Evaluation of food and nutrition situation in Iraq

Terminal statement prepared for the Government of Iraq by the Food and Agricultural Organization of the United Nations, Rome, 1995

V. Conclusions and Recommendations

The situation throughout the country is increasingly disastrous with economic decline spreading across almost all sectors of Iraqi society. Of particular concern to the Mission is the ability of the country to feed itself and to provide a quality system of health care. Malnutrition is widespread affecting nearly all social groups throughout the country with as many as 12% of children surveyed in Baghdad wasted and 28% stunted. If no action is taken the nutritional situation will undoubtedly get worse, and rates of child mortality will increase.

Despite the complexity of the problems, both the cause and the solution are, in principle, clear. Without hard currency the country cannot purchase food, medicines, spare parts, machinery, fertilizers, seeds, herbicides and other agricultural inputs. The reduction in imports combined with the resultant decline in agricultural production has led to a serious reduction in the amount and quality of foods available for consumption by the population. This reduction in availability is aggravated by hyperinflation (also caused by the inability to generate foreign exchange), as many families do not have sufficient money to purchase the food which is available in the market place. In a parallel manner, without spare parts for pumps and other needed material for the water supply and sewage disposal system, impure water and sewage backups produce severe health risks for the population. The combination of decreased food availability and the occurrence of infectious disease results in increasing malnutrition especially in children.

Although the Security Council Resolutions permit the importation of food, health and other basic necessities from Iraqi frozen assets, insufficient funds from these assets have been released for humanitarian purposes. As a consequence the amount of food required and the supplies needed to produce and process food have been far in excess of the amounts the GOI has been able to import with its limited foreign exchange. Further, although the resumption of sales of oil has been extensively discussed, the embargo on such sales has not yet been lifted. It is unlikely at the present time that the donor community will come forward with the resources needed to make up for the shortfall and in view of the deteriorating nutrition and health situation throughout the country the reduction in aid is a matter of grave concern. If this situation is allowed to continue the result will undoubtedly be even further deterioration in the nutritional status and health of large sections of the Iraqi population. There is a strong possibility of an outright collapse of the food and agricultural economy which would cripple the food ration system and lead to widespread famine and hunger.

A. Food Production and Access

1. The only viable long-term solution is for Iraq, a potentially rich country, to use its own resources for earning foreign exchange and hence be able again to feed itself and provide for the sick and vulnerable. The GOI and the Security Council are urged to come to an agreement on the sales of oil so that these needs can be met.
2. > Recognizing that Iraq faces enormous shortages of basic foods in 1995/96, the Mission urges that the country be enabled through appropriate and agreeable mechanisms to import necessary foods to feed its population. The estimated foreign exchange required for the purpose is US$ 2.7 billion.
3. Recognizing that rehabilitation and promotion of the agricultural sector has a crucial role towards ensuring food security in the country, the Mission recommends that suitable arrangements be made urgently to enable Iraq to import on a priority basis agricultural machinery including those used in drainage/irrigation work replacements and spare parts - and necessary seeds, fertilizers, pesticides and herbicides for the rehabilitation of agriculture.
4. Taking into account the linkages between nutritional status, health, and the quality of water and sanitation the Mission also recommends the importing of spare parts and equipment to ensure adequate access to potable water and the safe disposal of sewage material.
5. Recognizing the deterioration in the whole health care system including hospitals, clinics and primary health care facilities, the procurement of needed medical supplies, equipment and diagnostic material including essential drugs is urgently required.
6. Such suitable arrangements could entail the authorization by the Security Council of the release of additional funds, in particular from Iraq's frozen assets, for the import of the essential items mentioned above through a mechanism that both G0I and the Security Council would recognise and accept. FA0 can play a significant role in facilitating these actions, parti- cularly in the case of seeds, fertilizers, pesticides, herbicides and spare parts and providing institutional support.
7. Recognizing that the most vulnerable people need food assistance for survival, the Mission urges that the WFP food assistance be restored to previous levels and provided regularly for the targeted beneficiaries throughout the country on the basis of need (in both the North as well as in South and Central Iraq).

   B. Nutritional Status

   Because of the increasing cost of food and decreasing purchasing power, the ability to secure a balanced diet is increasingly unavailable to the vast majority of the population and nutritional status continues to go from bad to worse. If no additional funds or resources are provided the Mission recommends that the following steps should be taken:

8. In the light of the reduced public food ration the G0I should as far as possible ensure the ration is nutritionally balanced, in particular with regard to good quality protein, oil and micronutrients.
9. It is recommended that WFP give consideration to increasing the amount of rice, pulses and oil, essential items in the Iraqi diet, in the food aid they provide, particularly for consumption in social institutions and hospitals.
10. In order to improve the nutritional status of school children as well as those not attending school, the Mission recommends that a) food aid be provided to children through school feeding programmes and b) new programmes should be developed to address the needs of the increasing population of street children in the large cities.
11. Recognizing the need for households to supplement the ration with nutritious and least expensive foods, the continuation and expansion of current mass media campaigns in nutrition education is encouraged. How best to utilize the food available at the household level, how to prepare appropriate weaning foods and the benefits of breastfeeding are examples of important nutrition messages. Breastfeeding is particularly important given that the effects of malnutrition on mortality is much greater in the absence of breastfeeding.
12. The Mission endorses the various actions taken by the Government and UN agencies to improve nutritional status such as salt iodization, vitamin A supplementation with EPI and the establishment of nutritional rehabilitation centres and calls for their continuation and expansion.
13. The Mission views with concern the increasing prevalence of iron deficiency anaemia in both children and pregnant women and recommends the expansion of iron supplementation programmes. The distribution of anti-helminthic drugs would also be of value here. The Mission believes that the fortification of flour with iron as well as other micronutrients such as calcium, thiamine, niacin and lysine, while desirable is unrealistic in the present circumstances.
14. It is recommended that an appropriate Agency be charged with examining the overall problems and deficiencies in the health system in Iraq with the view to provide advice on the most cost- effective ways to utilize limited resources for delivering promotive and preventive health care.
15. The Mission calls for the continuation and expansion of public health campaigns. Simple messages such as promoting the boiling of drinking water and safe sanitary practises are effective in reducing the occurrence of infection, especially among children under the age of 5 years.
16. In order to improve the efficiency of corrective actions and to establish priorities in the allocation of the existing resources, including targeting of food aid to the most vulnerable groups, it is recommended a nationwide nutrition surveillance system be set up in Iraq with special emphasis on urban and peri-urban areas. An outline of a proposal for monitoring the food and nutrition situation is presented in Annex 2.
17. Given the critical health and social problems confronted by the population, the Mission recommends that academic and governmental institutions should be encouraged to perform relevant applied research and intervention programmes in nutrition and public health.
18. The Nutrition Research Institute and appropriate Governmental agencies should strengthen their efforts to reduce the number of products on the market which contain non-food grade components and do not meet minimum standards of food safety. FAO can provide assistance to the Government in this area if requested.

Selected Tables

(a) January to July
Source: Government of Iraq, Vital and Health Statistics Department.

(a) Selected causes include respiratory infections, diarrhoea/ gastroenteritis, and malnutrition.
Source: Government of Iraq, Vital and Health Statistics Department.

1 Reference period for infant mortality includes all children born between August 1989 and July 1990. Reference period for child mortality includes all children born between August 1985 and July 1990.

2 Index period (during economic sanctions) for infant mortality includes all children born in the year prior to the date of interview (September 1994 to August 1995). Index period for calculation of child mortality includes all children born from August 1990 to the date of interview (under the age of 5).

1 Reference period for infant mortality includes all children born between August 1989 and July 1990. Reference period for child mortality includes all children born between August 1985 and July 1990.

2 Index period (during economic sanctions) for infant mortality includes all children born in the year prior to the date of interview (September 1994 to August 1995). Index period for calculation of child mortality includes all children born from August 1990 to the date of interview (under the age of 5).