Dispatch From Iraq

International Rescue Committee
Thursday, 14 August 2003

A Visit From the Governor; Brucellosis; and the Kirkuk Clean Up Team

The IRC's public health program has started in the northern city of Kirkuk under the supervision of its new health manager, Dr. Ayoub Abdul Hameed. Eighteen Community health workers last week began visiting impoverished households in the city's rural surroundings while IRC medical teams provided the remotest areas with mobile health services and vaccinations. The landscape surrounding the road to the settlement of Al-Wessat south of Kirkuk is flat, dusty and harsh. Gusts of hot wind are whipping up sand and dry bushes tumble across the plain. Our car is soon covered with a layer of brown desert sand.

"People out here have never had any medical services," says Dr. Ayoub as the car struggles to avoid holes and rocks on the dirt track. "They are only seeing a doctor when they face something life-threatening."

"The water and electricity supply is very bad and diseases like typhoid and brucellosis - a bacteria spread by animals - are very common," he adds. "And many people have undiagnosed diseases, because we haven't got adequate facilities to test them."

"There is also a shortage of tuberculosis vaccine and we have not enough refrigeration facilities for vaccines."

Al-Wessat consists of some 40 mud-brick houses in uneven shapes and the residence of village chief Fadhel Al-Waan is soon filled with people lining up in front of Dr. Ayoub and his colleagues. IRC's community health workers meanwhile spread out in five teams who go from house to house, disseminating their health messages and gathering health data from the households.

Laboratory assistant Jumma Mahmud is taking blood samples which will later be analyzed in Kirkuk's central hospital for the most common parasites.

"Apart from many villagers with diarrhea and anemia, I have seen four cases of suspected typhoid, two severely malnourished children and two cases of brucellosis," Dr. Ayoub says, wiping the sweat from his forehead during a break.

As the day draws to a close, the overall health status of the village has been established and most children have been immunized against hepatitis, tetanus, polio, diphtheria and measles. The high-pitched screaming of newly-vaccinated children still ring in my ears as we are driving back on the bumpy, dusty road to Kirkuk.

The IRC has also completed rehabilitation work on the first clinic in the north. A total of US$ 4,700 has been spent fitting the Galose clinic near Kirkuk with new doors, windows and electric wiring. Work on the nearby Kelwar clinic is slated to begin next week. A total of 15 clinics in dire need of repairs have been identified.

"But we are concentrating on four clinics around Kirkuk to begin with," added IRC's new environmental health manager Fakhir Ibrahim.

The streets of Kirkuk are getting cleaner by the day. Every week some 900 tons of garbage is transported by IRC-contracted workers from the city's pavements, parks and squares to remote dumpsites.

"We are working in four out of the city's 36 sectors at the moment," IRC's chief supervisor for the project, Ahmed Ares, explains as we are standing next to a minor mountain of garbage in a residential area of central Kirkuk. " But we will double it next month."

The decaying refuse is spreading an intensely bad smell in all directions and a small group of workers wearing t-shirts displaying the IRC logo over the text "Kirkuk Clean Up Team" is shoveling plastic bags, bottles, bones and other garbage into a tractor trailer. Some 130 workers equipped with over 30 tractors, tippers and front-end loaders are working on the project.

In another part of the city IRC-workers are carrying out the work of clearing Kirkuk's clogged-up sewage system.

The street outside the Hussein apartment is filled with a black, thick and smelly liquid covered with green algae.

"This is what used to block the sewage system," one of IRC's contractors Ibrahim Asis explains, shaking his head.

A high-pressure jetting truck is flushing out the sewerage network, sending the thick substance into nearby manholes. Asis' workers are then lowered into the pits, manually emptying them of sewage using buckets.

The Hussein apartment blocks (up until recently called the Saddam apartments) were built by North Korean contractors in 1987 in Saddam Hussein's "Arabization" scheme, aimed at changing the demography by moving Sunni Arabs into Kurdish areas like this one.

One of the residents, a middle-aged Arab man named Khaled Feisal, explains that some 14,000 people live here and that the flats are gradually falling apart.

"This is the first time sewage has been taken up," he says.

Residents here and elsewhere in Kirkuk continue to complain about the lack of security. Crime remains high and attacks on US forces in Kirkuk occur frequently; two American soldiers were wounded when a patrol came under rocket-propelled grenade and small arms fire in the city on 9 August.

The IRC sub-office in Kirkuk, located in a two-story building in the south of the city, is now operational with a support staff of some 25 people.

Work on five compact water treatment plants serving some 5,500 people in Kirkuk has stalled. Contractors have already been identified and the repairs should have begun last week, but newly introduced procedures by the local Ministry of Water have delayed the project. IRC is currently in the process of getting approval with the proper authorities in Baghdad.

Eight projects in the so-called collective towns of Daratu, Benaslava, Basirma and Balqos have now started under IRC's environmental health program, funded by the US State Department for the three northern Governorates. The projects, each worth US$20,000 or less, emphasize quality environmental health services in their respective regions.

The collective town of Basirma, some 80 kilometers north of Erbil, is surrounded by majestic mountains and fields dried to a pale yellow by the blazing sun. A flock of sheep is grazing in the distance. Saddam Hussein moved people from villages in the surrounding mountains to this settlement, in order to control the population and deprive the Kurdish guerillas of safe-havens.

"Saddam knew that the Kurdish guerillas were hiding among the people in the mountain villages," says Khalil Maulud who has lived here with his family since 1988.

Maulud was himself a guerilla, known here as Peshmergas, and saw action in the battle for the nearby town of Salahaddin during the Kurdish civil war in the 1990s between The Patriotic Union of Kurdistan and its main rival, the Kurdish Democratic Party.

The IRC has launched US$ 40,000-worth of projects in Basirma through local NGO Kurdish Relief Association. The work includes the restoration of the local health clinic and renovation of the water network.

"Water pipes have broken in 600 places," says the program's Environmental Health Coordinator Biserka Pop Stefanija. "We will repair these as well as leaking water reservoirs. We are also constructing a water ditch."

"The Department of State-funded program has a total of 24 projects in the pipeline," says IRC Program Director Christina Munzer.

"We are reviewing 14 projects at a meeting this week," she continues. "Seven projects are located in Sulaymaniyah, four in Dohuk and three in Erbil, totaling US$ 226,100. The remaining ten projects, totaling US$ 191,757, will be reviewed at a meeting in early September."

Projects under consideration include first aid training for youth, health education and promotion for women, health center rehabilitation, capacity building of health staff and provision of basic medical supplies, latrine construction, garbage collection, drilling of deep wells, and construction of pump houses and water tanks.

In other developments, the IRC's proposal for five Citizens Advice Centers in the northern Governorates was rejected this week by the approached donor, the United Nations Office for Project Services. The UN agency cited financial constraints and the fact that the UN Oil-for-Food program is closing down permanently in November. The proposal aimed at staffing the centers with local government staff, which would receive extensive training enabling them to provide ongoing support and advocacy for IDP's and vulnerable groups.

In news from IRC's programs in the south of Iraq, repairs on nine compact water treatment plants have now been completed in Karbala, serving over 9,000 families - an estimated 60,000 people. Fences will be put up around the plants this week.

Six additional water treatment plants were rehabilitated in nearby Najaf in the past week. Thirty-one villages, benefiting more than 40,000 people, have now been fully rehabilitated in and around the city.

Following a request from the Department of Water and its Director Taufig Amure Sahl, the IRC also repaired a leakage on the pipes in one of the three main water storage tanks in Najaf town.

IRC southern health department this week distributed badly needed equipment such as surgery kits, nebulizers, and thermometers for the Shimaliya and Shiriah clinics in the rural outskirts of Karbala. The clinics serve approximately 6,000 people.

"Shimaliya is in very bad condition," says IRC's health manager in the south, Dr. Saeb Muhammad Ali, who also requested a contractor to review costs for minor repairs to the Shiriah clinic's windows, locks, tanks, and lights.

"These minor repairs have changed the clinic substantially and even led to a visit from the Governor of Karbala," he adds.

"Six community health workers have been selected for Shimaliya and Shiriah clinics and their training finished this week. The health promoters then spent six days working with their communities."

To date, over 3,100 families have received health advise by IRC Community Health Promoters in the Karbala area. The IRC has provided training courses in hygiene promotion, basic sanitation, and referral to a total of 88 community health workers in the city and its environs.

The IRC has now repaired and equipped six health clinics in the Karbala Governorate - Oroba, Nasser, Hur, Husseiniya, Shimaliya and Shiriah. These clinics serve approximately 160,000 people. Repairs this week started on the Jadwal al-Garbil and Mushorab clinics in Karbala Governorate, serving almost 50,000 people.

"The Jadwal al-Garbil clinic was in good condition and required only minor support," said IRC's Regional Coordinator in the south, Denis Dragovic. "The Mushorab clinic is in need of support both for equipment as well as infrastructure needs. A list of needs is being prepared and equipment will be purchased in next week."

In the past week, the IRC met with the doctor in charge of purchasing equipment for hospitals in Karbala, Dr. Adel Al Masroudi, to discuss the distribution and allocation of equipment supplies procured by the IRC. These supplies include basic medicines, bandages, cotton and syringes, worth US$ 24,000 in total. An idea that was also broached in the meeting was the use of IRC-procured beds, tents and medical tables to establish mobile clinics around the Shiite holy shrines in Najaf and Karbala during religious events and other busy periods, when many people require medical attention.

In other health news from the south, 700 hygiene kits were distributed last week through the community health outreach program in the poor, rural communities of Shimaliya and Shiriah. Each family was provided with one kit and those with more than 20 persons in the family were given two. Eight local NGOs, including the Iraqi Red Crescent Society, distributed the kits. The IRC has distributed 3,590 hygiene kits so far.

"Proposals for the distribution of hygiene kits were received from eight Iraqi NGOs and were evaluated according to the method of distribution, needs of beneficiaries, experience, capacity, and proposed record keeping," Denis Dragovic explains.

Work on clinics in and around Najaf started last week, with missing equipment being bought and distributed for the Hamman and Abassiya clinics. The IRC also launched training for 16 and 18 health promoters in Hamman and Abassiyia respectively.

IRC has now completed minor repairs on four clinics in the Najaf area: the Abbasiya, El Hur, Hiddarriyah and Manadera clinics, serving some 145,000 people. Community outreach and health promotion was conducted in these communities this week as well.

Kevin Reinhart, IRC's Coordinator for the IDP Citizens' Center in Karbala, this week reported that the project's recently hired lawyers traveled through villages surrounding Karbala in search of people who, in order to avoid becoming drafted into Saddam Hussein's army, did not register their marriages with the state.

"This has meant that they could not get family ration cards, and in some cases their kids could not go to school or use the health clinics," says Reinhart.

"Our lawyers record the details, check the religious contract under which they were married, arrange photographs of the children, write the petitions, and see that the petitioners show up in court on the proper dates," he adds.

"We expect to have all the villages done in a week, and then begin on the larger concentrations of the displaced here in Karbala proper."

In Baghdad the security situation has not improved in the slightest. Attacks on Coalition forces continue on a daily basis and the level of crime is very high. Anti-Coalition ambushes are also becoming more sophisticated. In some cases a group of attackers will hit a convoy and withdraw, leaving a second group to wait and subsequently attack the reaction force.

US forces has received intelligence reports that hundreds of Islamic militants who fled Iraq during the war have returned and are planning to conduct major terrorist acts throughout the country.

A car bomb exploded in front of the Jordanian Embassy on 7 August, killing 11 people and wounding 65. It is believed that the bomb was hidden in a minibus and remotely detonated. Two UN national staff members were injured in the explosion. The same day the Information Officer witnessed a severe gun battle between US Forces and suspected attackers on Karrada, one of the main shopping streets in Baghdad, only a few blocks away from the IRC office. Soldiers lobbed grenades and fired heavy machine-gun rounds into a shop in which the attackers were presumably hiding. The shop caught fire, sending a pillar of black smoke into the bright blue afternoon sky. Apache helicopters were hovering above and at least one dead civilian could be seen in a vehicle caught in the crossfire. At least two US soldiers were wounded in the attack. The fate of the attackers was unknown, according to soldiers at the scene.

International civilians are targeted as well, albeit on a smaller scale. A grenade was thrown over the wall of the NGO Handicap International's compound on 9 August. There were no casualties but several vehicles were damaged. The motive of the attack is unclear. The following night, two improvised explosive devices went off a few hundred meters from the British Embassy.

"Extremists are becoming more professional, and apparently have started to target high-profile non-military targets," observed IRC Security Coordinator Michael Niedermayr.

On 11 August, security officials outside the premises of UNDP, not far from the Sheraton Hotel in central Baghdad, saw a person placing a bright yellow bag near the premises. After investigating they discovered two grenades in the parcel. It is assumed that the bag was left for someone else to collect later and lob the grenades over the wall of the compound of the UN agency.

The southern city of Basra and neighboring cities saw several violent incidents and demonstrations over the past week, sparked by the lack of fuel and electricity. Surprisingly, pictures of Saddam Hussein are also starting to appear throughout this predominantly Shiite city.

Private vehicles, including NGO cars, were attacked with stones and burned. Some demonstrators were armed with hand grenades. Attacks on USAID vehicles occurred on 9 and 10 August, resulting in at least one death.

"We are taking appropriate measures in response to the security situation," said Niedermayr. "We are moving in two-car convoys and always in unmarked cars when traveling between cities. And as of today our drivers in Baghdad and Najaf are equipped with VHF-radios in addition to the satellite phones carried by international staff."

"We have a security management plan in place and should the situation deteriorate further, we will move all IRC staff to the relative safety of Erbil in northern Iraq."

For more information, or to contact International Rescue Committee, see their website at: www.theirc.org