Action points based on findings

·         Further develop a sustainable mechanism to collect information on ongoing mine/explosive remnants of war (ERW) casualties and their needs in southern and central regions of the Republic of Iraq. It is certain that there were many more casualties in Iraq in 2013 than those that were identified.

·         Increase participation of survivors and their representative organizations in the planning and coordination of victim assistance and disability issues throughout all of Iraq.

·         Ensure equal access to all services and benefits for both male and female mine/ERW survivors.

Victim assistance commitments

Iraq is responsible for significant numbers of landmine survivors, cluster munition victims, and survivors of other ERW who are in need. Iraq has made commitments to provide victim assistance through the Mine Ban Treaty and has victim assistance obligations under the Convention on Cluster Munitions.

Casualties

Casualties Overview

Details and trends

In 2013, the Monitor identified 124 mine/ERW casualties in Iraq.[1] Of these, 56 occurred in the Iraqi Kurdistan region in northern Iraq (Kurdistan) with the remaining 68 in central and southern Iraq. Following the establishment of a casualty data collection mechanism by the Directorate of Mine Action (DMA) in 2011, the DMA became the main source of casualty data in central and southern Iraq for 2013 for the first time since the Monitor began recording casualties in 1999, reporting the majority (51 of the 68) of casualties identified there. Prior to the DMA providing the data, the main source of casualty data reported by the Monitor for most of Iraq was gathered from media scanning.

All but 11 of the casualties identified in 2013 were civilians.[2] Six of the civilian casualties were Iranian nationals. Children made up 28% of civilian casualties for which the age was known (16 of 57), a decrease compared to 48% of the casualties identified in 2012.[3] Of the total child casualties, most (14) were boys; two were girls.[4] More than two thirds of child casualties (11 of 16) were caused by ERW. As in previous years, men made up the single largest casualty group, representing 65% of civilian casualties for which the age was known. There were at least four casualties among women in 2013.[5] There were six casualties reported among deminers; this represented a decrease compared to the seven deminer casualties in 2012 and the 20 deminer casualties in 2011.[6] All reported casualties among deminers occurred in Iraqi Kurdistan; one was a Serbian national.[7]

Iraq included eight casualties from submunitions in their 2013 Convention on Cluster Munitions Article 7 reporting that were not noted as such in the data submitted by the DMA to the Monitor.[8]

It is certain that there were many more mine/ERW casualties in Iraq that were not identified. This is due to a combination of factors, including the capacity of the DMA’s casualty data collection mechanism which is improving but still limited. In 2013, the DMA indicated that “there is no accurate data for mine and ERW casualties in Iraq.”[9] Media coverage of casualties is also far from comprehensive in Iraq.

The 124 casualties identified in 2013 represented an increase in the number of reported annual casualties as compared with the 84 casualties identified in 2012. However, it was less than the 141 casualties identified in 2011.[10] Since the number of casualties in Kurdistan was similar across the two years (56 in 2013 and 52 in 2012), most of the increase can be attributed to the increase in the number of casualties identified in central and southern Iraq (68 in 2013 versus 32 in 2012). The increase in casualties recorded in central and southern Iraq is likely related to improved data collection for those regions, rather than an actual change in the number of casualties occurring.

The total number of casualties in Iraq remained unknown, though it was known that there were many thousands. By the end of 2013, 31,618 casualties were confirmed, including 13,423 casualties registered in Kurdistan (10,721 killed, 2,702 injured).[11] In central and southern Iraq, 17,072 casualties had been identified through December 2013 in four provinces that were completed through the Iraqi mine and ERW victim needs assessment launched in 2011.[12] Most of the casualties (92%) registered through the survey were men.

Cluster munition casualties

Between 1 January 2013 and 31 March 2014, there were eight casualties reported from unexploded submunitions in the provinces of Dhi Qar, Muthanna, and Basra of central and southern Iraq; five people were killed and three were injured.[13] By the end of 2013, 3,019 casualties from cluster munitions were recorded in Iraq. At least 1,165 people were killed from cluster munition remnants and submunitions while 1,437 people were injured; the outcome of 417 casualties was unknown. Of these casualties, 388 occurred during strikes (128 killed, 260 injured).[14] Iraq’s survey of mine/ERW victims had identified 880 victims of cluster munitions (148 people killed, 732 injured) in five provinces as of March 31 2014.[15] Due to the level of contamination, it has been estimated that there have been between 5,500 and 8,000 casualties from cluster munitions since 1991, including casualties that occurred during cluster munition strikes, and that one quarter of these casualties were children.[16]

Victim Assistance

The total number of mine/ERW survivors in Iraq is estimated to be 48,000–68,000.[17] There were 15,173 survivors identified as of March 2013; 12,471 in central and southern Iraq and 2,702 in Kurdistan.[18]

Victim assistance since 1999

Since 1999, the availability of and access to adequate assistance for mine and ERW survivors in Iraq have been hampered by ongoing armed conflict and instability in the country. Between 1999 and 2003, international organizations, particularly the World Health Organization and the ICRC, worked to rebuild Iraq’s healthcare and rehabilitation systems that had been devastated by decades of previous conflict. Many rebuilt health and rehabilitation centers were then once again damaged or destroyed with the invasion by the United States (US)-led coalition in March 2003 and the related period of civil unrest. Continued armed violence prevented the rebuilding of services critical to survivors and contributed to the emigration of some 75% of qualified medical personnel; by 2008, healthcare had deteriorated and was considered to be in its worst shape in many years.

Starting in 2009, a slowly improving security situation allowed for some renovations to medical facilities and the building of new physical rehabilitation centers in south and central Iraq. Survivors were more able to access available services, and some survivors in central and southern Iraq that had the means to cover transportation costs could access free victim assistance services in Iraqi Kurdistan. However, through 2013 the volatile security situation in many areas continued to prevent many survivors in southern and central Iraq from having access to needed services. Persistent efforts by international organizations, international and national NGOs, and government ministries (especially the Ministry of Health) sustained the limited advances achieved since 2009 in regards to medical care and physical rehabilitation.

Since 1999, psychosocial support and economic inclusion programs have been extremely limited in southern and central Iraq with small scale projects organized by NGOs and the Iraq Red Crescent Society. In 2012, the Ministry of Labor and Social Affairs began a program to link persons with disabilities with employment.

In 2006, the DMA appointed a Victim Assistance Director to address the absence of national victim assistance coordination, but harmonization with relevant ministries remained essentially nonexistent until 2010 when the first national victim assistance meeting was held. Iraq had no victim assistance plan throughout the period. In 2011, the second annual national victim assistance meeting resulted in a set of recommendations for improving victim assistance, but no further steps were taken to develop the recommendations into a plan or to monitor their implementation.

The situation for survivors in Kurdistan has been significantly better than in the rest of Iraq throughout the period since 1999. Victim assistance services were coordinated by the two mine action authorities previously operating in the Kurdistan region, together with the regional Ministry of Health: the Iraqi Kurdistan Mine Action Authority (IKMAA) and the General Directorate for Mine Action (GDMA), which had merged into the IKMAA by 2012. Numerous NGOs operated in the region providing medical services, physical rehabilitation, and social and economic inclusion programs including several funded through the UN Oil-for-Food program up to 2010. Many of these programs have been sustained beyond the closure of this funding program with both national and international resources. Nevertheless, available services have been insufficient to address the needs of the many thousands of survivors in the Kurdistan region, a situation that has been exacerbated by the arrival of survivors from the south starting in 2009 and the influx of Syrian refugees beginning in 2012.

Victim assistance in 2013

In 2013, the DMA demonstrated an improved capacity to collect mine/ERW casualty data and victim assistance-related information, though this was still limited. The mine/ERW victim needs assessment was ongoing and the DMA maintained its casualty data collection system for central and southern Iraq. Ongoing injury surveillance and the development of a national disability registry continued, but were hindered by increasing levels of violence. In 2013, the national healthcare budget increased and the Iraqi and Kurdistan Ministries of Health assumed greater responsibility for the management and financing of physical rehabilitation.

Despite increased budgeting for and management of victim assistance services by the Iraqi government, the availability of all services needed by mine/ERW survivors remained limited and access to those services that were available was hindered even more than in other recent years in some parts of the country as armed violence rose to the highest level in 10 years. The influx of Syrian refugees in Kurdistan increased demand for healthcare and rehabilitation.

Assessing victim assistance needs

As of the end of 2013, the DMA had completed the ongoing mine/ERW victim needs assessment survey in five provinces: Maysan, Wasit, Dhi Qar, Muthanna, and Basra, identifying 23,398 victims.[19] The survey, launched in 2011, planned to cover the 15 provinces of central and southern Iraq by February 2015 and was being carried out in cooperation with local governments, relevant ministries (including the ministries of health, labor and social affairs, and education), and NGOs such as the Iraqi Red Crescent Society.[20] The needs assessment was designed to identify victims (both survivors and family members of persons killed by mines and ERW), determine their needs, and connect victims to available assistance, including medical and rehabilitation services and disability pensions.[21] Complete results of the survey were to be distributed to relevant government ministries and NGOs and also to be shared internationally.[22] Partial results of the assessment were shared through Iraq’s Mine Ban Treaty Article 7 report for 2013.[23]

In 2013, the Ministry of Health continued to operate the national injury surveillance system, which recorded injuries caused by mine/ERW among other causes. The system registered survivors who sought emergency or ongoing medical care through a health clinic. The Ministry of Health also continued to update the national disability registry with data collected from rehabilitation centers.[24] The deteriorating security situation throughout the country impeded the DMA’s plans to follow up with mine/ERW victims identified through these systems.[25]

No specific needs assessment for mine/ERW survivors was undertaken in Kurdistan during 2013, although service providers, especially rehabilitation centers, collected data on an ongoing basis when survivors accessed services.[26] IKMAA supported data collection efforts by service providers in Soran and Duhok.[27]

Victim assistance coordination[28]

In 2013, two victim assistance coordination meetings were held for central and southern Iraq, hosted by the DMA. One meeting was held in Basra and one in Muthanna, with the goal of developing recommendations for a 2013/2014 annual strategic workplan. Recommendations focused on concrete actions to be taken by the DMA, the ministries of health, social affairs, planning, youth and sports, the Iraqi Red Crescent and other actors to ensure access by mine/ERW survivors to a range of existing government programs and to improve the quality of existing services, particularly physical rehabilitation.[29] The victim assistance workplan established for 2013 was carried out by the DMA, in cooperation with partners, though activities were limited due to a lack of resources.[30]

In 2013, a special committee of the Office of the Prime Minister was established to address the poor coordination among government departments responsible for the delivery of basic services to persons with disabilities in central and southern Iraq.[31] On 5 September 2013, the Iraqi parliament passed a law to establish an independent national disability commission that was intended to include all relevant stakeholders, such as victim assistance coordinators, from the mine action authorities.[32] As of March 2014, the national disability commission, to be headed by the minister for labor and social affairs, was still being formed.[33]

In Kurdistan, victim assistance was included in disability coordination[34] through the Inter‐Ministerial Council of Monitoring and Developing People of Special Needs, established in July 2012 to coordinate the implementation of the Convention on the Rights of Persons with Disabilities (CRPD) in the region.[35]

Physical rehabilitation in central and southern Iraq was coordinated by the Higher Committee for Physical Rehabilitation and Prosthetics & Orthotics (HCPRPO), a committee of the Ministry of Health, working closely with the ICRC. In 2013, the HCPRPO carried out quality assessments in rehabilitation centers and worked to develop standards for physical rehabilitation. A similar committee was formed in Kurdistan in 2012, with the support of the ICRC.[36]

Iraq did not provide any updates on progress and challenges for victim assistance at the Fourth Meeting of States Parties to the Convention in Cluster Munitions in September 2013, the Thirteenth Meeting of States Parties to the Mine Ban Treaty in Geneva in December 2013, or the Convention on Cluster Munitions intersessional meetings in Geneva in April 2014. Iraq reported casualty data and information about victim assistance services provided in central and southern Iraq and in Kurdistan, through form J of its Mine Ban Treaty Article 7 report and form H of its Convention on Cluster Munitions Article 7 report for 2013.[37]

Inclusion and participation in victim assistance

Mine survivors participated in the two victim assistance meetings held in central and southern Iraq in 2013 through the Iraqi Alliance for Disability (IADO).[38] Mine survivors and other persons with disabilities participated in the ongoing implementation of the mine/ERW victim survey.[39] Following advocacy efforts by IADO and other members of civil society, the representation and participation of persons with disabilities on the national disability commission was included in the law mandating its establishment.[40]

Disabled persons’ organizations (DPOs) and survivors in Kurdistan implemented physical rehabilitation programs, peer support, and vocational training.[41]

Service accessibility and effectiveness

Victim assistance activities[42]

Emergency and continuing medical care

Despite increased management responsibility by the Ministry of Health and increased national funding for healthcare, in 2013 Iraq still lacked sufficient equipment and human resources to deal with weapons-related injuries, such as amputations and shrapnel wounds. Emergency trauma care was available in most major cities but specialized treatment, such as reconstructive surgery, was often only available through private clinics that were too expensive for many mine/ERW victims and other war wounded.[43] The ICRC continued to strengthen the emergency response capacity of hospitals in violence-prone areas through training and supplies.[44]

Medical services in Kurdistan were said to be improving, with free care for mine/ERW survivors.[45] Healthcare centers and hospitals were “overwhelmed” by the influx of refugees from Syria during 2013.[46]

Physical rehabilitation, including prosthetics

Access to physical rehabilitation services remained difficult for people living in remote locations for several reasons, including the cost, time, and distance of transportation, as well as a lack of information regarding services available. In several parts of the country, access was also impeded by increasing levels of violence.[47] In addition, due to the lack of qualified rehabilitation professionals, patients at all centers outside Baghdad (and Erbil in Kurdistan) faced waiting lists of one to three months.[48]

Within Kurdistan, access to appropriate rehabilitation services was significantly better than in the rest of Iraq and increased training for rehabilitation professionals was believed to have increased the quality of care.[49]

The ICRC continued working to increase access to rehabilitation by supporting the costs of transport and by providing raw materials to centers. The ICRC reported that the Ministry of Health progressively assumed more financial and management responsibilities in ICRC-supported rehabilitation centers.[50]

As part of its four-year project (2010–2014) to improve access to rehabilitation services, Handicap International (HI) provided training to rehabilitation providers at three centers in Kurdistan to improve the quality of care and promote a patient-centered approach. [51] Disability Information Points, managed by local DPOs in each of the three governorates of the Kurdistan region, continued to provide information about available services with the support of HI.[52]

Economic and social inclusion and psychological support

Economic inclusion activities continued to be carried out on a limited basis in Iraqi Kurdistan by NGOs[53] and by the ICRC in Kurdistan and central and southern Iraq.[54] The DMA referred mine/ERW victims (both survivors and family members of people killed by mines and ERW), along with other victims of armed conflict, for the provision of untaxed livelihood loans, free land, and adapted cars and financed group marriages for mine/ERW victims (identified through the mine/ERW survey.)[55] Also, as part of its program to support income-generating activities, thousands of female heads-of-households whose spouses were victims of conflict (including victims of landmines and ERW) continued to receive assistance from the ICRC to overcome government obstacles preventing women from registering for benefits and support for income-generating activities.[56]

In July 2013, Iraq’s Council of Ministers approved a 3% public sector employment quota for persons with disabilities.[57]

It was reported that many children with disabilities dropped out of public schools due to insufficient physical access to school buildings, a lack of appropriate learning materials in schools, and a shortage of teachers qualified to work with children with disabilities.[58]

While many hospitals had some capacity to provide psychological support to mine/ERW survivors immediately following their incident, Iraq lacked sufficiently-trained professionals to provide appropriate psychological support to mine survivors, most especially longer-term psychological support and follow-up trauma care.[59]

Disability organizations organized a hunger strike in front of government offices in Erbil and Sulaymaniyah to protest inadequate government benefits for persons with disabilities in December 2012. The Kurdistan government promised to consider their demands but had not responded by the end of 2013.[60]

Laws and policies

Central and southern Iraq had no legislation prohibiting discrimination against persons with disabilities.[61] In 2013, persons with disabilities remained among the most vulnerable people in their communities, facing numerous barriers to their full and equal participation in all facets of life. The situation of persons with disabilities living outside major cities was particularly difficult, due to a lack of access to basic services.[62]

Implementation of the 2012 decree that all public buildings should be made accessible for persons with disabilities was incomplete, and access to buildings as well as to educational and work settings remained limited in 2013.[63]

Iraq acceded to the CRPD on 20 March 2013.