Iraq Report
Growing up in a war zone

Mental health specialists say there has been an increase in domestic violence against children largely a result of the violence that has gripped Iraq since the USled invasion in 2003. They say the violence has affected people’s behaviour, according to an IRIN report.

“We have observed that there has been an increase in the number of cases of aggression against children in Iraq and the main perpetrators of this aggression are the children’s own parents. Their aggressive behaviour is seriously affecting the daily life of thousands of innocent children,” said Ala’a al- Sahaddi, vice-president of the Iraq Psychologists Association (IPA).

“Parental punishments are becoming harsher. We investigated cases in which children were left with water but no food for over two days, or who were beaten with belts or sticks that left them with broken bones,” al-Sahaddi added.

According to al-Sahaddi, most Iraqis nowadays behave aggressively towards each other, and exhibit disturbed behaviour. He said the few psychologists left in Iraq do not know how to treat these problems.

“Most of the children I see have disturbed behaviour or post-traumatic stress disorder. They suffer from domestic violence and are being treated with simple medication, as it is very hard to find more potent drugs in Iraq,” said Ibrahim Abdullah, a psychiatrist and member of the National League for the Study of Health Disorders (NLSHD).

“Most of the [affected] families come here for help and sometimes we can do nothing for them. Some parents are aware of their disturbed behaviour in dealing with their children but claim they don’t have control, and only realise what they have done when they see their children are hurt and require urgent medical assistance,” Abdullah added.

He said that with the ongoing violence it would be very difficult to change such behaviour.

During former President Saddam Hussein’s regime, there were about 90 psychiatrists in Iraq and some 45 psychologists but today there are fewer than 40 of both in total, according to the IPA, most of them having fled to Jordan, the United Arab Emirates, Lebanon and Syria.

Research findings

A privately funded study – entitled 'The effects of war on psychological distress' – by the IPA with the support of the NLSHD in Baghdad, Anbar, Diyala and Babil provinces, showed that of the 2,500 families interviewed, 87% had observed a family member with psychological distress.

Some 91% of the children interviewed said they faced more aggression at home than before the US-led invasion in 2003; nearly 38% had serious haematomas [localised swellings filled with blood] after beatings.

Fathers mainly to blame

Al-Sahaddi said two local non-governmental-organisations (NGOs), which prefer anonymity for security reasons, are helping child victims of domestic violence. The culprits, he said, are usually fathers, rather than mothers who themselves seek protection from local aid organisations.

“We are trying to help some of these children but the problem is huge as the psychological effects are enormous and are multiplying faster than we can manage. We desperately need support for projects which can help change this state of affairs in Iraq; we need national programmes which guarantee the safety of these children,” he said.

“There is no law in Iraq that criminalises parental aggression. Three months ago we had a case of a father who killed his son after beating him and causing haematomas, broken bones and asphyxia. The man was not charged and is free. He is seen as an innocent person just trying to keep order in his home. This is ridiculous,” he said. 

Emergency services struggle to cope

The four attacks in Baghdad on 18 April , in which more than 200 people died, have highlighted how overstretched the country’s emergency services are during major attacks, doctors and emergency services workers told IRIN News

“We were really desperate during the serious attacks on Wednesday [18 April] in the capital as most of the hundreds of injured people were taken to our hospital and we were unable to treat them because of the shortage in doctors, nurses, medicines and materials used in emergency operations,” said Dr Ali Haydar Azize at Sadr City Hospital.

“Our supplies [of medicines] were finished in the middle of treating the injured people. Some of them had to be taken to another hospital to save their lives but if we were fully equipped with materials and staff, we would have been able to treat all of them,” Azize added.

Iraqi hospitals are not equipped to handle high numbers of injured people at the same time because they depend on weekly deliveries of small quantities of medicines, said Azize.

The Ministry of Health said that while it has been sending supplies to every hospital in the capital and in other provinces, it does not have enough funds to fully stock medical stores.

“We will try to send extra medicines and materials to hospitals for emergency purposes but they [the hospitals] should be patient as the ministry lacks funds,” Barak Muhammad, a spokesman in the Ministry of Health, said. Doctors say such delays claim the lives of dozens of Iraqis every week.

“Violence is increasing and emergencies are our daily reality. Some people died on Wednesday for lack of medicines and others because of a lack of staff. Not enough doctors are left in Iraq and sometimes nurses have to step in and perform their [doctors’] duty to help save lives,” Azize added.

For some time, doctors and emergency services workers in Iraq have been urging the government in Baghdad and NGOs to provide them more medical supplies to cover their needs during big bomb attacks in the country.

“We have constantly been explaining our situation to the concerned NGOs and the government but unfortunately the situation is worsening rather than improving,” said Dr Ibraheem Ahmed, a physician at Yarmouk hospital, Baghdad’s main emergency hospital.

“Most of the time we have to ask relatives to go to a nearby pharmacy and buy some medicines or even syringes to help save the lives of the injured. We are forced to use adult syringes for children,” he added.

Ambulance shortage

Compounding the problem is a shortage of ambulances, equipment and ambulance drivers to transfer patients to hospitals during attacks. The emergency services often depend on civilians, who typically lack any medical knowledge, to transport the injured to nearby hospitals. Some-times, by the time they reach hospitals the injured are dead simply because they were put in a car incorrectly, doctors say. “Last Wednesday [18 April], we had to put five or six injured people in an ambulance at the same time because there were so many injured people and we only had three ambulances,” said Abu Safwat, an ambulance driver in Baghdad. “Taxi drivers and private motorists started to help but with the streets closed and the crowded situation, by the time they reached the hospital, they were already dead.”

Child mortality reaches new heights

A recent report by the USbased NGO Save the Children says that although Iraq’s under-five mortality rate is in the middle range when compared to other developing countries, it has worsened faster than in any other country.

Observers say the main reason for this is the continuing violence and lack of funds for the health sector. “Never in Iraq’s history have so many children died because of diseases and violence.

The mortality rate among them has jumped to a level which will require years to be controlled,” said Dr Jaffer Ali, a senior official and paediatrician in the Ministry of Health.

“In Iraq, children are dying from the easiest curable diseases worldwide like diarrhoea and pneumonia but with the deteriorated health situation in the country, the increase in the number of malnourished children and thousands of displaced living in poverty conditions, the possibility of reducing this high figure is remote,” Ali added. According to Save the Children’s report ‘State of the World's Mothers’, released on 8 May, 50 Iraqi children died per 1,000 live births in 1990.

Today, the rate is 125 per 1,000 births, more than double. The organisation said some 122,000 Iraqi children died in 2005 before reaching their fifth birthday. More than half of these deaths were among newborn babies in the first month of life.

Pneumonia, diarrhoea

“Pneumonia and diarrhoea are the other two major killers of children in Iraq, together accounting for over 30% of child deaths. Only 35% of Iraqi children are fully immunised, and more than onefifth are severely or moderately stunted,” the report said.

Specialists said the remaining deaths resulted from the daily violence which has been taking the life of innocent infants.

“It is rare to see an explosion in which a child is not a victim. Schools have been attacked constantly and families targeted in which children are killed in cold blood,” said Professor Abdel-Rahman Khalif, a human rights specialist at Mustansiriyah University in Baghdad.

Years of conflict

The Save the Children report also said that even before the US-led invasion in 2003, children were facing a grave humanitarian crisis caused by years of repression, conflict and external (UN-imposed) sanctions.

“Since 2003, electricity shortages, insufficient clean water, deteriorating health services and soaring inflation have worsened already difficult living conditions,” the report said.

“The priority in Iraq should be the health of the population but unfortunately this is being put aside and treated as an afterthought after many other sectors have been looked after,” Ali from the Ministry of Health added.

Medicines distribution flawed

The centralised distribution of medicines in Iraq has meant hospitals have not been able to stock sufficient quantities, some doctors and analysts say.

At present, every drug entering Iraq has to be tested by Kimadia, the government department responsible for quality control of medicines. Kimadia has 10 main storage warehouses in Baghdad, as well as depots in Basra, Mosul and Arbil, and regional warehouses in each of Iraq's 18 provinces. All drugs go through the same procedure, regardless of their origin, or even if they have already been tested by the World Health Organisation (WHO).

“The quality control [system] is overwhelmed, as Iraq is now importing more medicines than before. The centralisation of the administration makes quality control very slow due to bureaucracy, deteriorated security and lack of staff,” said Cedric Turlan, information officer for the Non-Governmental Organisations’ Co-ordinating Committee in Iraq (NCCI). It can take weeks, and sometimes months, for drugs to be tested. A consequence of this has been an increase in the smuggling of untested drugs.

“The quality control laboratory was also looted and is being rehabilitated. It is currently working at a much reduced capacity,” he said, adding that large-scale incidents led to shortages, and it took a long time before stocks could be replenished.

Security situation Rashid Fae'ek, an epidemiological and public health analyst, however, rejects the idea that the main problem lies with the centralised distribution system. He points, instead, to the inability of the authorities to function properly because of the security situation.

This has led to attacks on health centres, and staff abandoning their jobs or not being able to get to work. “The security situation has deteriorated in Iraq and the increase in the number of attacks against health professionals has prevented the public health system from working properly.

Every decision should be taken by the Ministry of Health which is short of professionals,” Fae'ek said. “The health system in Iraq isn't neutral anymore. Different fighting factions are attacking clinics and hospitals or targeting health professionals and thereby delaying the whole process as most of the professionals abandon their work or flee the country to survive, leaving a serious gap countrywide,” he added.

The distribution system was not faster under Saddam Hussein's regime but the security situation, the lack of access to some areas, logistical problems and gaps in some stages of the decisionmaking process were not at today's level, he said.