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Below are what I think are some interesting paragraphs from the full World Food Programme report about their Iraq relief operation, which runs in parallel with Food-for-Oil, mentioned in a news article Harriet sent to the list this morning. The full (18 page) report is at http://www.wfp.org/eb_public/EB.1_99_English/682e98.pdf . The WFP's page is at http://www.wfp.org/OP/Countries/iraq.html . WFP/EB.1/99/7-A/2 21 December 1998 PROTRACTED RELIEF AND RECOVERY OPERATION [PRRO] - IRAQ 6085.00 [...] 5. The main reason for outstanding nutritional problems is the massive deterioration in basic infrastructure, in particular water-supply and waste disposal systems. For example, it is estimated that access to potable water is currently 50 percent of the 1990 level in urban areas, and only 33 percent in rural areas. Deterioration of waste disposal systems is equally severe. The most vulnerable groups have been the hardest hit, especially children under five years of age. Throughout infancy they are subject to the vicious circle of exposure to unhygienic conditions (especially in urban centres), leading to diarrhoea and diseases which negatively affect nutritional status, which in turn reduces immunity to disease. [...] 11. The principal reasons for high rates of malnutrition in Iraq are: a) The inadequacy of water and sanitation infrastructure and services and the resulting high incidence of diarrhoeal and other water-related diseases. Addressing these problems is extremely challenging as the health care infrastructure in the country, which has traditionally had a curative orientation, is not equipped to address commonplace and chronic health problems. b) Lack of necessary micronutrients in the SCR 986 general ration. Although the ration meets basic caloric requirements, it is deficient in several nutrients which are essential to children’s normal growth and development (such as iron, Vitamin A, and some of the B group vitamins, notably folic acid). The effects of such deficiencies on the health of children, as well as women, are well known. Of these, the high prevalence of anaemia in Iraq is especially notable. Furthermore, for children already suffering from malnutrition, recovery and catch-up growth can only occur through the provision of additional, nutritionally appropriate foods. c) The fact that primary health care has not been a priority concern has led to the absence of basic health education. Thus, child care and other health-related practices are often not in line with best medical practice. A centralized approach to health care has also meant that there has been little community outreach. While such a system may serve the needs of a generally healthy population under 'normal' conditions, its weaknesses become evident in times of emergency and chronic nutritional stress. d) Inappropriate infant and child care practices. According to the UNICEF/MOH survey of March 1998, only 15 percent of children are breast-fed exclusively in the first six months of life and only one third of children are given no semi-solid/solid food between the age of six and nine months. When sanitary conditions are poor, the importance of exclusive breast-feeding on promoting good nutritional status and reducing infant morbidity and mortality increases. The WFP-supported programme will therefore actively sustain the training of mothers, through the Iraqi Red Crescent Society centres, in appropriate breast-feeding and infant and child care practices. 12. Because of the above outstanding problems of malnourishment, especially among children under five, intervention is required immediately to improve the nutritional status of children while the root causes of the problem are addressed through the larger intersectoral approach. [...] Risk Assessment 42. Implementation of the PRRO in Iraq is dependent upon several key external factors. These include: a) political stability/security to provide an environment within which programme activities can be implemented. The threat of both internal and external conflict must necessarily be factored into the success of the PRRO. b) The performance of the United Nations Oil-for-Food Programme. As the WFP operation is planned around the continuation (and improved performance) of this programme, any interruption or cessation of the agreement will affect the parallel assistance provided by WFP. [...] [the rest of the extracts, from the same report, re-state UNICEF malnutrition findings from March and October 1998] 3. In spite of the availability of the general food ration, and the above parallel assistance measures, there continue to be outstanding health and nutritional problems within the Iraqi population, particularly among children under five and their mothers. The most comprehensive statistical information on trends in malnutrition among young children has been collected by UNICEF in collaboration with the Ministry of Health (MOH). Results of this survey, conducted in March 1998 indicate that the malnutrition rate among children under five in centre and south Iraq is 22.8 percent underweight (low weight-for-age); 26.7 percent chronic malnutrition (low height-for-age); and 9.1 percent acute malnutrition (low weight-for-height). The figures for the Northern governorates are somewhat better, with 15.1 percent underweight, 25.3 percent chronically malnourished, and 2.7 percent acutely malnourished. No significant differences were found between rates among male and female children in any of the governorates.[1] 4. UNICEF and the Ministry of Health carried out another survey of the nutritional status of infants in the centre and south (0-11 months) in late October 1998. Preliminary results, available in early November, were consistent with those of the March survey and of a similar UNICEF/MOH survey conducted exactly one year previously. Rates for the two years were as follows: * general malnutrition (underweight for age): 14.7 percent in October 1998 against 14.6 percent in October 1997. * acute malnutrition (low weight-for-height): 8.3 percent in October 1998 against 7.5 percent in October 1997. * chronic malnutrition: (low height-for-age): 11.7 percent in October 1998 against 12.2 percent in October 1997. [...] [1]:Caution must be exercised in the interpretation of these results, as the sample was taken from primary health centres and is not necessarily representative of the entire population. However, they are believed to present a reasonably accurate picture of the general situation. 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