International humanitarian agencies predict that any war in Iraq will cause large numbers of civilian casualties. They worry not only about civilians being caught up in fighting but also about people dying from the disruption of Iraq's already fragile food- and health-assistance infrastructure. RFE/RL talks with humanitarian agencies about the problems they expect from any conflict in Iraq and the emergency preparations they are making.
Prague, 21 January 2003 (RFE/RL) -- Global relief organizations are intensively studying how they can best deal with what most predict will be a massive emergency following any war in Iraq.
Some of the planning by the United Nations has been leaked to the press in recent days. It includes a confidential document prepared by a senior UN task force last month that estimates that 100,000 Iraqis could be injured as a direct result of combat between U.S.-led coalition forces and troops loyal to Iraqi President Saddam Hussein.
The task force also estimates that another 400,000 Iraqis could be indirect casualties of the war. Aid groups commonly use that phrase to describe people who suffer accidents or illness due to the disruption of daily life and normal health-care services.
The document was posted without UN approval on the Internet, but UN officials have privately acknowledged its authenticity. The UN has not publicized its planning, officials say, because it does not want to give the impression it considers war in Iraq to be likely as it champions diplomatic solutions.
The confidential UN study also predicts that some 5.4 million people in the south of Iraq, and some 3.7 million in the Kurdish area of northern Iraq, would quickly need emergency food supplies to survive once an attack began. These people, like the bulk of the Iraqi population, are already almost entirely dependent on food assistance provided by the UN's oil-for-food program. The food is distributed by the Baghdad regime or, in the Kurdish areas, by the UN's emergency food agency, the World Food Program.
The UN study also estimates that some 2 million people could be displaced by a conflict in Iraq. UN agencies are reported to already be stockpiling food, blankets, and tents in warehouses along the Iran-Iraq border to prepare for refugees fleeing in that direction.
While UN agencies have been reluctant to publicize the details of their planning, a number of Western charity organizations have not been so reticent. They have been warning for months of the humanitarian consequences of any military action in Iraq and the difficulties aid organizations face in coping with them.
Brendan Paddy, a spokesman for Save the Children U.K., told RFE/RL from London that the main concern for aid agencies is the further degradation of Iraq's already tattered food- and health-assistance infrastructure. Save the Children is among the largest of the Western nongovernmental agencies currently working in northern Iraq. "All of the infrastructure is degraded. It isn't what you would expect in a country like Iraq, which should, frankly, be a middle-income country, given its oil wealth. In the south and center particularly, a lot of the damage done in the last Gulf War has not been repaired, so you have very vulnerable electrical systems, which are critical to health care," Paddy said. "If hospitals cannot get electricity and do not have generating capacity, then they are going to be in deep trouble in terms of treating people with anything above a very minor injury. You also have very decayed sewage [sic] infrastructure. For example, in Baghdad and also in Irbil [in northern Iraq], the streets are regularly flooded in winter with sewage and that has, potentially, very serious consequences for public health."
Iraq's infrastructures for electricity, water, sewerage, health care, and transportation now operate at minimal levels due to a decade of UN economic sanctions.
Aid workers also warn that, because much of the population subsists in poverty, people have little ability to stockpile food now to avoid malnourishment should distribution services be disrupted. Malnourishment greatly increases susceptibility to common diseases, often with fatal results. According to Save the Children, 23 percent of Iraqi children are already chronically malnourished, despite the oil-for-food program.
Some aid agencies also say they are encountering obstacles from Baghdad or Washington that make it hard to prepare emergency assistance programs.
UN agencies working in Iraq operate under the mandate of the oil-for-food program, which does not empower them to make preparations inside Iraq for coping with a war. So their preparations must be confined to stockpiling materials in warehouses in neighboring countries.
U.S.-based charitable organizations, among the world's richest and most technically capable, are having trouble stockpiling materials in two of Iraq's neighbors: Iran and Syria. Both Tehran and Damascus, like Baghdad, are on the U.S. State Department's list of government sponsors of terrorism, making it difficult for the organizations to get export licenses to send materials there. "In terms of what has happened with many of our NGO colleagues from the U.S., including our U.S. Save the Children sister organization, the government of the United States has very strict restrictions on licensing operations by those agencies in countries under [U.S.] sanctions. That has made necessary preparations to deal with the fallout from any conflict, which would have extremely serous repercussions because of people's vulnerability, very difficult," Paddy said.
A major alliance of U.S.-based humanitarian groups, known as InterAction, complained this week that the U.S. administration has been too slow in issuing export licenses for the blacklisted countries. The office of U.S. State Department spokesman Richard Boucher said the government is making every effort to expedite the licensing process while also observing U.S. law.
Senior U.S. and British government officials are due to meet this weekend to discuss how to coordinate international aid operations during any war. British International Development Secretary Clare Short will meet with Andrew Natsios, administrator for the U.S. Agency for International Development, in Addis Ababa. U.S. officials have previously said that Washington envisions stepping up food aid to Iraq in any crisis. They also have said that should the United States occupy Iraq, the U.S. military would play a major role in handling humanitarian relief operations.
In other preparations, Tehran announced this week that it is setting up 19 camps along its border with Iraq to shelter refugees in the event of combat. The Iranian Interior Ministry called on relief organizations to provide emergency aid for a possible 800,000 refugees. Turkey is reported to be planning camps just inside northern Iraq. Both countries, along with Jordan, have said refugees cannot travel beyond their border areas.
One of the worst nightmares for aid agencies is the possibility that Iraq, which is charged by the United States and Britain with having chemical and biological weapons, may use such weapons in combat and that civilians would be exposed to the released toxins.
Geoff Prescott of the British-based medical charity Merlin told RFE/RL that dealing with the effects of chemical and biological weapons is far beyond the resources of international aid organizations and the Iraqi health-care system. "It's medically extremely complex to deal with some of these chemical, biological issues -- indeed, add nuclear to that. One of the examples is with some of the nerve gases. You have to deal with giving people oxygen. You have to make sure that they are breathing very well. That takes a lot of resources and a lot of people to deal with casualties," Prescott said.
He said that even when relatively simple antidotes to some nerve gases are available, medical personnel need extensive training in administering correct doses so the cure doesn't kill the patient. He cited problems with administering atropine, a common antidote to some nerve gases. "For example, in Japan in [the subway gas attack] in 1995, they had to give atropine at 10 to 20 times the normal safe dose. That's particularly complicated, and somehow you need to get health staff able and willing to give very high levels of atropine to treat people. So people need detailed training before doing that," Prescott said.
Prescott said intensive-care facilities are also needed for patients to recover and that such facilities in Iraq are extremely limited. Failure to care for patients when biological weapons that cause communicable diseases are used risks the outbreak of an epidemic that can sweep through a population.
U.S. officials have warned Baghdad that any use of weapons of mass destruction would lead to the most dire consequences, a phrase that in military parlance often suggests retaliatory use of nuclear weapons. Washington gave Baghdad a similar warning before the 1991 Gulf War, in which no weapons of mass destruction were used.
Western leaders this week stepped up their demands that Hussein fully disarm or face a military campaign that would topple his regime. British Prime Minister Tony Blair said today he expects the UN to authorize military action if Hussein is proven to be concealing his weapons-of-mass-destruction programs from UN inspectors.
Britain announced yesterday it is deploying some 30,000 soldiers to the Persian Gulf, or one-quarter of its army. They will join more than 60,000 U.S. soldiers already in the region. Ongoing U.S. deployments are expected to double the size of the U.S. force in the weeks ahead.