UNICEF Humanitarian Action: Iraq crisis preparedness report

Situation Report
Originally published

Iraq is on the brink of an unprecedented humanitarian crisis. Over a decade of sanctions preceded by two disastrous wars have left Iraqi children and women with little capacity to withstand the effects of a massive military invasion of the country. Without large-scale and rapid assistance in the areas of health, nutrition and water and sanitation - as well as primary education - child and maternal mortality and morbidity rates are likely to increase sharply. Based on its extensive ongoing humanitarian operations in both northern and South/Centre Iraq, UNICEF is leading UN emergency efforts in the provision of non-food assistance - such as basic medicine and equipment, therapeutic and supplemental nutrition for malnourished children, water tankering and emergency repairs to the water and sanitation infrastructure, as well as basic education materials. As the humanitarian operation may be the largest and most complex ever undertaken, UNICEF has been making extensive preparations through the pre-positioning of over USD 8 million in emergency supplies and equipment and the establishment of logistics hubs along the border with neighbouring countries for a trans-border operation of relief supplies, equipment and services into Iraq. Staff, communications and warehousing are now in place in sub-offices in Jordan, Syria, Turkey, Iran and Kuwait. To enable it to effectively and rapidly respond to the humanitarian crisis, UNICEF is urgently requesting additional funds for preparedness for the pre-positioning of basic humanitarian supplies and additional logistical support.


UNICEF's presence in Iraq dates to 1983. It has been supporting humanitarian interventions in Iraq since the start of the Gulf War and the imposition of UN sanctions on the country, focussing on the areas of immunisation, primary health care, nutrition, water and sanitation, education and child protection. Since 1997, UNICEF has been a key partner in the implementation of the oil-for-food programme (OFFP) in northern Iraq, where UNICEF has managed an annual throughput of approximately USD 90 million. UNICEF is the lead agency in Water and Sanitation and Nutrition in Iraq and also has large programmes in Health, Education and Child Protection. In South/Centre Iraq, major achievements include the reduction of malnutrition rates (by over 20 per cent), provision of safe water to over 3 million people and reduction of diarrhoeal disease, the increase in breastfeeding rates (from 15% to 30%), the rehabilitation of almost 500 primary schools and PHCs, the restoration of the EPI cold chain system, control of measles and neonatal tetanus and maintenance of zero polio cases for over 3 years, support to teacher training and reform of the juvenile justice system in the country.

UNICEF has built up critical knowledge, experience and partnerships in implementing relief and rehabilitation programmes in the country, with a staff body of over 270 (51 international) in 4 offices in the country who are directly supporting the implementation of these programmes. Additional international staff are available for quick deployment in support of emergency operations.



Malnutrition rates in S/C Iraq among U5 children have improved recently (the prevalence of wasting and underweight decreased from 11 to 4 per cent and from 23.4 to 9.4 per cent respectively from 1996 to 2002) - with acute malnutrition, in particular, decreasing sharply in the north. The most important reasons for the stabilisation in the nutritional status of U5 children is the highly efficient system of food distribution in the country, through which every household receives a monthly supply of basic food items. Improvements in the supply of potable water, the recovery of basic health services and the successful nutritional screening programme operated by the government have also contributed to the reduction of malnutrition in the country. However, these improvements remain highly tenuous and households are extremely vulnerable to any deterioration or interruption of services. The poor nutritional status of pregnant women - especially high rates of micro-nutrient deficiency - continues to result in a high proportion of infants (30 per cent) being born with low-birth weight (compared to 5 per cent in 1990). These children are much more likely to suffer from chronic malnutrition, and any disruption in basic services will increase their high vulnerability to diseases that may result in their death.

While all families in Iraq receive a monthly food ration distributed each month by the government, approximately 60 per cent of the population is fully dependent on it. Although the caloric content of the ration has increased from an average of 1,093 kcal per person/day prior to the OFFP, to 2,215 kcal by September 2002, it does not meet the minimum level of 2,472 kcal set by the UN Secretary General under the OFFP. Other factors also limit household food security. Since many households do not have any additional source of income, families are often forced to sell part of the food ration to purchase other necessary items such as medicines and clothing. As a result, over 18 million people are food insecure in the country (S/C and North) and would be highly vulnerable during a conflict. Since August 2002, the government has been providing 2 months of additional rations to families in order to build up a stock of basic food items at the household level. However, on average, the food ration lasts no longer than 20 days per month, and there are currently serious shortages in some commodities, especially pulses (the main source of protein). As a result, household food reserves are expected to last no longer than 6 weeks, and widespread hunger would follow if the food distribution is not quickly resumed.

Following the onset of an emergency, the most immediate concern would be the approximately 240,000 children currently undergoing nutritional rehabilitation in the country as well as the 140,000 malnourished pregnant women in need of supplemental feeding. Any breakdown in primary health services and interruption in the supply of nutritional supplements will result in the immediate deterioration of children currently malnourished. The supply of food and health care to the approximately 2,000 orphaned children residing in institutions as well as the estimated 2,000 children confined to institutions for the rehabilitation and supervision of juveniles would also need to be carefully monitored and assisted if necessary. UNICEF projects an expected increase in acute malnutrition rates in under-five children from 4 to 30 per cent (20% moderate and 10% severe) as a result of critical food shortages and an increase in morbidity rates in children (especially diarrhoeal disease) from the consumption of contaminated water.

Emergency programme objectives include the following:

1. Regular assessments of the nutritional status of the target population are conducted and the basic, underlying and immediate causes of the prevailing nutritional situation are identified.

2. The performance and effectiveness of nutrition programmes and changes in the context are monitored and evaluated.

3. Moderate and severe cases of malnutrition are detected and successful treated through the resumption supplementary and therapeutic feeding under the Targeted Nutrition Programme (TNP).

4. Exclusive and complementary breastfeeding is promoted in the country.

5. Malnutrition resulting from micronutrient deficiencies are corrected

Preparedness activities undertaken to date include:

  • 155 tons of therapeutic milk and 1,575 metric tons of high protein biscuits distributed to 68 pediatric hospitals and 560 PHCs and 2,800 CCCUs in both Iraq South/Center and Northern Iraq, to benefit 240,000 malnourished children along with 130,000 pregnant and lactating women.

  • 100,000 water bags and hygiene kits pre-positioned in the NRCs across the country.

  • In the North, supplies to establish 30 additional therapeutic feeding centers have been stored including weighing scales, measuring boards, cooking pots, stoves and other equipment. Similar preparedness undertaken for 4 centers in Iran

  • 4 tons of Therapeutic milk and 25 tons of UNIMIX pre-positioned in Ahwaz and Kermanshah completed with necessary micro-nutrients.

  • 1,500 metric tons of high protein biscuits are pre-positioned in UNICEF warehouses in Jordan and Iran for possible trans-border interventions. An additional 1,400MT of HPB is ordered and in the pipeline

  • Intensification of a national breastfeeding promotion campaign

  • A total of 10 national and international staff undertook emergency nutrition training

  • As lead agency for sector in Iraq, UNICEF is supporting a sub-regional sectoral coordination unit headed by a UNOCHI seconded staff member, which already convened two sub-regional inter agency coordination meetings to establish co-ordination mechanism, agree on supplies and programs standards and ensure appropriate geographical coverage. The main counterparts will be WFP, WHO, and CARE.

Water and Sanitation

The severe deterioration of the water and sanitation infrastructure in the country since 1991 has resulted in declining access to these services for the Iraqi population. Some 5 million people (or 25 percent of the total population) are already at risk because of a lack of access to water and sanitation services. In the event of the destruction of the main electrical power grid, the supply of potable water and the continuation of regular sewerage services may be interrupted owing to the dependence of these facilities on electricity. Although such disruption could partially be resumed through the use of back up electrical generators, the lack of maintenance, spare parts as well as the supply of fuel during an emergency places the majority of the population at risk. The continuation of sanitation services, equally dependant on the provision of electricity, is of particular concern in Baghdad, where 25 per cent of the total population resides. In addition, most if not all of the planned locations for refugees camps were not equipped with appropriate water supply, let alone proper waste and sanitation equipment and structure

UNICEF as the lead agency in the water and sanitation sector plans to conduct assessments along with its partners in order to determine the immediate requirements for emergency interventions to provide safe water and ensure ongoing sanitation services. Assessment activities will continue throughout the emergency intervention to plan, monitor and determine the level of response interventions according to the identified needs.

In the affected urban areas, UNICEF and its partners aim to provide populations with access to at least a minimal level of potable water. Where necessary, UNICEF will provide water tankering to the affected populations with a particular focus on IDP populations, hospitals and other health facilities. UNICEF will provide support to establishing emergency latrines among affected populations and carry out hygiene awareness campaigns in parallel. However, the bulk of UNICEF's interventions will focus on the repair and maintenance of electrical generators and electrical-mechanical equipment to enable the functioning of water treatment plants and sewerage systems in urban areas as well as compact units in rural areas.

Emergency programme objectives include the following:

1. To ensure the availability of potable water and sanitation services to most affected areas and most vulnerable populations.

2. To ensure that the affected/displaced populations in urban areas have access to minimal potable water service through the use of water purification tablets and limited water tankering (especially to IDP areas and health facilities).

3. To ensure that IDPs - with particular emphasis on women and children - have access to facilities, supplies and information that contribute to their hygienic status and protects them from water borne diseases.

4. To ensure the availability of relevant information and communication material (IEC) concerning safe water and hygiene, especially related to water purification and prevention of water-borne diseases.

5. To co-ordinate all UN and NGO assistance in the area of Water and Sanitation

Preparedness activities undertaken to date include:

  • UNICEF has overhauled and repaired backup generators for over 100 water and sewerage facilities in the country in both Baghdad and in the governorates.

  • 5 mobile electrical-mechanical engineering teams (over 60 staff) are on 24-hour standby in strategic locations in Baghdad to ensure the continuing functioning of the sewerage service of the city and part of the water supply. Fuel storage tanks for generators in the city have also been set up.

  • A water tankering operation using mobile water treatment units and collapsible storage tanks for up to 100,000 people is set up in Baghdad city

  • Water equipment for up to 300,000 IDPs in Iraq pre-positioned in neighbouring countries.

  • Rehabilitation of water systems in El-Hol camp in Syria undertaken in collaboration with UNHCR.

  • 40,000 jerry cans pre-positioned in Ahwaz and Kermanshah, along with water bladders for up to 200,000 people, with a possibility to double that quantity in partnership with MSF and OXFAM.

  • In Syria, construction of water storage and supply network for 12,000 refugees, along with construction of latrines completed for up to 5,000 people in the Al-Hol camp.

  • UNICEF has hosted a sub-regional meeting in Beirut for all partners involved in the sub-region in emergency preparedness. One outcome was the establishment of a WES secretariat for emergency co-ordination, headed by an OXFAM seconded staff member. The main counterparts are OXFAM, ICRC and UNHCR.

  • Partnership agreements with OXFAM, NCA and CARE in place.


The main health problems faced by Iraqi children include the following: malnutrition, diarrhoea, acute respiratory infections (ARI), vitamin A deficiency, iodine deficiency, malaria, leishmanisis and measles. Morbidity rates among U5 children are very high, with acute respiratory tract infections (ARI) and diarrhoeal disease representing over 70 per cent of the morbidity - in both the North and S/C. A survey conducted by UNICEF in selected governorates in May 2000 showed that between 42 and 54 per cent of children under the age of 5 had suffered from diarrhoea in the previous 2 week period, between 38 and 43 per cent had been ill from ARI and up to 51 per cent had experienced fever. The prevalence of diarrhoeal disease in under-five children has increased from 4 bouts per year in 1990 to almost 15 in 1999 - mainly as a result of low quality water supply and inadequate hygiene practices in the household. Nearly 876,000 cases of diarrhoea were treated in S/C Iraq in 2002, a decrease of only one per cent from 2001 and an increase of over 12 per cent from 2000 - despite significant efforts to rehabilitate water supply facilities in the country. The case fatality rate for diarrhoea and ARI is 2.9 per cent and 1.4 per cent respectively, more than a ten-fold increase from 1990. Neonates (children less than 28 days old) are much more vulnerable to death, due to malnutrition in pregnant women and complications during delivery, outdated and dangerous delivery practices, the shortages of essential equipment and supplies, the absence of exclusive breastfeeding, as well as poor hygiene and sanitation and the consumption of contaminated water leading to diarrhoea and dehydration.

Routine immunisation has been extremely problematic in recent years due to a combination of erratic and often poor quality supplies of vaccines and cold chain equipment under the OFFP, the low salaries of health workers and supervisors and the absence of cash support to cover transportation costs and social mobilisation activities. Surveys and assessments conducted by UNICEF suggest that the currentl EPI coverage rate is less than reported levels: DPT3 and TT2 vaccination rates were found to be less than 70 and 63 per cent in the MICS 2001 survey and measles immunity was less than 80 per cent. Serious outbreaks of vaccine preventable diseases, such as polio and measles, were regularly recorded until the late 1990s when UNICEF - funded mainly by ECHO as well as the Norwegian and Netherlands governments - supported semi-annual, nation-wide immunisation campaigns to eliminate and control the transmission of these diseases. Measles is currently the main concern. While there have been no outbreaks in S/C Iraq since 1998, an outbreak was recorded in the North in 2001 and more than two-thirds of measles cases are now occurring in older children (as a result of continuing low rates of routine immunisation coverage). Since routine vaccination rates are around 80 per cent, the risk of an outbreak of measles is significant.

While improvements have been made in recent years, approximately 70 per cent of the equipment and supplies constituting the EPI cold chain needs urgent replacement to ensure regular and reliable routine immunisation in the country. Most of the cold chain equipment dates from 1991 (provided by UNICEF), and only a limited amount has been replaced (again mostly by UNICEF and funded by ECHO).

While the government is importing basic drugs and vaccines under the OFFP, the supply has often been erratic and shortages have been reported in the country (including antibiotics), including in the northern autonomous governorates where supplies are provided by the government through bulk purchasing arrangements. Contracts with outside suppliers have not been reliable, resulting in frequent shipments of expiring drugs and vaccines. At present, supplies of some drugs in the country are sufficient for approximately 4 months at current consumption rates. However, other key life-saving medical supplies and drugs are in short supply due to the failure of suppliers to meet basic contract conditions and deliver supplies on time.

Although a substantial amount of emergency obstetric supplies and equipment has been ordered under OFFP, nearly one half of district hospitals lack the operating theatres for their installation and use to conduct emergency obstetric care services. In an emergency, women experiencing complications during delivery are extremely vulnerable, as only district-level health facilities are planned to be opened and ambulance service will be limited. Roads and bridges are also expected to be affected. Basic drugs needed to control haemorrhaging are also lacking in health facilities, in part because of the ban by the 661 Sanctions Committee on the drug atropine.

Emergency Programme Objectives:

1. To prevent outbreaks of measles in IDP settlements and contiguous areas through vaccination of children between 6 months and 12 years of age.

2. To ensure the availability of emergency drugs for PHC facilities, IDPs and targeted areas.

3. To ensure the safe delivery services for women in PHC facilities, IDPs and targeted areas.

4. To ensure the availability of relevant IEC material concerning health, especially care and management of childhood illnesses.

Preparedness activities undertaken to date:

  • Polio campaign and mop up measles and DTP campaigns have been successfully carried out nation-wide in Iraq, benefiting over 4.2 million children under-five.

  • 1 million sachets of ORS have been distributed to all PHCs in the country.

  • Emergency health kits, consumables and ORS have been pre-positioned for up to 1.8 million children in south/center, and up to 250,000 IDP children in the north. Similar types of material have been pre-positioned for up to 50,000 children in Iran, 90,000 in Turkey, 20,000 in Syria and 10,000 in Jordan.

  • Safe birthing kits for 100,000 women are now pre-positioned. Ten additional kits to benefit 150,000 women are pre-positioned in Jordan and Iran for trans-border operations.

  • UNICEF office in Northern Iraq has 356,000 ORS sachets in its warehouse. 200,000 additional sachets are in the pipeline.

  • Drugs to fight black fever have been ordered (64 children recently died of an outbreak in the South).

  • UNICEF and WHO have jointly hosted a sub-regional health co-ordination meeting for all partners involved in emergency preparedness.

Child Protection

As a result of the deteriorating socio-economic conditions and serious family impoverishment in Iraq, issues of child protection have been increasing in magnitude and in complexity. The last ten years have witnessed a substantial increase in the number of children needing protection (children with disabilities, street children, and working children, children in conflict with the law and orphaned children). These phenomena have emerged as a result of the inability of an increasing number of families to look after their own children or to make ends meet. Consequently, many children are dropping out of school, and engaging in full-time work or in hazardous income-generating activities, as a coping mechanism. Many more children, boys as well as girls, aged between 6 and 15 years, are increasingly becoming exposed to delinquency. Data on these children are not currently available.

Due to lack of adequate resources, the Government of Iraq (GOI) is severely constrained to cope with this expanding population group. The GOI was only able to include humanitarian supply items needed for social protection activities during the second half of 2001 under the OFFP, and a very limited number of these items have arrived in the country so far. More importantly, however, the absence of a cash component under the OFFP limits badly needed rehabilitation, training and social support services need to assist children with special protection needs.

Contemporary approaches to caring for children in need of protection are not familiar to government counterparts who have had little contact with the outside world in the past twelve years. Existing laws have not been revised or modified. Outdated systems of rehabilitation and care prevail. The GOI's policy on rehabilitation of children in need of special protection is oriented towards institutionalisation. The typical scenario is that children caught loitering, begging or committing other minor offences on the streets are apprehended and arrested by the police, and referred to the Ministry of Labour and Social Affairs (MOLSA). They are then placed in special institutions together with teenagers who have been tried and sentenced under Iraqi law. Similarly, children deprived of family support and abandoned are often institutionalised and live in harsh conditions, frequently suffering from malnutrition and lacking good opportunities for education and development. There are few International NGOs and agencies, and only two local NGOs (The General Federation of Iraqi Women and General Federation of Iraqi Youth) that work for children in need of special protection in Iraq.

Currently, there are approximately 2,300 children confined to institutions in Iraq. As these children already suffer from poor living conditions, malnutrition, poor educational services and recreation, they will be some of the most vulnerable children in the event of an emergency. In addition, given past experience from Iraq and other countries, UNICEF expects that as many as 5 per cent of children from displaced or refugee populations might be separated from their families in a time of crisis. Early interventions are needed to ensure that they are both properly cared for, registered and that tracing and reunification can begin as soon as possible. Finally, Iraq continues to suffer from the legacy of the Iran/Iraq war and the Gulf War, whereby thousands of landmines and unexploded ordnance (UXOs) risk the lives of children every day. A military conflict in the country would only add to the level of contamination in Iraq.

The main objectives to be achieved in an emergency include:

1. to ensure safety and well-being of institutionalized children during the emergency

2. to ensure safety, psycho-social support and family reunification for unaccompanied children

3. to ensure that refugee and IDP populations that have settled along borders are aware of the risks of mines and UXOs

The main preparedness activities carried out so far are:

  • Distribution food and non-food items for 2,300 institutionalized children and an additional 100,000 IDP children in Iraq

  • Establishment and training of mobile psycho-social care teams in northern Iraq

  • Training of teachers in south/centre on psycho-social interventions in schools

  • Distribution of education materials and broadcasting of TV spots on land mine awareness in Iraq

  • Pre-positioning of non-food items for 20,000 refugee children in Iran and Turkey

  • Pre-positioning of tents for unaccompanied children in Turkey and Jordan

Primary Education

Primary education is the sector that has been hit hardest as a result of over 12 years of sanctions. Prior to the 1990s, Iraq had one of the best education systems in the Arab world, achieving universal primary school enrolment and significantly reducing women's literacy in the country. However, by 2000, 24 per cent of children are not attending primary school, with nearly twice as many girls staying out of schools as boys: 31.2 per cent of girls and 17.5 per cent of boys. Other worrying trends include the sharp increase in adult female illiteracy. Immediate causes include the decline in coverage and quality, with two and often three shift in schools due to the shortage of buildings and teachers; few books and supplies; and little revision of the school curriculum in recent years. Underlying causes include the extremely deteriorated condition of the existing school infrastructure: over 8,000 school buildings need to be urgently rehabilitated while an additional 5,000 schools are needed to meet the growing population of primary school children. Basic causes include the need for more emphasis on quality; weak linkages between sectors; insufficient community involvement; weak management information systems and the need for reform of key policies that inhibit effective targeting of assistance for the most vulnerable. In the event of a crisis, children will be unable to attend school until parents are satisfied that the danger of their children attending class is over.

Given the extremely poor condition of schools, it is expected that many schools will be considered unsafe for children to attend. It is also expected that schools will be looted and therefore lacking in education materials, while some schools could be temporarily used as shelter for families who may loose their houses during the conflict. Many families may also be reluctant to send their children to school due to the absence of school materials. Teachers will also be reluctant to return to school, due both to the unsafe conditions of the schools and to the risk of insecurity and/or looting in the communities. At the same time, attendance in regular education activities is vital to ensure the recovery of children from trauma caused by the conflict and from any further psycho-social harm resulting from the relief and recovery effort in the country. Reactivating the primary education system will be one of the most urgent and immediate emergency efforts required in the country.

The main objectives of current UNICEF preparedness efforts are:

1. To ensure the resumption of primary education for children and adolescents in affected areas of the country through the provision of basic educational supplies and teaching materials

2.ensure that children in distress receive adequate psycho-social support in schools

3.ensure safe and adequate learning environment in areas where schools have been severely damaged

Preparedness activities undertaken to date:

  • School-in-the-box and recreational kits for 100,000 children are pre-positioned inside the country to help restart primary education activities following a conflict in the country as well as to address psycho-social needs of children during an emergency. Similar material is pre-positioned for up to 10,000 children in Iran, and 8,000 children in Turkey.

  • Winter-compatible tents to be used for educational activities have been procured.

  • Organization of several inter-agency coordination meetings with all Education actors sub-regionally.


Being the lead agency for water and sanitation, nutrition and education for emergency response within Iraq, UNICEF has already undertaken a significant amount of emergency preparedness. UNICEF has pre-positioned basic emergency supplies in Iraq and the countries surrounding Iraq, where it will support UNHCR in its response to potential refugee populations. Throughout this process UNICEF has been actively co-ordinating its efforts with governments, UN sister agencies, the national Red Crescent Societies and international NGOs. As events in the political arena are fast evolving, UNICEF is working hard to ensure its emergency response capacity to meet the needs of affected populations.

UNICEF is grateful for all donations received so far. However, further assistance is needed to expand preparedness levels on the eve of a humanitarian crisis. In order to mitigate the affects of a humanitarian crisis on the children of Iraq, UNICEF would like to request additional funding urgently needed to increase preparedness and eventually response levels in terms of key humanitarian supplies and operational capacity to guarantee utmost impact possible of any humanitarian intervention.

The below presentation reflects funding requirements for a targeted emergency preparedness level able to meet initial and basic needs as the humanitarian crisis unfolds.

PRIORITY FUNDING REQUIREMENTS (15 December 2002 -20 March 2003)
Sector Items
Health & Nutrition High Protein Biscuits and Therapeutic Milk, vaccines, emergency health kits
Water & Sanitation Water purification units, water bladders, purification tablets, jerry cans, hygiene kits
Education School in the box kits
Child Protection Blankets, plastic sheets, cooking sets, recreation kits
Advocacy & Communication IEC and visibility materials
Cross-sectoral Training, telecommunication equipment, assessment missions, coordination meetings, prepositioning staff for logistics and sub-offices, operationalization of sub-offices

Funds received to date for preparedness activities, and pending funding requirements

Funds source
United Kingdom
Other Governments
TOTAL funds received

Further details of the Iraq emergency programme can be obtained from:

Olivier Degreef, Office of Emergency Programmes, UNICEF Geneva, Tel: + 41 22 909 5546, Fax: + 41 22 909 5902,
Dan Rohrmann, Programme Funding Office, UNICEF New York, Tel: + 1 212 326 7009, Fax: + 1 212 326 7165, Email:
Carel de Rooy, Iraq Country Office, UNICEF Amman, Tel. +962 6 551 4253 -ext 105, Cellphone: +962.79.692.61.77, Email: