The allied attack on Iraq in January-February 1991, and the hardship inflicted on the civilian population, prompted many UN agencies and non-governmental organizations to mobilize relief efforts in the country. I spent seven weeks in May and June leading a relief team in southern Iraq. Relief work was already underway in the Kurdish north, in the center (Baghdad) and in the largely Shi‘i south.

In the north, the Iraqi government, over the last decade, had forcefully removed many Kurds from rural to urban areas, and destroyed their home villages. After the allied assault this spring, many of these already displaced Kurds fled to Turkey, Iran and their home villages. The relief agencies, wishing to maintain a presence in the country, faced a dilemma. Relief work that was appropriate in the February through April period became inadequate later on, as some of the population needed aid that would help them settle in their original villages. Response to such demands from the local population put the aid agencies in direct confrontation with Baghdad.

Relief work in Baghdad was logistically the simplest and was encouraged by the government, but should not have been a priority. Most relief agencies brought in hardware, medicine or food, thinking that the items were in short supply, but soon discovered that they existed in abundance in the main stores in the capital. They concluded that there were sufficient supplies in Baghdad, and that they should divert relief efforts to other areas which are not a priority for the government.

Southern Iraq posed a completely different challenge. Over the last ten years, Iraqis in many areas of the south have been subjected to three serious armed conflicts: the Iraq-Iran war, the Gulf war of 1991 and the uprising that followed Iraq’s withdrawal from Kuwait. All three caused heavy damage to private and public properties, and severe destruction to agricultural land. Basra University has estimated that 80 million palm trees, more than 90 percent of the total, have been destroyed in the Basra governorate alone. Health centers and government-owned or -run installations were either heavily looted or destroyed. Schools were vandalized and looted; some even lost chairs and blackboards. In Basra, the largest city in the south, electricity cuts over extended periods aggravated the damage to sewage installations: All pumping stations were flooded, causing total destruction of vertical pump motors and electric control boards. In densely populated areas of the city, this caused flooding in ground floors (in most houses the only floor) with sewage to a depth of half a meter. This situation, coupled with the restricted availability of government subsidized food and the two- to fivefold increase in prices of most basic items, resulted in alarming health and nutrition conditions for the local population in general, and for children and mothers in particular.

The government, and the relief agencies which operated in Iraq prior to the outbreak of the war in January 1991, were not ready for the situation that prevailed after the war. Agencies were understaffed, and operating budgets were a small fraction of what was required. Even today, the heads of departments responsible for health, water/sanitation and electricity do not seem to incorporate in their action plan the fact that unless the embargo on Iraq is lifted it will be impossible to restore services to pre-war levels. The war has produced a new environment which requires action that is imaginative, creative, less costly and, most important, responsive to the present needs of the various communities. The health system has to respond to the facts that Iraq is facing diseases that did not exist before the war and that medical staff need reorientation and training. The failure in water and sanitation, coupled with an increase in malnutrition, necessitates more emphasis on primary health care, and reliance on preventive rather than curative medicine.

Most agencies in Iraq concentrated on sending in food, medicine, milk and high-protein biscuits. A few helped with hardware -- for example, kerosene refrigerators or generators for hospitals, and pumps to help restore the operation of water or sewer networks. All agencies followed sectoral approaches, which were not well coordinated. Input in one sector sometimes nullified the benefit of an input in another. The same agency, for instance, would provide medicine to treat waterborne diseases, and at the same time make substantial contributions to restore the operational capacity of the water supply systems; in many cities of the south (especially Basra and Amara), sewage drainage installations were non-operative, so that the restored water supply caused extensive sewage flooding in the streets, resulting in a continued high incidence of waterborne diseases.

Agencies had difficulty mobilizing Iraqi people to be involved in the restoration of basic services and economic recovery. The government discouraged community-based work. The majority of the population works for enterprises owned by the government. In one town in the south, almost 80 percent of the work force were government employees or in the army. Further, the government kept expectations high by promising that public services would be quickly restored to previous levels.

Reports coming out of Iraq led many people to believe that things were improving quickly, and especially that basic public services were being restored. Except for Baghdad, though, the general situation in Iraq soon reached a plateau. The government rapidly used all available spare parts (new or retrieved from damaged equipment) to restore services at an amazingly quick pace. But since there was no strategy and clear plan, this progress was soon thwarted by the inevitable shortage of spare parts essential for maintenance. Most installations were running with no standby equipment. All agencies in Iraq are facing more pressure from local governments to increase the hardware they bring in, particularly spare parts for health, electric, water and sanitation facilities. But sustaining the infrastructure is beyond the financial capability of all the NGOs and the UN agencies. The government is unwilling to admit the restrictions on its capabilities and does not want to mobilize the population to help confront the situation. The only salvation for the Iraqi people seems to be the lifting of the economic embargo.

For the first couple of weeks after the end of the war, NGOs had considerable freedom of action in most of Iraq due to the prevailing disarray and confusion, and had substantial policy input into direct relief efforts. As the Iraqi government has regained control, only NGOs that are willing to implement projects and schemes designed by government ministries will have a future in Iraq. As control increases, the government will probably squeeze out of the country any NGO which fails to abide by the plans of the ministries.

The UN approach of allowing the Iraqi government to export oil to purchase food, medicine and equipment needed to operate public utilities will render financial assistance to Iraq redundant. Some NGOs and UN agencies will still have input in the form of assisting the government to implement various projects, but the priorities will be defined completely by the authorities in Baghdad. This is a turning point which must force all relief agencies to contemplate the extent, if any, of their continued involvement in Iraq.