IRAQIS ON THE MOVE: Sectarian Displacement in Baghdad

Transcription

1 IRAQIS ON THE MOVE: Sectarian Displacement in Baghdad An Assessment by International Medical Corps January 2007 International Medical Corps 1919 Santa Monica Blvd., Suite 300 Santa Monica, CA K St. NW, Suite 400 Washington, DC IMC UK Goswell Road EC1V 7EB, London +44(0)

2 Table of Contents About This Report... 3 Executive Summary... 3 Part I: Humanitarian Emergency: IDPS in Crisis Scope and Purpose of the Integrated Plan Lack of Funding as Key Constraint Major Risk Factors Humanitarian Context Current Situation Host Communities Militias, Religious and Political Party Involvement Security Situation Inside Iraq: Protection Concerns Baghdad s Neighbor Governorates Properties, Land and Displacement Deterioration of Security Socio-Economic Factors Logistical/Cultural Limitations Planning Assumptions Displaced Population: Breakdown of Numbers Assessment By Categories Displacement of Minorities Christians Christians of Baghdad: Aid & Interventions Iraqi Christian Refugees Displacement of Minorities: Palestinians Refugees in Iraq Known Palestinians Settlements in Iraq: North, South and Central Part 2: IDP Interventions IDP Humanitarian Assistance, Relief & Development Three-Phased Response Phase 1: Humanitarian Assistance Phase 2: Reintegration and Transition Phase 3: Long Term Development Food Water and Sanitation Health and Nutrition Mental Health Effects Education Economic Development: Livelihoods, Assets and Skills Recommendations Preparedness Measures & Management Coordination Arrangements Appendix: IDP Narratives Appendix 2: Mapping Displacement International Medical Corps: Baghdad: Sectarian Displacement, January 2007

3 About This Report Baghdad s Internally Displaced Persons (IDPs) This repot reflects an integrated assessment by International Medical Corps of the current humanitarian situation in Iraq, with particular focus on Baghdad. In developing the report, nine regional offices throughout the country cooperated closely in an extensive consultation. The information and conclusions presented in this document are drawn from their reports, their assessments and their field analyses. Data for this study was compiled through a variety of sources including Iraqi government entities, religious and tribal leaders, focus group discussions and neighborhood-to-neighborhood, door-to-door interviews throughout Baghdad and outlying governorates where many of the displaced families and individuals have relocated. In total, it represents the attitudes and comments of thousands of Iraq families contacted by the more-than 300 staff and 1,400 volunteers whom International Medical Corps currently has working on IDPrelated issues. This team, one of the largest of its kind in Iraq, is also engaged in humanitarian relief and development in sectors that include primary healthcare, nutrition, water and sanitation, and mental health in 16 of the 18 governorates in Iraq. Despite this large sample, the findings are not the result of a carefully controlled scientific study. They constitute an assessment based on a significant amount of information that was gathered in a chaotic environment. The data, the conclusions and the projections set forth here should therefore be read as signposts of important trends and directions of humanitarian conditions in Iraq. They should not be taken as precise scientific evidence. This report integrates IMC s past experience of the IDP situation within Iraq with new contingencies, focusing on the areas of water/sanitation, health and nutrition, housing and shelter, and economic needs. Executive Summary While news of Iraq appears daily in the world s media, the country s untold story is that of its internally displaced population. Sectarian violence is contributing to a dramatic rise in the displacement of Iraqis and an acceleration of the humanitarian crisis. It is straining and overburdening the already fragile economic and social fabric of those communities hosting Internally Displaced Persons (IDPs). Since February 2006, International Medical Corps (IMC) assessments indicate that as many as 540,000 people have been newly displaced inside Iraq, due in most part to escalating sectarian tensions. About 80 percent of these are from Baghdad. It is projected that there could be up to one million more IDPs from within Baghdad governorate over the next few months as sectarian violence continues. Unlike earlier IDP movements, the current displacements appear not to be temporary. This report focuses on the alarming nature and pace of displacement trends over the last three months, sparked by the events around the Al-Sadr City car bombing in November In this short period alone, the number of displaced has increased by over 43 percent, and diminishing number of districts in the capital, such as Karrada and parts of Al-Mansoor, can be described as still mixed along sectarian lines. While often over-used, the words humanitarian crisis accurately describe conditions now unfolding inside Iraq. Today s displacement is creating acute vulnerability, triggering a wide range of needs and stunting development. The risk of regional destabilization stems from: sectarian ghettoization; the scope and trajectory of the military conflict; the potential use of heavier weaponry to target segregated areas; and the extent to which essential infrastructure will be further affected by conflict. There are many humanitarian challenges resulting from these population movements. IDPs are facing malnutrition, a lack of shelter and access to health services including maternal and child health, inadequate water and basic sanitation, and unemployment. The effects on education, opportunities for employment and freedom of movement for the entire population are devastating. Host populations can be as destitute as the IDPs themselves, and several governorates that have been receiving Baghdad IDPs, such as Karbala, are already saturated. Minorities including Palestinians, Ahwazis and Christians also are facing persecution and to date have not received substantial assistance. International Medical Corps: Baghdad: Sectarian Displacement, January

4 Often dependent on the generosity of host families who are themselves poor, IDPs have inadequate access to food. Irregular supplies of government rations resulting from the deteriorating security situation means that strained host populations, as well as IDPs, have run through meager stores of food and resourcesharing is becoming increasingly difficult. The influx of IDPs into communities has increased the burden on already deficient water and sanitation infrastructure, thus exacerbating the situation. Having fled their homes with few belongings, exposed to violence and injury and without adequate access to food and water, IDPs are at greater risk of ill health and disease. Already poorly equipped and inadequately staffed, health care centers located in areas of high IDP concentration are unable to cope with the increased caseloads. There is a chronic shortage of medication, lab materials and X-ray films in the country, which renders many health facilities useless. Security constraints have hindered Sunnis from accessing facilities located in Shi a areas, and vice-versa. The impact is felt not only by patients but also by medical staff who, fearing for their lives, have become reluctant to travel to their work places unless situated in areas deemed safe. Interviews with IDPs indicate that the many factors related to displacement and violence are having a serious impact on their mental health, while unemployment is driving bread winners to find alternative sources of income. Resources currently available to address these growing needs fall far short, and it is clear that the humanitarian response to this crisis needs to be re-examined in light of the emerging displacement patterns and the rapid escalation of violence that has occurred in recent months. This report calls for immediate attention by the international community to the plight of displaced Iraqis and identifies key factors that must be recognized: Internal displacement occurring in Iraq today cannot be viewed as short-term and unsustainable emergency-centric interventions alone are not sufficient. Given the potential long-term displacement of Iraqis, humanitarian interventions must include a comprehensive approach that not only responds to basic needs, but also includes conflict resolution and mitigation strategies, support for host communities and self reliance components for IDPs. Access to health services is becoming increasingly difficult for IDPs and the ability to meet the health needs of the population is diminishing as the numbers of IDPs grow. Hospitals and health care centers will need to improve their delivery systems and the loss of health care professionals due to the risks to personal safety must be addressed. Steps must be taken to prevent food insecurity and malnutrition, particularly if the Public Distribution System (PDS) is further disrupted. Due to population movements, IDPs are not receiving food rations and are currently relying on private donations and host families. Coordination mechanisms and capacity of responsible government ministries need to be strengthened. Shelter strategies must be put into place as the number of IDPs increases, recognizing that host communities alone will no longer be able to absorb IDPs in existing homes and structures. It is critical that employment opportunities become a major focus of a response to the needs of IDPs and to communities as a whole. Forced return of IDPs to their original homes in neighborhoods or areas dominated by members of other sects is likely to spur additional violence and a new wave of displacement. IDPs should not be returned to their place of origin without mechanisms in place to ensure their safety and protection from potential harm and abuse. 4 International Medical Corps: Baghdad: Sectarian Displacement, January 2007

5 Part I: Humanitarian Emergency: IDPs in Crisis 1. Scope and Purpose of the Integrated Plan Based on the analysis of the information gathered, and in light of the rapid, sustained escalation of violence in recent weeks, it is clear that response planning for humanitarian needs of the civilian population must be reassessed urgently. Given that a large segment of the population is in flux, with entire groupings being forcibly displaced into locations markedly defined and divided by sect, we are particularly concerned about the increasing ghettoization and isolation of communities and their resulting vulnerability to external threats and wide-scale harm. Assistance and support for Iraq s growing IDP population must be robust and geographically widespread to anticipate and ease new burdens on the existing host population, which is already struggling and on infrastructure that is already severely strained. 2. Lack of Funding as Key Constraint Relief agencies acting within Iraq face severe funding constraints from donors for the coming year. As a consequence, the capacity of these organizations to respond and meet fundamental objectives remains below the critical requirements set forth during inter-agency planning for humanitarian interventions. These funding constraints must be urgently addressed if IDPs are to be assisted within Iraq. 3. Major Risk Factors A variety of factors could have dramatic humanitarian consequences. These factors could impact assistance operations, increasing the number of people affected as well as the ability of the relief sector and donors to respond to their essential needs. Among the factors families are weighing in making a decision to flee their homes are: The risk of a wider regional destabilization caused by ghettoization and strategic isolation of sects. The scope and trajectory of the military conflict, including the use of heavier artillery and weaponry to target segregated areas, as well as an imminent potential for widespread sectarian cleansing. The conflict s further impact on infrastructure, in particular health and nutrition, transportation, electricity, and water and sanitation facilities. Continuing effects of curfews and lack of access to populations in need for extended periods of time. Availability of existing food supplies and other essentials inside Iraq. The impact of winter and the environment in the coming months. Relations with neighboring countries and refugee populations. Reduction in asset-based forms of income, livelihoods and ability to withstand micro-economic shocks. International Medical Corps: Baghdad: Sectarian Displacement, January

6 4. Humanitarian Context 4.1 Current Situation Iraq is a state with a history of displacement. Population flux began during the Iran-Iraq war, when populations fled fighting between the two countries or were forced to move within Iraq for reasons including policies of the Saddam Hussein regime. The targeted persecution of individuals and groups, such as the Kurds, is one example of this. Starting in 2003, fighting between multinational forces and insurgents generated new population movement. As a result of these earlier disruptions, Iraq contains pockets of people previously displaced and thus more inclined to further movement. This has been particularly the case since 2003, as all major population groups are now affected by displacement. While the causes of displacement under the former regime are no longer present, many Iraqi IDPs from the Saddam era remain in urgent need of assistance in finding durable solutions. Iraq s present humanitarian needs arise from violence, natural disasters (mainly floods), disease and a weak infrastructure. Internally displaced populations, in contrast to refugees or returnees, are commonly the most vulnerable and also pose greater challenges and burdens for their host communities. The complexities of a weak state with numerous militias, foreign troops, rampant criminality, and loose alliances between Iraqi groups and foreign insurgents, have created an environment in which the number of IDPs is growing at an accelerated rate. All evidence points to further and larger internal displacement. Displacement in Iraq has been divided into four phases: Pre-2003 regime change; Post-2003 regime change; The push by irregular forces, often externally funded, to trigger violent confrontation between Sunnis and Shi a that climaxed with attacks on Samarra holy shrines in February 2006; The latest coalition efforts to placate the main insurgent elements, particularly before the expected adoption of a revised American military strategy. In the past three years displacement was primarily due to military operations and fighting between the USled Multi-National Forces/Iraq (MNF/I) and insurgent groups. Displacements generally have been of a temporary nature, with IDPs returning when fighting subsided. From , displacement occurred in predominantly Sunni areas of central Iraq, when MNF/I forces launched military operations in Fallujah, Al Ramadi, Haditha, and Al Qaim - all cities located in Al Anbar province as well as in other areas such as Tel Afar. However, displacement is now being fueled by growing sectarian violence, post-samarra. IDPs move to where they feel safer, have relatives, or both. Therefore, as armed groups intimidate Iraqis on the basis of sect or ethnicity, they flee to areas where they can feel welcome (Kurds and Turks being the most recent example). Some of the displaced come from agrarian backgrounds and have chosen to move back to rural areas to be near family. In certain instances, these host populations are in greater need than those in Baghdad. Overall, however, Iraqis from urban areas who have become displaced tend to migrate to other urban areas where there are more services and sources of income and at this point cities contain the majority of IDPs. (NCCI Iraq Emergency Situation, Final Report, May 2, 2006, p. 14.) 6 International Medical Corps: Baghdad: Sectarian Displacement, January 2007

7 4.2 Host Communities The vast majority of IDPs seek to integrate with host populations. Because of this, finding a region where they have family is usually the primary factor determining their destination. This alone has helped forestall a greater humanitarian crisis, as local communities share their resources with IDPs, who in turn are better able to integrate into the host community. Nevertheless, IDPs are becoming an increasing strain on host communities. Although they can offer shelter, host populations are often as destitute as the IDPs themselves, especially in areas where public services are operating at minimal levels. Sanitation can be abysmal, and even the most economically stable regions of Iraq offer little employment or educational opportunities to newcomers. 4.3 Militias, Religious and Political Party Involvement Religious charities and religious-based political parties frequently offer assistance to IDPs who arrive in their communities. Many groups demand that relief groups (known as non-government organizations or NGOs) provide services and supplies through them, in an attempt to exclude NGOs from aid distribution and monitoring. These religious-based political groups publicly dissociate themselves from militias although claims persist that these groups are backed by paramilitary wings. A few religious groups offer health services and set up small clinics. Political and religious parties provide shelter and aid to IDPs in order to secure votes or allegiances. This trend of politicizing aid merely adds to the divisive forces currently at work in a country already beset by the separation of populations along sectarian lines. In many respects this separation is similar to the ethnic and religious division of populations that occurred in the Balkans during the 1990s. This is an added incentive for donors to concentrate on neutral aid for IDPs. It is also a sign that NGOs must be particularly cautious in approaching and aiding IDP communities that are protected by a political or religious party. 4.4 Security Situation Inside Iraq: Protection Concerns Stability is precarious in host communities that are overwhelmed by the burden of new IDPs, where tension grows over resources, or feelings of insecurity sometimes turn these communities into secondary displaced There continue to be daily reports of bombing, kidnapping, hostage-taking, harassment and targeted assassinations of Iraqi civilians and public figures. In Baghdad, for example, civilians face daily threats from illegal armed gangs. This prevents children from attending school and families from accessing health care. Criminal gangs also hamper the ability of humanitarian organizations and local public administration offices to reach and assist both host and displaced families. Many IDPs are unable to obtain necessary health care and psychosocial support, report incidents of abuse, or gain access to justice. Certain districts and neighborhoods previously considered medium-risk are now completely high-risk, including: Al-Karkh; Yarmook, Hay Al-Amel, Al-Shohada, Al-Shorta, Al-Saydyia, Al-Bayaa, Hay Al-Jama and Hay A-Khadrha, and Al-Rasafa. Until just a few weeks ago, Al-Rasafa, for instance, was considered relatively safe; now it is not. Moreover, the high cost and quantity of explosives being used in car bomb and mortar attacks seem to indicate that indigenous groups are being assisted by external actors. Kidnappings and targeted assassinations have had an immensely negative impact on education within Iraq. Most institutes are now empty. Teachers and students face kidnappings or sniper attacks from gunmen stationed on roofs in Baghdad s Al-Munadham educational precinct, which houses major health, arts and science education institutes. The deans of three major universities confirmed in interviews that teacher populations have fallen by 80 percent, with many fleeing or asking for unpaid leave or retirement. The violence is having an impact on nearly every sector of society. Health care workers, for example, are often reluctant to report to work in hospitals or health facilities that are located in an area where they may be in a minority. International Medical Corps: Baghdad: Sectarian Displacement, January

8 4.5 Baghdad s Neighbor Governorates Several governorates, such as Karbala, that have received large numbers of Baghdad IDPs, are saturated and have stopped providing incoming families with official certificates and facilities. Nevertheless, arriving families prefer to reside illegally in such governorates and avoid registration, rather than remain in Baghdad. Many families have also chosen not to register with the offices of the Ministry of Displacement and Migration (MoDM), either because they fear being traced or because they are in strong enough financial circumstances that they need no assistance from the MoDM. Because the majority of IDPs in the south live in host communities in which IDPs and local residents often live under one roof, it is extremely difficult to accurately estimate their total number. Karbala, due to its close proximity with Baghdad, was formerly the preferred destination for Shi as. However, this is changing as government regulations prevent new registration. The influx of IDPs from Baghdad into Karbala has strained electricity supplies and health services, as well as caused inflation on daily goods and housing rates. In addition, some local host households have registered as IDPs to benefit from assistance programs, which has inflated numbers and made it more difficult for agencies to provide services. Three governorates adjacent to Baghdad, Diyala, Anbar and Salah Deen, have experienced a continuing deterioration of security due to MNF/I and Iraqi forces counter-insurgency operations. Insurgents targeted in one area flee to another, creating instability among all adjacent governorates to Baghdad. Areas such as Baquba have altered dramatically. Baquba is the administrative center of Diyala, with a civilian population of approximately 50,000. Originally, the city was a mix that included equal ratios of Sunnis and Shi as, as well as many Kurds. Following the attacks in Samara, the city s Shi a population came under intense pressure. As a result, over the past few months almost half of Baquba s original residents have been forced to flee. Relations between sects deteriorated steadily with the increase of sectarian murders, kidnappings, and mortar attacks, as well as the creation of checkpoints. Baquba is now dominated by Arab Sunnis. All Baquba roads are highly dangerous and substantial risks are involved for anyone traveling in particular through Tahreer, Mualimeen Gatoon and Buhruz districts. This has had a negative impact on the educational, commercial and economic situation in that area. Since the majority of departing families are Shi a, most IDPs from Baquba fled to southern governorates such as Karbala and Najaf and the Shi a-dominated areas of Baghdad. Those families who have relatives inside the Diyala governorate have moved to areas such as Shifta, Khalis Moqdadiah and Baladruz to settle at least temporarily. Kurdish families fled to the Kurdish areas of Diyala, including Khanaqin and Mandli. The affluent were able to flee Iraq and move to Syria, Jordan and Europe. With continued revenge killings and the damage to infrastructure, there is no sign that security pressures in Baquba, now a Sunni-dominated city, are abating. However, if large-scale violence continues, residents appear unlikely to relocate to Baghdad because Baghdad is equally insecure, and the two main Baquba- Baghdad roads cross Shi a-dominated areas. 8 International Medical Corps: Baghdad: Sectarian Displacement, January 2007

9 The alternatives are to move within the governorate or outside Iraq, neither of which is financially viable for the majority of people, in part because the influx of Bagdad IDPs has inflated rental housing rates. Moreover, most neighboring countries are refusing to take further refugees, meaning that as options diminish, further movement will occur within Iraq Properties, Land and Displacement Because of sectarian tensions and direct threats that have followed the February 2006 Samara mosque bombing, most displaced families now are unable to sell their properties. In the Sunni- or Shi a-dominated areas where thousands of people are regularly forced to leave their homes within a matter of hours, families are given no time to rent or sell their houses, and they are not allowed to return to make arrangements for disposing of their property and belongings. Those who try to sell their houses in anticipation of fleeing, are stopped by insurgents posting not for sale or wanted signs on their properties. Even though houses previously valued at around 14 million ID (9,500 USD) had dropped to as low as 2 million ID (1,400USD), there are no interested buyers. Several Sunni families displaced from Shi a-dominated areas moved into houses deserted by displaced Shi a families. This was the case of 479 IDP families from Hurria, Shuala, Hay Al Amel (Baghdad), and Al Shaab and Hay Aur (near Al Sadr City) who settled into houses in Abu Ghraib. In mixed-sect dominated areas, the abandoned houses of one sect s expelled families are being given to newly arrived displaced families fleeing the violence from the opposite sect either for free, or at cheap rental fixed fees usually collected by local mosques. In several areas of the capital, the controlling militias and religious parties occasionally offer displaced families from the opposite sect the ability to rent their properties - at a reasonable rate, or free of charge in exchange for maintenance - to an arriving displaced tenant from the militia or religious party s own sect. Although announcing houses for sale is still allowed, poor economic conditions force many displaced families from the sect suddenly a minority in their onceevenly mixed neighborhood to enter into agreements to swap houses at no cost through trusted agents or mosque officials. A few relatively stable areas, like Kadmeia and Karrada in Baghdad, are considered attractive for IDPs to settle, but this relative stability has caused property prices to triple. And wealthy families living in these either predominantly Shi a or Sunni areas have no desire to sell or let their houses Deterioration of Security Those fleeing because of general insecurity rather than sectarian strife are confronted with a different dilemma. IDPs from Ramadi, for instance, settled at first with relatives and then in rented houses in safer areas within Ramadi, Baghdad, Ana, Heet or Fallujah. They preferred to rent these houses and were unlikely to return to their places of origin because of chronic insecurity in some areas of Ramadi. However, unlike those displaced by sectarian tensions, these IDPs are not being prevented from selling or renting their homes either by insurgents or due to a lack of time. Rather, they cannot dispose of their properties because there simply are no buyers. International Medical Corps: Baghdad: Sectarian Displacement, January

10 Consequently, property and rental prices have skyrocketed in safe areas, such as the city of Ana, which is not only stable but also enjoys ample supplies of water and electricity. In this city, a house previously valued at 26 million ID (18,000 USD) now sells for 100 million ID (68,000 USD); rentals can rise as high as 500,000 ID (350 USD) per month, versus a year ago when they were under 100,000 ID (70 USD). Thus, areas of Ramadi such as Malab, Sofie, and Azezia, are now nearly abandoned, with just a few hundred families remaining. At the same time, rents have risen in safer quarters like western Ramadi. A house in Thobat Ola, near Warar Bridge was available eight months ago for 120,000 ID (80 USD) per month; that price is now 300,000 ID (200 USD). As certain areas become saturated by mass displacements, there is expected to be an increased need for emergency temporary shelter. This was the case for 400 IDP families who arrived in Al Khadra from Hurria in recent weeks. While host populations tried to accommodate the influx, many IDPs resorted to squatting in public or municipal buildings such as schools, mosques and old jails. Others had to settle for tents, despite the onset of winter Socio-Economic Factors In most upper- and middle-class neighborhoods, such as Hay Al Kadraa (north of Baghdad), housing prices had been relatively high (average monthly rentals were 500 USD, with homes selling for about USD 500,000). But when approximately 10 percent of the families fled the area, mostly due to deteriorating security caused by criminal gangs, kidnappings and assassinations, property prices and rentals decreased by more than half. The middle class, mostly comprised of government employees or ex-officers of Saddam Hussein s army, lived in areas such as Dora and Seidie (south of Baghdad). Fourteen-hundred mostly Shi a families have moved from these areas in recent months due to sectarian tensions and threats from insurgents, and found it difficult to rent out their homes. The Sunnis from these areas also have moved, as they tired of the intensifying Iraqi government and MNF/I security operations, including the searching for weapons and insurgents, and arrests by security forces. However, these families could not afford to sell their houses even at these decreased prices. 4.7 Logistical/Cultural Limitations Regardless of the area of Baghdad, there are recurring problems with food supply; the Ministry of Trade (MoT) has been slow in shifting operations to meet changing needs, causing many IDPs to rely on food rations (Public Distribution Services) for their daily nutrition. The MoT is unable to send additional quantities to areas where IDPs have settled, a move that would require relocating warehouses and scaling up distribution. The food shortage and water problems, in turn, lead to malnutrition and communicable diseases among IDPs. These groups typically have difficulty finding employment. The majority are poor and unskilled, forced to seek daily opportunities for paid manual labor. Furthermore, local tribes and affluent families tend to choose locals for employment, rather than IDPs. Because of these and other factors mentioned above, IDP camps have had to be created in some areas of Baghdad to cope with the crisis. These commonly are in the center of a municipality, where aid organizations and local authorities can easily reach them. These IDPs are among the poorest, housed in tent camps that are antithetical to Iraqi culture. For this reason, it is unlikely that these camps could be more than a very temporary solution for IDPs. Indeed, more common than camps are IDP community settlements, comprised of IDP families who squat or live independently or semi-independently, usually in abandoned public buildings or former military bases. There are also make-shift dwellings of one or two rooms made of mud, debris, or concrete blocks and wood. These generally are constructed after the IDP settlement is already saturated with IDP families. 10 International Medical Corps: Baghdad: Sectarian Displacement, January 2007

11 4.71 Planning Assumptions Having provided emergency assistance to Iraqis living in extraordinarily difficult and insecure areas such as Tal Afar and Al Anbar, humanitarian organizations within Iraq have gained valuable experience in the context of crisis. They also have gained an understanding of the need to tailor each intervention to the uniqueness of a particular region, ethnicity, social class, origin and sect of the beneficiaries. Based upon extensive contacts with community residents, their leaders, members of relevant institutions and others during the course of this study, we believe an approach designed to address the effects of Iraq s violence and displacement should be based upon the following assumptions: A significant number of low-income Iraqi families, and increasingly all middle- and upper-class income households, have already left and will continue to leave their homes for locations that are perceived to be safer and more amenable. It is impossible to envisage any short term repatriation efforts or actions in the coming two to three months Based on the humanitarian sector s past interventions in highly volatile cities within Iraq, it is likely that access to the targeted cities and peripheral areas will continue to be possible. Some extreme situations, however, may preclude the transportation of goods into a city or, in the case of present-day Baghdad, into certain quarters dominated by a particular religious entity or sect. Generally, however, there is usually an outflow, not an influx, of populations in these areas. Violence will persist and worsen in the foreseeable future, forcing relief organizations to take precautionary measures. Agencies currently have key staff ready to respond in any of the targeted locations, and are able to scale up with additional support or program staff. This capacity is likely to remain throughout relief and reconstruction efforts, allowing for further response in new locations in Iraq during humanitarian emergencies. Due to the dynamic and usually unpredictable nature of the situation, donors and implementing partners will have to remain flexible at all times. Continuous monitoring of the situation on the ground will enable relief organizations to identify interventions that best fit with the emerging concerns of communities in need and their situations. Implementing partners, therefore, in close coordination with donors, must be prepared to shift or expand interventions at short notice, in accordance with changing field conditions. Systematic coordination with local governments will increase IDP integration into their temporary or permanent locations, and to address priorities of the host population. Economic development programs always should be implemented with the support of targeted IDP workers to ensure that the activities are culturally acceptable to them and their peers. When part of an IDP community is selected to benefit from a program, such as income generation, the individuals should be selected based on community leaders advice and on need. Interventions should always take into consideration the delicate political environment in each targeted area. This environment should determine which staff monitors which area, how assistance unfolds, which groups may need to be avoided or consulted, and what activities may be interpreted as political. For instance, areas of food- and non-food-item distributions must be chosen carefully in order to avoid putting beneficiaries at risk, and also to be acceptable to and accessible by the population. The psychological dimension of the IDP crisis must be taken into consideration. The escalation of sectarian violence and the likely formation of ghettos will place each of these sectarian groups at higher risk of violence. The ever-clearer demarcations and more homogeneous nature of IDP settlements will make them easy targets for attack by opposing factions. This will require extraordinary caution in providing assistance to displaced groups. While emergency assistance should work to implement quick-impact projects, a priority should be placed on effective, sustainable, long-term interventions. International Medical Corps: Baghdad: Sectarian Displacement, January

12 4.8 Displaced Population: Breakdown of Numbers The sectarian violence, especially in Baghdad, has been escalating steadily since the Al-Sadr City car bombing events in November On the basis of ongoing focus group discussions with members of each socio-economic level and religious belief in all regions within Baghdad that included thousands of individual families, IMC has compiled the following estimates of IDP movement between February 28, 2006 and January 10, Based on those same focus group discussions, as well as information acquired in conversations with community leaders, religious leaders, relevant members of Iraqi government organizations and other observers, we have compiled projections of IDP movement in the coming months. 4.9 Assessment By Category Category 1: This includes families residing within areas of the city that are now either predominantly Shi a or Sunni in character. These areas comprise about 5.25 million of the capital s estimated population of seven million. Shi a-dominated districts in this category include Al-Sadr City, Al-Husaynia, Abu-Dsheer, Al- Kadymia, Al-Shola, Hay Al-Amel, Al-Baya, Baghdad Al-Jadyda, Al-Zafarania and Al-Karada. Sunni-dominated districts within Baghdad include Adamyia, Al-Gazalia, Al-America, Abu-Grabe, Al-Taji, Al-Dora, Al-Karkh, Al- Mahmoodyia, Al-Yousifia, Al-fazel, Al-Madaein, and Tarmyia. 12 International Medical Corps: Baghdad: Sectarian Displacement, January 2007

13 In this category we expect over 90 percent of the families to remain in place, irrespective of the current situation and threats. This figure reflects that many already have been displaced from other areas and the perception among those in this category is that they are currently residing in optimum security reunited with familial links, kinship ties and tribal groups. Foremost factors among their choice of location include food, water, first-aid medical supplies and weapons for protection. IMC noted that this was the case for both Sunni and Shi a predominant areas. This projection also takes into account that roughly three million of these residents mainly in Al-Sadr City and Al Shoula lack the economic means to move. Category 2: This comprises the remaining 8-9 percent of residents in the aforementioned districts, or about 450,000 people, who are preparing for relocation to more secure areas along the following lines: Fewer than 5% expressed the intent to leave Iraq and were working to process documentation needed to leave the country; 8-10%, almost exclusively Shi a, will move to the southern governorates (Babil, Basra Karbala, Najaf, Wassit, Qadysia, Thiqar, Missan); 5-7%, mainly Sunni families, intend to move to the East, West, and North, particularly to Diyala, Anbar, and Salah Aldeen: About 1%, mainly Kurds, intend to relocate to the Kurdistan region in the north. Category 3: This represents about 1.7 million people, including residents of districts of Baghdad which still have sizable Sunni or Shi a minority populations ranging between percent, but which we project will become dominated by one sect as those of the minority sect move to different locations. Only a few isolated districts will continue to remain mixed. We project that more than 40 percent of the population in these districts - over 700,000 - will become IDPs in the next several months. Currently mixed districts include Al- Mansoor, Al-Yarmook, Al-Maamoon, Hay Al-Jamia, Al-Shorta, Al-Harthia, Al-Shaab, Al-Shorta Rabia, Al- Shorta Khamisa, Al-Eelam, Al-Saydyia, Al-Muwasalat, and Abu-Malef. Those households out of the entire population which intend to leave mixed districts, based on interviews and focus groups, will probably relocate as follows: 5% are preparing to leave Iraq. 20% will be moving to other districts within Baghdad, with each sect concentrating its numbers in distinct districts. 15% are making the arrangements to move either to southern governorates (if they are Shi a), or to the west and north governorates (if they are Sunni). In total, we project that in the coming months more than one million residents of the Iraqi capital could be displaced, moving to new locations either within Baghdad itself, to outlying governorates, or outside Iraq. The information we have gathered suggest the following disbursement: About 200,000 would leave the country; Between 300,000 and 350,000 Shi as would move to the southern governorates; Between 250 and 290,000 Sunni would move to the east, west and north, although we anticipate the majority will move north; About 10,500 or a little less would move to Kurdistan. About 350,000 would be displaced within Baghdad itself; about 60 percent of this movement would be Shi a, 40 percent Sunni. International Medical Corps: Baghdad: Sectarian Displacement, January

14 5.0 Displacement of Minorities Christians For Christians wishing to leave the inflamed governorate of Baghdad, the unstable areas of Mosul and radical Basra, then Erbil or Ninewah, is their most viable option unless they want to leave the country. Some churches have attempted to chart movements of parishioners but have been unsuccessful because numbers are continually changing. Those attending church services have decreased rapidly, while a further indication of movement has been the large number of requests for church records for the purposes of obtaining travel documents and transfers to churches abroad in the hope of assistance there. Calm and stable, Erbil has become the safe haven for Christian IDPs who can resume a normal life and start businesses or obtain employment relatively easily. The chosen neighborhood is Ainkawa, a predominantly Christian enclave that has, over the last two years, received more than 2,700 families, mainly from Baghdad and Mosul. These families had few troubles selling their properties and businesses in their original locations as, belonging to neither Islamic sect, they do not face threats or property devaluation issues. The government of Kurdistan has encouraged this move to Erbil and has supported them with monthly salaries. Recently, 900 plots of land were also distributed to these Christian IDP families in Ainkawa. Christians in Baghdad are currently at risk not only from the high unemployment levels and related issues, but also from the threat of kidnappings and death. In the eastern Baghdad neighborhood of Rusafa, the government still maintains a semblance of control yet unemployment and poverty levels are extremely high and many residents are fearful of traveling to work. The majority of pupils and students in Rusafa are still able to attend schools and colleges despite threats, yet many have had to interrupt their education to find work. Female student attendance in secondary schools and colleges has decreased markedly as parents seek to protect their children from the violence. Explosions and university tutor assassinations also create significant fear. The health situation has deteriorated as security constraints have hindered NGOs from providing free medicines and treatment to patients. Those who fall ill pay large sums of money to be treated and if treatment involves x-rays, lab tests and costly equipment, patients wait months to receive the necessary care. The only exceptions to this long wait are those with powerful influence or those willing to pay heavy bribes to move appointments forward. Typical rates of surgery begin at 500,000 Iraqi Dinar for the most basic of treatment. Christians in Karkh are located within a majority Sunni area which falls outside of government control. Only a few remain because intense bombings and violence have led to widespread departures. The main factor for displacement has been the bombing of churches and direct threats of assassination. Many simply abandoned churches in 2005, and kidnapping of priests or other clergy continues. Unemployment and a lack of available education here are also major issues of concern. 5.1 Christians of Baghdad: Aid & Interventions Churches do help Christians with food and some financial support, but this assistance pales compared to the level of need. No medical help is offered by the churches. Christians not only flee or migrate due to unemployment, security risks, killings and occupation of homes, but also because of the bombing of churches themselves and direct threats to Christians. In particular, kidnapping of priests, their torture, inhumane treatment and ransom demands have had a particularly strong and adverse effect on the psychosocial health of the population. Some Christians had to move to the north (Kurdistan) and to the Ninewah Valley villages where their ancestral homes are located. Churches and homes were formerly destroyed by the Kurds yet the current Kurdish government now encourages this movement and has reconstructed villages and churches in collaboration with the humanitarian organizations. These IDPs in the north, although safe, suffer from unemployment. The government of Kurdistan has allocated a monthly income of 100,000 Iraqi dinar per family, as well as food rations and food aid from humanitarian organizations. This is very low given the high cost of living and fuel prices. A barrel of gasoline or kerosene costs approximately US $100 or more, with cooking gas (LPG) fetching 25-30,000 ID per bottle. 14 International Medical Corps: Baghdad: Sectarian Displacement, January 2007

15 Occasionally, cooking gas runs as high as ,000 ID. Those in Ninewah are better off than those in Erbil, Sulemania or Duhok as they live on ancestral properties which do not require high rental payments. IDPs in the North benefit from good, affordable health treatment as well as the MMUs which offer access to services. Education continues, yet Arabic-Kurdish problems surface as children are able to attend Arabic schools opened by the government of Kurdistan for IDPs with trained teaching staff and transportation for students not only in major governorate zones but also within rural villages. Yet the IDPs have been set back as certain subject fields within Baghdad s university system are unavailable. As a result, many students alter their specializations and do not achieve desired qualifications. 5.2 Iraqi Christian Refugees Migration to Jordan started in the 1990s due to trade sanctions on Iraq that lasted 13 years; but large numbers also migrated to neighboring countries such as Jordan, Syria and Turkey. Inflation in northern Iraq has meant that many altered their original destination and instead headed to Syria where the cost of living is lower. However, they still face unemployment and exploitation. Christian workers suffer from low wages, job insecurity and poor working conditions. Many depend on financial help from relatives in the Western world. The churches in Syria and Jordan offer assistance in the form of food items or jobs in churches or monasteries but they often are overburdened and receive little international agency support. Emigrants face poor health due to high medical treatment costs and lack of access to care, yet most are able to continue with their education. Major constraints include residential fines and authoritative oversight by government agencies. 6. Displacement of Minorities: Palestinians Refugees in Iraq Of the approximately 30,000 Palestinians who were registered in Iraq by the United Nations agency for Palestinians refugees, an estimated 5,000 to 6,000 Palestinian families remain in the country, according to UNHCR and other organizations. The Iraqi Ministry of Displacement and Migration currently estimates the number varies between 22,000 and 25,000 individuals, with the majority living in Baghdad. One hundred twenty-two families live in Ninewah, 61 in Basra and 15 additional families are scattered throughout Kut, Ramadi and Diwaneya. The rest (particularly in Baghdad) either have been killed or have fled to neighboring countries through Syria. With all borders now closed to them, Palestinians who are forced to stay in Iraq face targeted death as they are perceived by many Iraqis to have been favored by the government of Saddam Hussein. Many have been kidnapped, tortured or killed. They are routinely threatened and their families are living in fear, expecting to be the next victim of militias and armed groups. The sectarian violence and threats from militias have left 120 families homeless, forced out from unstable areas such as the Al-Qudus camp in Al-Tobchi, Al-Hureya, Al-Ghazaleya and other areas. Those families are currently moving back and forth among the existing Palestinian complexes, settlements or abandoned buildings in Baghdad, such as Al-Baladeyat Palestinian refugee complex or in makeshift camps in the Sunni dominated areas, where they are out of reach of Shi a militias. International Medical Corps is currently finalizing a separate, formal needs assessment of Palestinian refugees in Iraq. International Medical Corps: Baghdad: Sectarian Displacement, January

16 6.1 Known Palestinian Settlements in Iraq: North, South, and Central In Iraq s northern (Ninewah, Sinjar, Mosul) and southern (Basra, Al-Ashaar and Al-Zubeir) areas, Palestinian families integrated with local populations a long time ago; they were able to buy houses, find jobs and live as ordinary Iraqi citizens. According to MoDM, no displacement has taken place for any of these 183 Palestinian families, and living conditions are generally good. In Baghdad and in central Iraq, however, Palestinians circumstances vary. They live in: congregational residency complexes or housing either built or rented by the government for housing Palestinian refugees, under poor or intermediate economic conditions; abandoned buildings, under very poor economic conditions; or individually owned houses or flats integrated within residential quarters, under good economic conditions. While some of these families need little humanitarian assistance, large numbers suffer from acute poverty, are unemployed, and cannot provide for even basic needs. Living conditions deteriorate daily, especially for those families who have lost breadwinners to the violence. The most vulnerable live in five main congregational complexes: 1) Al-Baladeyat Complex This complex is located in the Shi a-dominated area of Al-Baladeyat in east Baghdad. It housed 6,000 people in 2004, and 9,000-10,000 by The complex consists of 16 buildings, each containing 24 flats. Sometimes two-to-four families share one flat. Security began to deteriorate last year, with mortar attacks throughout the nights and organized raids and abductions by militias, many who use stolen police or security forces uniforms and equipment. There is a continuous process of displacement to and from the complex, which hinders accurate reporting and registration of numbers of IDPs. The improvement of shelter, water, and sanitation is essential for all families in this complex. 2) Al-Za afaraneya Complex Located in the mixed-sect Za afaraneya area in southeast Baghdad near Al-Rasheed, Al-Za afaraneya is an abandoned military building with internal partitions. Palestinian families gradually settled in this complex after the 2003 war, and the total number of families currently based here is No displacement from this camp has been reported, but living conditions are very poor. Residents are in dire need of proper shelter, water and sanitation, and basic needs interventions. The complex could be expanded and rehabilitated to increase its capacity to provide shelter for the previously mentioned 120 homeless Palestinian families. 3) Hay Al-Sahha Complex Based in Al-Dora, Hay Al-Sahha is located in a still-mixed but Sunni-dominated area. The complex is located near Abotcheer, which has the highest percentage of Shi a in Al-Dora. About Palestinian families used to reside here, but 30 were forced out two months ago by Shi a militias. Twenty four families were allowed to return, and the remaining six had to flee to the Al-Baladeyat complex. 4) Hay Al-Iskan Complex Located in the Tobchi area of North Baghdad, this complex consists of government-owned houses of identical design, and flats rented by the MoDM. Of the 400 families here, about 100 received direct and indirect death threats from Shi a militia six months ago, forcing them to leave the area for the Al-Baladeyat complex and surrounding areas. The majority of vulnerable Palestinians families would prefer to flee to bordering countries such as Syria and Jordan, but interviews with family members indicated the closed borders and poor financial circumstances prevent them from doing so. There are three other locations to be assessed in a forthcoming report. 16 International Medical Corps: Baghdad: Sectarian Displacement, January 2007

17 Part II: IDP Interventions 7.0 IDP Humanitarian Relief & Development Widespread conflict and the deterioration of security for the general population in Iraq continue to force people to flee their homes and livelihoods. The displacement is resulting in a large number of people without access to food, shelter, or health care, which places a tremendous burden on the host communities to which they flee. Given the rapid pace and the shift in the nature of this displacement, humanitarian interventions must be comprehensive in approach. This requires not only that the responsible Iraqi authorities engage actively in managing this crisis, but that all actors local and national governments and institutions, donors, and the international relief and development community engage in coordinated programming that can mix emergency relief or reintegration support with development assistance, which enables the needs of IDPs to be addressed efficiently and effectively, but in flexible and creative ways. Since IDPs needs shift over time, the capacity to utilize diverse resources in an integrated manner is critical to the success of any intervention. 7.1 Three-Phased Response Humanitarian interventions under the current circumstances can be viewed in three phases, with the recognition that these phases may occur simultaneously. Phase 1: Humanitarian Assistance While the cause of displacement, the nature and intensity of the conflict, and the size of the geographical area affected all play roles in determining the type and amount of humanitarian assistance needed, Iraqi IDPs have typically required emergency housing, food, water and sanitation systems, healthcare, and protection for relatively short periods of time. With the conflict escalating, however, it is generally expected that the need for emergency humanitarian assistance will increase. Immediate risk factors include: Lack of clean water and neglect of the water and sanitation infrastructure Increase in disease incidence Malnutrition and food insecurity Lack of shelter Livelihood crises Poor health care services Disruption of education Human rights violations To establish specific assistance needs, relief agencies should work with local authorities in areas where IDPs are most likely to concentrate to collect comprehensive baseline data about existing sources of shelter, food, water, and health care. Using disaster-tracking systems, which enable relief agencies to monitor ongoing emergencies, appropriate intervention strategies are then developed. In addition to meeting the basic needs identified above, these often involve ensuring IDP access to education, training, tools, microcredit, legal assistance, trauma counseling, family tracing, agricultural inputs, protection from exploitation, and general support to improve self-reliance. Efficient and effective humanitarian assistance should always pave the way for IDP communities to move toward self-reliance. 1 USAID Assistance to Internally Displaced Persons Policy, PD-ACA-558, USAID 2004 International Medical Corps: Baghdad: Sectarian Displacement, January

18 Phase 2: Reintegration and Transition Phase Two, or transition and reintegration, may last several months. It focuses on the scaling up of needs assessments and the creation of durable solutions for IDP populations in communities. At this stage of the intervention, IDPs have three choices. They may 1) return to their homes; 2) absorb into their host communities; or 3) relocate to areas near extended family or other, secure areas. For those who choose to return home when local circumstances and security permit, significant assistance, from both local authorities and international NGOs, will be required to rebuild their homes and communities and address obstacles to their reintegration. Their needs range from the short-term, such as transportation, to the long-term, including protection from involuntary return, help to reclaim their land and rebuild houses and businesses, support to establish accountable local governance systems and strong civil society, and programs to reconcile lingering sectarian and political tensions and safeguard the rights of female-headed households. It is critical that the international community work with local governments and other institutions in this second phase to foster durable peace and stability and prepare the way for long-term development. In this context, it is important to note that information gathered and attitudes expressed in this study indicate that the displacement that has taken place since February 2006, and which is projected for the future, will have a permanence that was not present among IDPs prior to that time. The enmity surrounding the current violence is serving to cement these movements. Simple fear prevents IDPs of one sect from returning to homes located in areas dominated by another sect. Since conflict may flare up again, each IDP scenario must be evaluated, with humanitarian responses framed accordingly. Donors, stakeholders and NGOs must monitor security on the ground and ensure that assistance is provided in strict keeping with vulnerability criteria 1 developed for this purpose. Phase 3: Long-Term Development The third phase of IDP intervention is long-term development, during which infrastructure is upgraded and home and host communities are rebuilt. IDPs returning home or resettling permanently in new communities would need assistance to construct or repair water systems, health care infrastructure, schools, and transportation routes. In addition, they often require access to vocational training, technical assistance, and business or agricultural loans. It is critical at this stage that all actors involved support the Iraqi national authorities as they plan at the country or provincial level and implement programming at the local level. All work should be closely coordinated with tribal leaders, local communities, and the IDPs themselves. Their inclusion in broad-based development strategies reflects a growing understanding that population displacement can negatively affect stability and the long-term development prospects of a nation. To ensure the success of IDP reintegration in Iraq, it will be critical to approach it through a long-termplanning lens. While short-term emergency and basic needs such as food, water, and shelter for IDPs must be met in any intervention, planning in Iraq should also take into account the need to build sustainable communities that have a sense of ownership over communal values, interests, and access to infrastructure. In other words, IDPs as members of their communities must become stakeholders in the country s longterm development. 7.2 Food Prior to June 2006, when the MoT changed its policy, IDPs fleeing their homes for other governorates were not allowed to claim food rations in their new locations. Thus, dependent on religious groups and on the generosity of host families often poor themselves, many IDP families had inadequate access to food. Their lack of money made it difficult, if not impossible, to supplement rations with goods from the prohibitively expensive open market, where inflation, transport difficulties, and power outages at food storage facilities have sharply driven up the price of food over the course of the conflict. Already suffering a food shortage due to the inadequate and irregular government rations, strained host populations as well as IDPs have run through their meager stores of food, and resource-sharing is becoming more difficult. 1 IMC s vulnerability criteria whilst rendering assistance to IDP includes: large families with 6 members or more; families that left their homes with no belongings and are unable to seek refuge with relatives; female -headed families; families with pregnant women, children under 5, injured or disabled members. 18 International Medical Corps: Baghdad: Sectarian Displacement, January 2007

19 Consequently, the lack of sufficient nutritious food will adversely affect the health of IDPs. This is particularly true for children under five and pregnant women, whose food needs, when not met, will result in malnutrition and contribute to rising maternal and child mortality rates. This, in itself, is a major cause of trauma and discontent in Iraq. 7.3 Water and Sanitation Long years of conflict and economic sanctions have led to the neglect of the water supply and sanitation infrastructure in most parts of Iraq. Water treatment plants, water supplies, reverse osmosis units, compact units, and sewage networks are all in various states of disrepair, often functioning at just half their original capacity, or less. The desperate need for water has driven many communities to resort either to illegal tapping of the pipe network where possible, or worse, to use water from polluted rivers. Inadequate access to safe water, improper hygiene practices, and nearly non-existent sewage facilities contribute to the dramatic increase in waterborne diseases, directly impacting women s and children s health. Given the country s already weak water and sanitation infrastructure, the influx of IDPs has increased the burden on these poorly functioning facilities, exacerbating the situation. IDPs, whether residing with host families or in remote locations within the governorate, increasingly are unable to access quality water supplies. Tension over the division of basic needs and essential community resources has created conflicts and serves as an obstacle to the integration of IDPs into host communities. 7.4 Health and Nutrition As with water, the country s health care infrastructure has been neglected. The extensive network of primary health clinics located in almost every Iraqi city, town, and even village has historically been responsible for the majority of citizens everyday health care needs, from immunizations to maternal and child health, to dental care and vision examinations, to prevention and treatment of communicable diseases such as tuberculosis. However, years of neglect, poor planning, and lack of resources have left these clinics with a chronic shortage of trained doctors, medications, lab materials, and X-ray films, and unable to cope with their increased caseloads. It is not uncommon to find a PHC with 20 staff persons serving a population of 30,000, or, conversely, with more than 180 staff serving an area of 5,000. The IDPs most in need of PHC services are at high risk for ill health and disease. Having fled their homes with few belongings, IDPs travel for days in often difficult conditions. They are exposed to violence and injury, and with inadequate access to food and water, are in real need of, but often unable to access, essential primary health care services. The most vulnerable groups, such as women and children suffer the most. Women and children, for example, are not included in department of health vaccination campaigns. Since there are few female medical staff members, and local custom dictates that male staff may not treat female patients, many women go without any health care whatsoever, particularly in areas served by small PHCs, which are almost always staffed only by males. To complicate matters further, security constraints have hindered Sunni medical staff and patients from accessing facilities located in Shi a areas, and vice-versa. NGO experience has revealed that maternal health in Iraq suffers most as a consequence of this, as women are unable to access essential obstetric care, even in emergencies. This could have serious consequences for maternal and child mortality in Iraq. While the collection of certain types of data from displaced populations is neither possible nor practical in the current environment, the Iraqi Ministry of Health, with the assistance of outside organizations such as UNICEF and WHO, has compiled some figures that allow a big-picture look at In the current context, wherein Baghdad is likely to be re-mapped along sectarian lines, certain health facilities including primary, secondary and tertiary healthcare facilities, by virtue of their locations, will be inaccessible to large sections of populations. general health indicators. For example, the overall crude death rate in 2002 was 8 per 1,000, and the infant mortality rate was 108 per 1,000. Now, out of 1,000 children, an estimated 131 did not reach the age of 5, and the maternal mortality rate was 294 per 100,000 live births 1. At the same time, the most recent data show that malnutrition in Iraq is around 26% for stunting, 16% underweight, and 9% for wasting; compared to 28% stunting, 12% underweight and 4.4% wasting in The numbers indicate that acute malnutrition is growing at an alarming rate. 2 The current conflict is contributing to chronic malnutrition in Iraq. 1 Maternal, Child and Reproductive Health Strategy in Iraq, United Nations World Food Programme, Iraq Country Office, Food Security and Vulnerability analysis in Iraq, June International Medical Corps: Baghdad: Sectarian Displacement, January

20 7.5 Mental Health Effects All IDPs experience some degree of physical and mental stress. They are exposed to violent conflict; they are subjected to constant fear, anxiety, and often shock; they have witnessed the death of friends or family; and have lost their homes, personal property, and livelihoods. Once they flee, they travel long distances without food and water. The physical and psychological stress is then compounded by alien surroundings, especially in cases of those displaced to other parts of the country where there is a dearth of resources and lack of access to basic amenities. While the degree of trauma experienced from violence, displacement, persecution, and other injustices depends on the nature of the experience and individual coping mechanisms, some population groups, such as women and children, are more vulnerable than others. 1 In focus groups conducted by IMC in various IDP communities, nearly 70 percent of the mothers reported that their children suffer intense psychological distress when they hear sounds of helicopters, gunfire, or explosions. About 60 percent of them report that their children suffer pervasive feelings of sadness, cry often, and seem to cling to their parents a great deal more than they did before. About 17 percent of the mothers reported their children also showed signs of pervasive anxiety and fear. An equal number of mothers said their children seemed constantly tired and lacked energy. Over a third experienced repeated sleep disturbances and nightmares. About 25 percent of the mothers observe that their children were falling ill frequently, particularly with respiratory and skin infections. While this might be a result of poor living conditions, frequent illness could also be stress-related. Several mothers also reported that their children are irritable and easily angry; many appear unable to concentrate ( day-dreaming ) or to be interested in daily activities, even play. Forced to flee from their homes to other parts of the country, where they live in public buildings, IDP camps or other forms of temporary shelters, away from familiar surroundings and routines such as school and friends, children develop adjustment problems that predispose them to deeper psychosocial and mental health issues. Turkmen IDP children in Karbala said that their major problem is inability to speak Arabic. Such inability to communicate not only leads to anger and frustration, but also creates learning problems at school and integration into local communities. 2 In Baghdad, the ongoing sectarian violence, including threats, killings and kidnappings, has resulted in widespread insecurity. As a result, children s mobility is severely curtailed. They are unable to go outside of their homes and play, attend school, or interact with other children, thus affecting their social and emotional development. Childhoods fraught with restrictions, threats, and violence have a tremendously negative impact on emotional and behavioral development. For example, according to UNICEF, a survey showed that 13 percent of adolescents between 15 and 19 had lost their father; others report that out of samples of 500 in Baghdad, all children under 12 have witnessed violent events in the street. UNHCR, Country of Origin Information, Iraq, October 2005, pp Ibid. 20 International Medical Corps: Baghdad: Sectarian Displacement, January 2007