaths.

5) BASRAH WATER TREATMENT PLANT Return to top

We visited Basrah's principal water treatment plant, which supplies some ten million litres a day. Thanks to chlorine and machinery provided by the NGO Bridges to Baghdad (chlorine was banned under the sanctions for many years), the plant is now working at full capacity but new filters and pumps are badly needed. The plant was built in 1957 and is showing signs of wear, with pipes needing replacing and frequent leaks. According to the director, the water quality is influenced by factors including the weather; after windy weather, with sand and dust in the air, water quality goes down considerably. She said that in the city centre, the water supply is usually regular but the situation deteriorates in the rural areas, with some places having a water supply for only an hour or day or even going several days without water. Whilst the director felt that the water quality at this plant was good, she admitted that she herself did not drink tapwater, and always bought bottled water for her family. At 300ID a litre, few people can afford to buy water.

6) INTERNALLY DISPLACED PERSONS CAMP Return to top

On the outskirts of Basrah is a settlement originally built as government offices but now home to hundreds of people displaced from their homes by the Iran-Iraq or Gulf wars. The buildings were never finished, and there are no railings on the balconies or open staircases, a terrifying prospect given the number of tiny children running around. There is no sanitation whatsoever; toilet buckets are emptied out into streams of raw sewage which bisect the area and cause the most appalling stench, which must get progressively worse as the weather gets hotter. Dozens of children, many barefoot, were running around these streams of sewage.

We visited Najat and Abdul, a couple who have lived at the IDP camp since 1995. They used to have their own home, but it was destroyed in a bombing raid after the Gulf war. They have six children, ranging in age from 4 to 20; a seventh child, Rabab, died two years ago at age 11 from an untreated heart condition. The family is clearly struggling. Abdul has no work, and their only income is from Najat's work selling clothes in the market. Only two of the children go to school; it is too expensive to send them all because of the need to pay for clothes and schoolbooks. They survive mostly on the monthly government food ration, which Najat said usually runs out after about twenty days (this was common to virtually all the families we spoke to in Iraq). Despite the appalling conditions under which the family is forced to live, Najat still managed to retain some optimism. She told us that although things were getting worse every day, she hopes the situation will change.

7) FARMING Return to top

We met with an official at the Ministry of Information who told us that due to exceptionally low spring rainfall, the harvest this year would be poor. In fact, the UN has predicted a total failure of the wheat and barley crop. The official we spoke with expected the shortfall to be made good from government reserves, but obviously this has implications for the future. It is likely that fruit, vegetables and dates will also be severely affected by the drought.

On our way from Baghdad to Basrah we passed through Iraq's most fertile land. Although the road stayed close to the Tigris river, many of the irrigation ditches were dry, pools of free-standing water were low and stagnant, and the earth looked parched. The Tigris itself was very low in Baghdad, with sandbanks appearing in the middle of the river. Irrigation is made more difficult by the breakdown of pumping machinery, with the result that many previously reclaimed areas have returned to uncultivable salt flats.

There has recently been an outbreak of foot and mouth disease in Iraq, affecting one million cattle and sheep by January 1999. According to Dr Amir Khalil, director of the UN's Food and Agriculture Organisation in Iraq, 15 million doses of vaccine are needed to contain the outbreak, but the government has used all its reserves, cannot make the vaccine in Iraq, and cannot afford to import it at a dollar a dose. The FAO is also struggling to contain an outbreak of the screw worm fly which they say is, 'much beyond the capacity of the government of Iraq.'

8) CONCLUSION Return to top

Our trip was not simply about breaking sanctions, nor merely a fact-finding mission, a chance to talk to officials and take photos of sick children. More than that, it was a chance to understand the human impact of sanctions on the people of Iraq. The shoeshine boys outside our hotel, the mothers too malnourished to breastfeed their babies, the engineers and doctors working as taxi drivers, the young woman who cannot continue her studies because there are no up-to-date books available.