Author: Sen, B.
Shortly after the end of the most recent war in Iraq, UNICEF and the World Bank discussed the idea of preparing a series of “Watching Briefs” covering key social sectors namely health, education, water and environmental sanitation, and child protection. The purpose was to contribute to building a knowledge-base and enhancing partnership and cooperation between the UN and the World Bank.
The purpose of this social sector watching brief is to establish a baseline that tracks the trends in the indicators of social development and social sectors in the past two decades in Iraq, particularly from 1990 onwards.
The scope of the watching brief covers the three sectors of education, water and sanitation, and health and nutrition, as well as the cross-sectoral themes of child protection and HIV/AIDS prevention. The methodology used for preparing the watching brief included a desk review of documents analysing the pre-2003 situation, discussions with key informants and review of ongoing assessment findings for the post-2003 war situation.
Findings and Conclusions:
Pre-War Trends and Social Policy Perspective
The modern Iraqi economy had been largely dependent on oil exports. In 1989, the oil sector comprised 61% of the GNP, services (primarily in the public sector) contributed to 22%, followed by other industries with 12% and agriculture with 5%. The oil sector, however, does not have strong horizontal and vertical linkages with the domestic economy that could have a multiplier effect on employment and economic growth. One of the results of this over-dependence on oil export economy has been the narrowing of the economic base over the last three decades, with the agricultural sector’s contribution rapidly declining in the 1970s. Therefore, the imposition of sanctions post-1990 had a particularly severe effect on Iraq’s economy and food security levels of the population. The State of the World’s Children Report, 1997 (UNICEF) states that the per capita income in Iraq dropped from $3510 in 1989 to $450 in 1996. The average salary dropped to 3 to 6 US dollars per month by 1999, largely due to a rapid depreciation of the Iraqi dinar.
Not being self sufficient in food production, after the sanctions, the Iraqi government introduced free food rations comprising of 1000 calories per person/day or 40% of the daily requirements. After 1997, with the introduction of the OFFP, this gradually increased over time. Only in 1999 could the per capita food consumption per day increase to approximately 2150 calories, following two years implementation of the OFFP. In 2000, it was estimated by UNDP that the average family spent as much as 75% of their income on food. Since 1991, when the current public food distribution system was put in place by the government, most Iraqis became dependent on the food rations they received through this system. It is estimated that 60% of the Iraqi population rely on food rations to substantially supplement their daily food requirements.
A survey on the extent and geographical distribution of poverty in central and southern Iraq in March 2003, by the World Food Programme (WFP), found that even with the above food rations, one in five Iraqis suffered from chronic poverty and were unable to meet all their basic needs. The systematic identification and targeting of social programmes to this poorer segment of the population has never constituted an explicit policy in the social planning of the past. The focus of the Iraqi government had always been on universal service provision and a denial of the existence of specific needs of special groups within Iraqi society.
The national survey carried out in 1997 placed the total population of Iraq at 22 million, with an average annual growth rate of 2.95% between 1987 and 1997. OFFP estimated the population of Iraq in 2002 at 27.2 million, based on the registration for food rations. The population is marked by its youth, with 45% of the total being under 14 years of age in 2000. Over 65s only accounted for 3.5% of the total population.
This dimension of the demographic profile of Iraq has a variety of implications for social planning. The youth of Iraq face a unique set of problems today, in addition to those characterizing youth everywhere. They have been essentially born and grown up during the 1990s, when both the economic and social well-being of Iraq’s population was rapidly declining, as well as various kinds of freedom lost to an increasingly repressive regime. Hence, they faced a variety of deprivations and vulnerabilities. The sanction period was characterized by a gradual decline in the mainstream of social services as well as not having any social policies that support young people specifically. Life skills based education, which includes both psychosocial care and more functional skills, has never been an important part of the educational sector in Iraq. Absence of freedom to express themselves in the political climate of Iraq has deprived them of their right to recreation and freedom. Sexual education, critical for HIV/AIDS prevention, is nonexistent in the public domain of Iraqi society. The absence of social policies and programmes for youth has grave implications in the current post-war context and for the future of Iraq. The demographic profile illustrates the need for social policies and related programmes to focus on children and youth in Iraq today.
Infant Mortality rates in southern central Iraq rose to 107 per 1000 live births in1999, over double of the 47 per 1000 live births in 1989. Similarly, under 5 mortality rates rose from 56 per 1000 live births in 1989 to 131 in 1999. However, the situation was quite different in the three governorates of northern Iraq. While between the period 1989 to 1994, the infant and child mortality rates rose marginally (IMR: 63 to 71; U5MR: 80 to 89), when there was both a civil war and persecution by the Saddam regime. This rise was not evident in northern Iraq because of the adequate flow of resources provided by the OFFP. The dramatic changes in the child survival rates in southern central Iraq have been attributed to a variety of factors such as the declining economic well-being of the population, its effect on mother and child nutrition levels, as well as the declining access to healthcare and food security.
The daily per capita share of drinkable water was reduced from 330 litres per day in 1990 to 150 litres in 2000 in the capital city of Baghdad. In other urban centres, this share was less at 110 litres and, in rural areas, even less at 65 litres per day. However, in reality, the actual water available was far less, as the above figures are based on water production rather than on what was delivered at the household level. Distribution losses were estimated to be as high as 50% and water quality continued to be uneven. Those vulnerable groups residing at the end of the distribution channels barely got any water supply. Inadequate electric supply, non-standardised imported spare parts, due to fixed suppliers under the OFFP, and a lack of modern know-how by local technical personnel are some of the reasons attributed to the failure of the water supply systems built in the pre-1990 period.
A survey carried out by UNICEF in May 2000 noted that close to half the children under 5 years suffered from diarrhoea. Over half of the children suffered from fever and over one third of the children suffered from acute respiratory infections. An Iraqi child suffered on average fifteen diarrhoea spells before the age of 5 years. The scarcity of clean, drinking water in adequate quantity, the absence of sanitation systems in specific locations, poor hygiene practices for childcare, feeding and limited access to healthcare services all contributed to this situation.
The literacy rate in Iraq had reached 78% in 1977. More distinctly, the adult female literacy rate had reached 87% by the year 1985, but declined rapidly since then. Between 1990 and 1998, over one fifth of Iraqi children stopped enrolling in school, increasing the number of non-literates within a decade and losing all the gains made in the previous decade. By the year 2000, the number of children of primary school age not attending school increased to 23.7%, even though education until primary school is compulsory and secondary level had been free in Iraq since 1976. One of the main reasons identified for this decline was the inability to expand the number of schools due to a lack of financial resources. While drop-out rates from schools continued to be relatively low, a large number of schools, particularly in the major cities, were highly overcrowded and ran multiple shifts.
Iraq has a well-defined legal framework relating to children, prevention of child labour, orphans and juveniles. However, both the institutional and legislative framework put in place by the erstwhile government focused more on the state as the sole provider of services (i.e. a purely institutionalised approach) rather than alternative, more child friendly, community-based approach. With the economic hardships increasing in the 1990s, the implementation of these laws for the protection of children in vulnerable situations also weakened, and more and more children entered the informal labour force. Although no definitive estimates exist as to the prevalence of street and working children, the decade of the 1990s saw a dramatic increase in their numbers, from a virtually non-existent level in the 1980s.
Iraq has been one of the few countries in the Middle East that made a social investment in women’s education. It submitted its second and third reports to the Committee that monitors the implementation of the Convention on the Elimination of Discrimination of Women (CEDAW) in 1998. While labour law legislation formulated in 1971 guaranteed women equal opportunity in government employment and women continued to be a majority in some professions (65% of all teachers at both the primary and secondary school level are women), they are less well represented in other professions.
However, this situation started changing from the late eighties with increasing militarisation and conflicts on the one hand, and declining economic situation in the 1990s on the other. The maternal mortality rate rose from 117 deaths for every hundred thousand births before 1990 to 294 in 1998. Although a decline in both general healthcare services and education is largely responsible for this, deep-rooted gender biases in many segments of Iraqi society also started playing a role. Nearly 30% of young girls no longer attend primary school. While dropout rates for both boys and girls are low at the primary school level, in fifth grade, the difference increases - being 7.8% for boys and 16.4% for girls. The MICS 2000 survey by UNICEF showed that adult female literacy was only 63.5% compared to 83.7% for males. Nearly 30% of women gave birth without a professionally qualified medical professional in attendance. One of the consequences of the economic hardships and war casualties in the last two decades has been the increase in the number of women-headed households, a majority of whom have joined the informal labour force.
The rise in the maternal mortality ratio from 117 to 294 per 100,000 live births within a decade is of concern. It constitutes one third of all deaths among women aged 15 to 49. The two main causes for this is the absence of quality healthcare at the time of delivery and the prevalence of malnutrition amongst pregnant women. There is also the issue of early marriage in Iraq, 40% of women in Iraq are married before the age of 18. Birth intervals were also short, with 41% of births being spaced at less than two years. The total marital fertility rate ranged between 6.9% in urban areas to as high as 9.9% in rural areas. All the above data shows that there is an increasing trend where the vulnerabilities of women have increased over the decade of the 1990s.
The story of each social sector highlights the major achievements accomplished in the past, but also the weaknesses in the perspectives that guided the policy and programme approaches for their rehabilitation and development. In the health sector, the emphasis had been on establishing a hospital-based, curative healthcare system, with a specialized disease control approach, rather than a community-based public health approach. Similarly, in human resource development, emphasis had been placed on the training of specialist doctors rather than nurses and parameds who can do the majority of the functions in a public health programme. With the HIV/AIDS pandemic on the horizon, the same approach came to characterize Iraq’s HIV/AIDS prevention programme.
In the water and sanitation sector, the focus had been on the rehabilitation of the large water and sewage treatment plants. Less emphasis was given to ensure that water of adequately safe standards reaches the vulnerable population groups at the end of the distribution channels. Hygiene and sanitation practices, which could have prevented the rapid rise in morbidity and mortality, especially in infants and children, were not adequately addressed. Choice of technologies has often been inappropriate, especially in the rural context. Dependence has been solely on large, sophisticated plants, for which indigenous technical capacity did not exist. In education, while adequate emphasis had been given in the past to primary education compared to higher levels, knowledge inputs required in the learning process in today’s context has been stagnant. Curricula have not changed in Iraq’s schools for over two decades, and in-service teacher training has been virtually absent. In child protection, the approach had been to provide solutions for vulnerable children such as the disabled and orphans, through a highly-institutionalised approach, rather than more effective community-based approaches. Problems such as the growing number of street and working children have been largely ignored by the earlier government.
The OFFP and the continued presence of UN agencies throughout the period of the 1990s attempted to bring about certain changes through introducing new types of social programmes. They were partially successful in the autonomous governorates of northern Iraq, where both the share of resources and the cash component in the OFFP were better. Additionally, the UN was directly responsible for the programme’s implementation. Social policies within Iraq continued to ignore these lessons, both positive and negative.
Impact of 2003 War and Post War Situation
The most direct impact of the current war has been the damage caused to the social infrastructure due to collateral damage and by the extensive looting of facilities and equipment. Other than specific loss to different buildings due to collateral damage, much of the movable assets within the social infrastructure have been lost due to extensive looting in the post-combat phase. It is estimated that 500 schools in Baghdad are damaged, and all equipment and material looted from the majority of the schools within greater Baghdad. Fifty percent of the 1410 water treatment plants in Iraq are no longer functioning and all the sewage treatment plants in Baghdad are out of action. Electricity supply to nearly forty percent of all water and sewage treatment plants have yet to be restored. It is estimated that nearly US$ 500 million worth of spare parts, equipment, water treatment chemicals and service vehicles have been looted or destroyed. Whilst some of the hospitals within the urban centres that escaped damage or looting have started functioning with minimum levels of equipment, a majority of the primary healthcare facilities are yet to renew their functioning. Both staff as well as users of such services, particularly women and children, are refraining from attending either school or health facilities due to the adverse security environment.
The collapse of the political regime has not only meant a major change in the political governance structure in Iraq, but also the near total collapse of the public administration that has been traditionally responsible for all social services in the country. The extreme centralization that characterized the management of the social services system, through different central ministries, has compounded the problem of reactivating the system at the local level. Unless all the various central level ministries, many of which were shut down after the war (either due to collateral damage or extensive looting or senior personnel not reporting for duty), start functioning fully, it is difficult to revive their functioning at the local level.
The second immediate impact of the war and the consequent regime collapse has been the continuing social instability and highly insecure environment that has come to characterize many of the major cities in Iraq at present. How long this phase will continue is difficult to say, given the fluid situation on the ground currently. This environment is not only affecting the safe transportation, storage and supplies of emergency material, but also created problems for the rapid re-functioning of many of the previous service facilities.
The 2003 war, followed by the extensive looting of much of the social facilities, has, in many ways, put the clock back to where it was in 1991. Rehabilitation of the physical social infrastructure, and ensuring the technical human resources that managed the social sectors are brought back, are two obvious priorities in the immediate short term. The size of the social infrastructure in Iraq is, however, large, with approximately 13000 schools, 3000 health facilities and just over 1400 water and sewage treatment plants. This would require substantial financial resources, more than what Iraq’s oil exports can pay for in the short run.
Simultaneously, there is a need for both immediate humanitarian assistance and the need to design and implement a comprehensive safety net for the most vulnerable sections of the population. With increasing sections of the population becoming vulnerable, there is a need for identifying such segments of the population for special targeting of social policies and programmes. Of particular importance is the need to formulate policies and programmes for the extremely vulnerable population of youth within Iraq today. Also, geographical distribution of poverty and other dimensions of vulnerability need to be taken into consideration for the future, as these issues were left unanswered in social policy formulation in the past. In the long run, however, there is a need for major system reforms that encompass new social policies and institutional structures in each of the social sectors. Such reforms will need to create conditions for markets to function, local communities to participate and own social programmes, and civil society institutions to form and build themselves up.
Several assessments as to the exact situation on the ground and needs of each social sector are ongoing within Iraq. These will provide estimates of the financial needs of each sector. There is a need to fill in other information gaps for planning more comprehensively in each of the social sectors. These include a systematic human resource and institution inventory of current availability and capacity, as well as training needs assessment of present staff in each social sector. For the purpose of a new social policy formulation, a review of the laws, acts, and government decrees that guide the functioning of each social sector is required. All such assessments should incorporate the gender dimension through gender-segregated data collection, to ensure that the rising gender disparities within Iraq are closely monitored. In addition, there are certain specific assessments required by each of the social sectors. In health and nutrition, there is a need to constantly monitor the health and nutritional status of specific population groups and settlements to target programmes better.
A disease surveillance system, already initiated by WHO, needs to be institutionalised throughout Iraq to ensure early warning systems for controlling disease outbreaks and epidemics. In water and sanitation, there is a need for an assessment of technologies that are being currently used in the sectors, in order to evaluate their appropriateness. Also, an assessment of the drinking water distribution system needs to be carried out together with its access and reach to different population groups. In education, there is a need to review the entire curricula and teacher training system. In child protection, there is a need to identify the extent of the most vulnerable children in the population as well as the children out of school and without healthcare.
In essence, the 2003 war, post-war looting and its consequences, as well as the underlying weaknesses in Iraq’s social sectors, call for a more comprehensive reconstruction effort than solely humanitarian assistance or physical rehabilitation of social facilities. They need to be centred on systems of reform processes.
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Emergency – Response
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