Preparing for the humanitarian consequences of possible military action against Iraq

The case presented to the House of Commons International Development Committee
The last war never ended

CARE International is one of the few agencies operating in government-controlled areas of southern and central Iraq. Our programme revolves around the rehabilitation of water treatment plants, schools and hospitals. As such we are in a position to see the precarious condition of most of the country's infrastructure, destroyed in 1991 and operating under the constraints of sanctions since then.

We are also in a position to see the conditions in which people live. We come across siblings who cannot go to school together because they only have one pair of shoes between them, meeting at the school gates half way through the day to change over. We come across the teacher whose salary is barely enough to keep his family as well as make the payments on the second-hand pair of trousers that he is still paying for by installments. And we come across the girl who no longer goes to school because she has no clothes respectable enough for her to be seen in public.

These anecdotes illustrate that there is already a humanitarian crisis in Iraq. Twelve years of sanctions have brought a once educated, prosperous and healthy population to the brink of destitution. This is a country where people were used to modern standards of living and continue to have modern aspirations despite the indignities to which they have been reduced. Education is free, yet one third of children no longer attend school because their parents cannot afford the ancillary costs, such as a pair of shoes. Iraq sits on the world's largest oil reserves yet most people have electricity only six hours a day. The cruel reversal of fortunes of the Iraqi people has led to a humanitarian crisis for which both the Iraqi government and the western world have their share of responsibility.

Today, 60-70% of people in southern and central Iraq depend on government food rations, supplied under the Oil-for-Food programme, and some 40% have no other source of food. The rations, distributed monthly, last maybe 25 days, requiring families that can afford to do so to resort to the market place. This is a market where a bus fare is the equivalent of a day's wages, a book costs a month's earnings, and house would take 100 years to pay for. It is no wonder that people have literally eaten into their assets - homes, jewelry, furniture, wardrobes - and have nothing left to fall back on.

We may think the last war ended in 1991, but ordinary people in Iraq are still fighting destitution every day.

Despite our firm conviction that war is not inevitable, and our strenuous advocacy for a diplomatic solution, we reluctantly accept that a war is very likely to take place. We do not condone this war, and neither do we wish to give the impression that we are somehow complicit in the preparations for it. However we have a responsibility to the population we have been serving all these years. We have therefore been engaged in low profile preparedness planning for some months.

In the event of a war, there are two principal threats to the distribution of food rations. The first is logistical, arising from the physical disruption of food import and distribution infrastructure, as well as the closure of the local stores that are the end point in the supply chain. The second is administrative; if the Government of Iraq is overthrown or rendered otherwise ineffective, there will be no legal body to administer the proceeds of the Oil-for-Food transactions, and this will disrupt the existing food pipeline.

While the government has taken the precaution of doubling the food ration to two months' nominal supply, these are dry goods which will be difficult to prepare when supplies of bottled gas and kerosene run out. The UN estimates that as a result of a war some 3 million people will be in need of therapeutic feeding, 2 million of whom will be children.

Iraq's water infrastructure depends on electricity, and most urban Iraqis get their water from a tap, not a well. Electricity and fuel installations are prime military targets. With no electricity, water pumping and treatment stations will cease to operate once their back-up generators have run out of fuel. Populations in both urban and rural areas will have to resort to hand-dug wells or open water courses, which will increasingly become contaminated by untreated sewage.

CARE in Iraq has pre-positioned portable water tanks, known as water bladders, along with emergency supplies of fuel, to be able to maintain a minimal water supply in selected areas in the immediate aftermath of an attack. This can provide up to half a million litres of water a day, which is a miniscule response in relation to the likely scale of need. Even with the level of water consumption of, say, a poor urban slum in southern Africa, CARE can serve at most 25,000 people. Based on UN estimates, 2.5 million people will need water.

Children, already debilitated by malnutrition, will be especially susceptible to diseases of poor sanitation such as cholera and dysentery. Approximately 23% of under-fives are chronically malnourished, and the average Iraqi child already suffers 14 bouts of diahorrea a year. Hospitals and clinics, functioning precariously after years of sanctions, will be overwhelmed under the combined effect of a shortage of water, no electricity and a growing volume of patients.

In addition, the UN estimates that direct civilian casualties of the war will be up to 500,000 people, of which between 10% and 50% will be deaths.

Humanitarian preparedness

There is a wide range of possible scenarios based on the intensity and duration of the combat as military strategies unfold. These affect the type and scale of the ensuing humanitarian emergency, both in Iraq and the possible knock-on effects throughout the region. This makes it difficult for a single agency such as CARE to prepare for all eventualities.

Some agencies are predicting and preparing for massive flows of refugees and internally displaced people, variously estimated at between 500,000 and 2 million people. CARE has chosen to concentrate its planning around relief for a population trapped in situ. It is our assessment that, because of a shortage of fuel and the existing levels of poverty, most people in the south and centre of the country will stay where they are. This includes the staff of CARE, who are all Iraqi.

CARE International is not well prepared to deal with even this limited scenario. It is very difficult to scale up disaster preparedness within Iraq without sending out the message that the war is a foregone conclusion. Throughout this period of rising international tension we have continued to undertake our long-term rehabilitation of infrastructure within Iraq - ironically, funded by some of the same governments (through DFID and ECHO) who may soon support the destruction of those facilities. Meanwhile, we have increased staffing in our office in Amman to allow us to gear up to a full emergency response if required.

Another major constraint to the level of preparedness possible has been resources. CARE has not accepted funds for emergency preparedness from the governments of either the UK or the US, as we consider this as adding legitimacy to their preparations for war, and contributing to its inevitability. It may also compromise the security of our staff in Iraq. Our other resources are already stretched dealing with emergencies in Southern Africa and the Horn, as well as the ongoing situation in Afghanistan.

We are alarmed at recent reports that the UN is unprepared for the humanitarian consequences of a war which they will be expected to endorse. The UN system reports that it is severely under-resourced (current funds of US$ 15m being described as 'peanuts' in a recent press interview). We have seen no information made available about how the warring nations will honour their obligations to the civilian population under international humanitarian law.

The situation in Iraq is unique from a humanitarian standpoint because of the very real possibility of the use of non-conventional weapons (nuclear, biological and chemical) in the theatre of war. Most analysts seem to agree that Iraq has not developed full nuclear capability, though the technology for "dirty bombs" is not sophisticated. Some reports have speculated that the US might use tactical nuclear weapons against certain Iraqi installations. There are fears that an Iraqi regime with nothing to lose may resort to chemical or biological weapons. Even if the warring parties exercise restraint, there is the ever-present possibility of an accidental release of toxic or radioactive materials.

This will create a new breed of civilian casualty, in the short and long term, as well as new levels of risk to humanitarian workers. The aid community is simply not equipped to deal with this, either in terms of hardware (clothing, equipment, drugs) or software (training, insurance, systems). We have yet to come to terms with the consequences of working with people affected by depleted uranium shells, widely used in the last Gulf War and in Kosovo. There is a very real danger that we will fail in our responsibilities to the victims of these weapons, or commit grave errors in our ignorance and inexperience, or both.

Access by humanitarian agencies to the people most affected by military action must be maintained during and after the war. In providing emergency assistance to vulnerable people, CARE International is concerned about infringements on the impartiality of our humanitarian operations due to military control. It is crucial that under any circumstances where military action occurs, there is a clear demarcation between civilian and military roles.

If circumstances do not allow humanitarian agencies access to vulnerable populations during or immediately after the war, international humanitarian law requires the warring parties to attend to the needs of civilians. Governments have been all but silent about the need for this preparedness, and have somehow assumed that the humanitarian agencies will do the job for them.

After the dust settles

The prospect of an invasion of Iraq has posed CARE International UK, along with the rest of the UK humanitarian community, some difficult moral dilemmas. There are those in our agencies who do not see a great difference, on the scale of moral rectitude, between the military annexation of a country, using its mineral wealth to pay for that occupation, and the rule of an authoritarian government. We have a deep unease at playing any part in a war being waged by our own government on uncertain pretexts. But we are also driven by our solidarity with the people of Iraq, whom we have sought to serve under the current oppressive conditions, and by whom we will continue to stand.

While we have reluctantly accepted that a war in Iraq is now likely, CARE International has established principles for our engagement in the ensuing humanitarian operation. These echo the humanitarian principles of impartiality and independence, and define the 'humanitarian space' in which we are prepared to act, namely:

  • unimpeded access to vulnerable and affected populations, regardless of affiliation;

  • ability to conduct independent assessment of humanitarian need;

  • freedom from direction or interference by political or military objectives;

  • dissociation from military command structures;

  • safety and security of staff.


CARE International urges the British Government to pull back from the brink of war and pursue all peaceful means to achieve its political aims. The humanitarian consequences of a war will be to exacerbate the plight of an already impoverished people, and will have knock-on effects of unpredictable but surely massive proportions.

In the event of a war we urge the British Government to do all in its power to maximise the humanitarian space available for relief agencies to operate. There must be a clear separation of civilian and military roles. It is of paramount importance that the control of relief and rehabilitation efforts be in civilian hands, with a strong coordinating role by the UN. This needs to be effectively resourced, and independent of the political and military designs of any nation.