Iraq

UNICEF Humanitarian Action: Iraq Donor Update 14 Jan 2003

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I. EMERGENCY PREPAREDNESS
In light of a possible humanitarian crisis in Iraq, UNICEF is focussing its efforts mainly on preparedness activities to respond to the immediate and basic needs of children and women in Iraq and the neighbouring countries. UNICEF's planned interventions focus on reducing and mitigating the impact of a conflict on health and nutrition status, ensuring access to potable water and sanitation facilities, and ensuring learning opportunities by children as well as their care and protection. Within Iraq, UNICEF is the lead agency for water and sanitation and co-lead agency for food focusing on therapeutic feeding and nutrition surveys. UNICEF will actively participate in other areas such as health, education, protection, transport, logistics and communication, Internally Displaced Persons (IDPs) and asylum seekers. Whether inside or outside Iraq, UNICEF is ensuring that its humanitarian response is co-ordinated with the response of respective governments, sister UN agencies, Red Cross/Crescent Societies and international NGOs.

To support the readiness and training of its staff to be able to provide humanitarian assistance to children and women in Iraq in various possible scenarios, UNICEF obtained two advances from its Emergency Programme Fund (EPF). The first advance of US$ 380,000 was used for the capacity-building of its own staff as well as those of its partners (governments, UN agencies and NGOs). The second EPF advance of US$ 2 million, together with the subsequent receipt of a US$ 5 million loan from UN OCHA's Central Emergency Reserve Fund (CERF), UNICEF has been procuring and pre-positioning humanitarian supplies in Iraq and surrounding countries. These supplies which will enable a minimum readiness level include emergency health kits, vaccines, nutritional supplements such as high protein biscuits and therapeutic milk, educational supplies, water storage units, water purification tablets, hygiene items, blankets and shelter material.

By November 2002, UNICEF had pre-positioned some US$ 2.9 million in essential relief supplies inside the country using regular programme funds and the UNICEF EPF advance. Out of the US$ 5 million CERF advance received in end-December 2002, US$ 4.2 million has been used to procure additional humanitarian supplies of which 40% will be pre-positioned inside Iraq and 60% in Iran (Kermanshah) and Jordan (Aqaba). Some 75% of these funds have been earmarked for the purchase of additional nutrition supplies, 10% for health supplies, and another 10% for child protection supplies while the remaining 5% is being used for cross-sectoral purposes.

The balance of the CERF advance is being used in the neighbouring countries to continue their preparedness activities. UNICEF has opened an office in Kermanshah in Iran and is working to establish a presence in Deir Al Zor in Syria, and in Dyarbakir and Silopi in Turkey. It is also collaborating in assessment missions and follow-up meetings to establish a number of UN common regional services.

II. CURRENT HUMANITARIAN SITUATION

The total population of Iraq is estimated at 27 million (23.3 million in the South/Centre and 3.7 million in the North) including over 3.5 million of children under 5. The government, through the Oil-For-Food Programme (OFFP) has succeeded in mitigating the worst effects of sanctions and the consequences of two devastating wars, the humanitarian remains a reality. The under-five (U5) mortality rate for South/Centre (S/C) Iraq - 136 per 1,000 live births - is 2.5 times the level recorded in 1990. In the northern governorates, the situation has improved somewhat with the U5 mortality rate declining from 80 deaths per 1,000 live births (1984-1989) to 72 deaths per 1,000 live births (1994-1999). The maternal mortality ratio has also more than doubled since 1990 - to 294 per 100,000 births in the South/Centre (S/C), and remains high at 120 in the North, accounting for one-third of all deaths among women between 15 and 49 years of age. In S/C, the main causes of high U5 mortality remain malnutrition and the high prevalence of diarrhoeal disease and acute respiratory track infections. While nutrition, water supply and sanitation as well as primary health services have recovered in recent years, the population is much more dependent on government services made available through the OFFP1. Widespread unemployment and poverty have left few households with assets to withstand even a short-term interruption in basic services that would follow a conflict in Iraq.

Below follows a brief assessment in the key areas in which UNICEF works:

Nutrition

Close to 60 per cent of the population in Iraq are fully dependent on the food ration distributed each month by the government. 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 July 2002, the government has been providing 2-3 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 for the 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 services to the 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.

Water and Sanitation

It is estimated that 5 million people (19 per cent of the total population) are at risk for lack of access to safe water and sanitation. The supply of potable water in S/C Iraq is dependent on the continuing operation of water treatment plants in urban areas and compact units in rural areas - all of which require electricity from the main electrical grids. Any disruption of electrical power following a conflict would therefore seriously interrupt the provision of safe water for much of the population. If this occurs, the partial resumption of water supply would be dependent on the use of backup generators for the water treatment plants (WTPs) and CUs. However, electrical generators are available for only 70% of the WTPs in urban areas and only 10% of the CUs in rural areas. In addition, this equipment has not been regularly maintained and the expected constraints in distributing fuel during a crisis would also affect the supply of potable water. In the North, the water supply is also linked to a network of WTPs as well as boreholes requiring electrical generation with the main electrical supply in S/C.

The sewerage and sanitation situation in the country is equally of a concern to UNICEF and other agencies, especially in Baghdad, which contains nearly 25% of the population of S/C Iraq. The pumping of sewerage out of the city to sewerage treatment plants relies on a network of pumping stations in the city, and few of these stations have backup generators for operation in the event of a disruption of the main electrical supply for city. In the North, most of sewerage disposal takes place through a system of cesspools and septic tanks not dependent on electricity.

Health

The main health problems faced by the Iraqi population include the following: malnutrition, nutritional anaemia, vitamin A deficiency, iodine deficiency (goitre), malaria, acute respiratory infections, 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. In S/C more than two-thirds of measles cases are now occurring in older children (as a result of continuing low rates of routine immunisation coverage)2. Since vaccination rates are around 80%, the risk of an outbreak of measles is significant. DPT3 and OPV3 vaccination rates are high at 92% while BCG rates are around 80%; TT2 vaccination rates are 69% for pregnant women and 63% for child bearing age women. While the cold chain infrastructure has been largely restored in the country, UNICEF is planning a follow-up assessment to be conducted in S/C to identify potential gaps.

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), especially in the North 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 vaccines and drugs in the country are sufficient for approximately 4 months at current consumption rates. Therefore, UNICEF expects shortages of essential drugs, especially antibiotics, to occur within one month of the onset of crisis in the country as rates of diarrhoeal disease and acute respiratory infections will increase significantly (due to population displacements, contaminated water, and shortages of heating fuels). The risk of a measles outbreak among displaced populations is also significant.

III. PROGRAMME OVERVIEW

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 OFFP, and is the lead agency in South/Centre for Observation in the Water and Sanitation and Nutrition sectors and is a key partner in Education. In the north, UNICEF implements the OFFP on behalf of the Government of Iraq and manages an annual throughput of approximately USD 90 million. UNICEF is the lead agency in Water and Sanitation and Nutrition in the north and also has large programmes in Health, Education and Child Protection. As a result, UNICEF has built up critical knowledge, experience and partnerships in implementing relief and rehabilitation programmes in the country, with a body of international and national staff highly experienced in implementing these programmes.

UNICEF will provide emergency assistance within its existing programme areas, using its partnerships and experiences gained in responding to the current humanitarian crisis complementing the efforts of government and other partners. These areas have been identified through the vulnerability analysis described above, and are based on surveys and studies on the humanitarian situation in the regular programmes in north and S/C as well as the regular assessment and analysis work being undertaken in the country through the OFFP Observation function. These areas of intervention have been fully co-ordinated with UN and other partners in Iraq.

Table 1: Comparison of UNICEF's Current Programme with its Planned Emergency Response3

Programme Response
UNICEF Humanitarian Response
Chronic Emergency (Current Situation)
Acute Crisis (Rapid Onset)4
Primary Health Care (PHC) National polio and measles campaign; Strengthening of cold chain and training of EPI workers.

Rehabilitation of PHC centres; training of health workers on reproductive health, CDD/ARI
Measles vaccination in IDP and contiguous areas, plus vitamin A supplementation.
Provision of essential health kits and reproductive health kits to facilities; dissemination of key, life-saving messages.
Water and Sanitation (WES) Rehabilitation of WTPs and compact units; repair and rehabilitation of sewerage pumping stations; and development of WES MIS Provision of purification tablets; water tankering to health facilities and to IDP areas; provision of hygiene supplies to IDPs; dissemination of key, life-saving messages on hygiene.
Nutrition Training of volunteers and support to growth monitoring; support to TNP Support to the severe and moderate malnourished U5 children through supplemental and therapeutic feeding; nutritional monitoring and technical support to WFP on supplementation; dissemination of key messages on breastfeeding.
Primary Education Rehabilitation of primary schools; introduction of qualitative reforms to education; teachers training; development of an EMIS. Psycho-social support to IDP children through a resumption of basic educational activities in IDP areas.
Child Protection Development of systems for the de-institutionalisation of children; reform of the juvenile justice system Monitoring equity and access to humanitarian services by IDPs; identification of children with special protection needs; development of safe spaces for children and youth.

IV. STANDING READINESS LEVEL AND RESPONSE CAPACITY5

Emergency Programme Objectives

The following are the emergency programme objectives during the first month of a crisis for Iraq. In all cases, UNICEF will work in areas that are accessible to its staff (national and international):

Health

To ensure a proper assessment of the health conditions of the affected population is carried out on time, especially of children and women.

To prevent outbreaks of measles in IDP settlements and contiguous areas through vaccination of children between 6 months and 16 years of age.

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

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

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

Nutrition

To ensure a proper assessment of the nutritional conditions of the affected population is carried out on time, especially of IDP children.

To carry out nutritional monitoring and surveillance of the population and especially vulnerable groups.

To ensure continued rehabilitation of acute malnourished children in CCCUs, hospitals and IDP areas.

To ensure the availability of relevant IEC material concerning nutrition, especially breastfeeding.

Water and Sanitation

To carry out a proper assessment of the water and sanitation conditions of the affected population.

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

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).

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.

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.

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

Child Protection

Carry out a rapid assessment of the conditions of institutionalised children, as well as IDP children with special protection needs (unaccompanied children, children with disabilities and traumatised children).

Ensure that institutionalised children with special protection needs have access to shelter, food and clothing, especially institutionalised and IDP children.

Ensure special care, protection and physical and psychosocial support for IDP children with special needs

Ensure special care, protection and psychosocial support of unaccompanied children, and their reunification with their families

Ensure the development of safe spaces for children and youth in IDP areas.

Reduce the risk of injuries and death as a result of landmines and/or unexploded ordnance (UXOs) and cluster bombs.

Education

To conduct a rapid assessment of the education sector and psycho-social situation of children, especially in IDP areas

To ensure the resumption of educational and recreational services in IDP and other affected areas for children and adolescents, through the provision of basic educational supplies and teaching materials

V. FUNDING REQUIREMENTS

As previously mentioned, to support a series of preparedness activities, an advance of some US$ 2.5 million and US$ 5 million has been obtained from UNICEF HQ's Emergency Programme Funds and OCHA's Central Emergency Reserve Fund respectively. It is to be noted that these funds have been loaned to support immediate preparedness activities and therefore need to be reimbursed through contributions from donors to enable UNICEF's continued support to other pressing emergencies around the world. The following tables gives a breakdown of the utilisation of the US$ 2.4 million loan obtained:

Table 2: PREPAREDNESS ACTIVITIES SUPPORTED BY EPF

Sector/country
Iraq
Iran
Jordan
Syria
Turkey
MENARO
Total
Health/nutrition
520,000
18,500
25,000
12,000
0
0
575,500
Education
335,000
23,000
51,500
2,600
0
10,000
422,100
Water/Sanitation
195,000
52,500
8,100
64,000
0
0
319,600
Child protection
0
117,000
26,500
3,000
0
20,000
166,500
Advocacy / Communication
0
7,500
1,500
2,000
0
48,500
59,500
Cross-sectoral
90,000
86,400
17,800
23,500
66,000
554,000
837,700
Total
1,140,000
304,900
130,400
107,100
66,000
632,500
2,380,900
RC (5%)
119,045
Grand total
2,499,945

The following table details the additional funding requirements, by sector. (The US$ 5 million CERF loan is being used to support some of the requirements identified in the table.)

Table 3: ADDITIONAL FUNDING REQUIREMENTS

Sector
Items
Quantities
Cost (US$)
Nutrition Nutritional supplements for rehabilitation of malnourished children (HPB and THM) 1,950 MT (HPB) 2,080 MT (THM)
4,100,000
PHC Emergency health kits 60
600,000
WES WES equipment to support water tankering and hygiene to affected IDP area 8 water purification units, 100 water bladders, 60,000 jerry cans, 200,000 sets hygiene items
700,000
Child Protection Basic non-food items for IDPs Blankets, plastic sheeting and cooking sets, clothes
600,000
Cross-Sectoral


1,000,000
Total
7,000,000
RC (5%)
350,000
Grand total
7,350,000

UNICEF has made maximum use of the funds made available to ensure a minimum readiness should a conflict occur. However, the organization needs to obtain from donors funds over and above the level of the two EPF advances and CERF loan to enable their reimbursement and the expansion of its contingency preparedness at country and sub-regional level and within the overall UN co-ordinated contingency preparedness and humanitarian response.

Staffing and relocation

Plans to strengthen operational bases in neighbouring countries are expected to be achieved primarily through redeployment of UNICEF staff from Iraq including those funded by OFFP. However, should OFFP be suspended and its staff not be available to the agencies, UNICEF would have to ensure that additional funds are immediately available to cover the costs of staff. An initial estimate of these costs would be a minimum of US$ 2.5 million for a period of six months. Equally, if essential staff and offices were to be relocated to a place where UNICEF has no presence (staff, offices, vehicles, IT/telecoms equipment), redeployment cost could increase by as much as US$ 5 million for a period of six months.

Footnotes:

1 In the North, all basic services are provided under the OFFP and are administered by UN agencies.

2 UNICEF is planning to support the Ministry of Health to conduct a measles immunisation campaign for children between 6-15 years of age in early 2003 in both S/C and northern Iraq to reduce the risk of a measles outbreak..

3 Please note that the "acute" phase refers to the period from 2 days after the onset of a crisis to one month.

4 Current readiness level 550,000 people

5 Response capacity with 48 hours of an emergency

Details of the Iraq programme can be obtained from:

Carel de Rooy
UNICEF Representative
Iraq
Tel: +964 1 7192318
Fax: + 873 761 473 375
E-mail: cderooy@unicef.org

Olivier Degreef
UNICEF EMOPS
Geneva
Tel: + 41 22 909 5546
Fax: + 41 22 909 5902
E-mail: odegreef@unicef.org

Dan Rohrmann
UNICEF PFO
New York
Tel: + 1 212 326 7009
Fax: + 1 212 326 7165
E-mail: drohrmann@unicef.org