Potential impact of conflict on health in Iraq

Briefing note: March 2003

This compilation of health information draws on data from the Iraqi Ministry of Health, the World Health Organization, other agencies of the United Nations system and other sources, using the most recent and reliable figures.

Part I highlights potential health risks that may be faced by people if a humanitarian crisis occurs; and the public health goals and health measures that should be taken in response to the crisis.

Part II indicates the preparations being made by the Government of Iraq, UN agencies (including WHO), non-governmental organizations and others concerned to safeguard the health of Iraq’s people in the event of a humanitarian crisis.

Part III describes the current public health situation in Iraq with an emphasis on communicable (including vaccine-preventable) diseases; noncommunicable illnesses; the health of children and their mothers; food security and nutritional status; the health system, including the availability of essential medicines and equipment; and environmental health issues, including access to clean water and sanitation.

Part IV describes historical trends during the 1990s, with an analysis of changes that are attributed to the effects of health policy, conflict, sanctions and the Oil-for-Food Programme (OFFP).

Public health concerns during conflict

Risks to health during conflict

Conflict will inevitably cause loss of lives, physical injuries, widespread mental distress, a worsening of existent malnutrition (particularly among children) and outbreaks of communicable diseases. Internally displaced and refugee populations are at particular risk. Common, preventable diseases such as diarrhoea, threaten life. Chronic illnesses that can normally be treated lead to severe suffering. The dangers of pregnancy and childbirth are amplified.

Conflict in Iraq will also reduce people’s personal security and restrict their access to food, medicines and medical supplies, clean water, sanitation, shelter and health services. People's coping capacities are already severely strained: many will find the privations of war overwhelming and need both economic and social support.

The pattern of conflict has an immediate impact on civilian suffering. If water supplies are damaged, sanitation impaired, shelter damaged, electricity cut, or health services impaired, mortality rates start to rise. If these risks are to be minimized, those involved in conflict must give priority to ensuring that civilians can access these basic needs. If access is impaired, it must be restored as rapidly as possible. Population movements and crowding in temporary shelters increase the risk of waterborne disease outbreaks such as cholera, typhoid and dysentery. In refugee and internally displaced persons’ camps during (and after) previous wars in Iraq, diarrhoeal diseases accounted for between 25% and 40% of deaths in the acute phase of the emergency. 80% of these deaths occurred in children under two year of age.

Box 1: Consequences of lack of access to a health centre

In the longer term, disruption of surveillance for monitoring disease in the general population, breakdown of public health programmes, damage to health facilities, and malfunction of water and sanitation systems will lead to increased levels of illness, further suffering and higher death rates. The incidence of acute lower respiratory infections, diarrhoea and vaccine-preventable infections will increase. There will be outbreaks of communicable diseases – including measles, meningococcal meningitis, pertussis and diphtheria. New disease patterns - including conditions that have previously been controlled - may be observed.

Health measures required in a humanitarian crisis

The most pressing health-related actions in the event of further conflict will be:

• ensuring adequate, safe drinking water and access to sanitation;
• providing medical supplies and treatment for people affected by trauma and other injuries;
• preventing outbreaks of communicable diseases such as cholera, typhoid or measles;
• making sure that adequate stocks of essential drugs, medicines and medical supplies for common conditions are in position;
• providing access to basic health care for persons with chronic conditions which need continuing treatment (e.g. renal dialysis and cancer care); and
• tending to the special needs of vulnerable populations, including pregnant women, children, the elderly, and those who are chronically ill or disabled.

Internally displaced or refugee populations face additional risks to their security and health: they are more vulnerable to disease. Those involved in conflict, as well as organizations responsible for humanitarian assistance, need to liaise with local authorities to manage the additional risks faced by such populations.