Gerald R. Martone, director of emergency response at the International Rescue Committee (IRC), says that stemming the spread of waterborne diseases such as cholera is by far the biggest humanitarian problem facing Iraq. We talk about weapons of mass destruction, he says. But there is nothing like the efficiency of a contaminated water source to wipe out a population. The IRC, a nonprofit agency that provides a range of help to refugees, will focus on assuring disease-free water supplies in Iraq, he says.
Martone also says that Iraq, perhaps the most fertile country in the Middle East, can produce enough food to feed its own people.
He was interviewed by Bernard Gwertzman, consulting editor for cfr.org, on April 9, 2003.
What are the major humanitarian problems facing Iraq in the aftermath of the current war? Is there a crisis?
It depends on how you define the word crisis. You can argue that there has been a crisis for the past 12 years, since the first Persian Gulf War. The economic sanctions on Iraq have really strangled the economy and punished to a large extent the civilians more than the demagogues in power in Iraq. So there have been alarming rates of waterborne illness and malnutrition, particularly among children, as a result of the sanctions.
The water supply was not properly treated?
Right. Iraq is an industrialized country. Its water treatment facilities and sewer treatment facilities are mechanized. They require pumps, electrification, and disinfecting chemicals. A lot of the spare parts for those pumps and generators and some of the chemicals were considered dual use [meaning they could have military and non-military applications] and Iraq had trouble importing the kind of equipment and supplies they needed to keep them running [because United Nations sanctions barred imports of many dual-use materials].
Can these things now be shipped into Iraq?
Some are now permitted because the sanctions continue to be improved. They have become smarter. And some of the items previously excluded because of dual use are now permitted. But the disruption as a result of warfare— people not coming to work at water treatment plants and disruption of supplies needed for water sewage facilities— is really affecting the productivity of the water treatment plants.
So water supply is the No. 1 problem now?
Yes, it is.
What about food?
Food is not [a problem]. As we know from any emergency in the world, it takes several weeks before the first evidence of undernutrition occurs. I said undernutrition and not malnutrition. Malnutrition takes much longer. So thats one thing. And there has been [food] stockpiling on the part of Iraqi families. The government had doubled rations over the last several months in anticipation of this war under the [U.N.-run] Oil for Food program. So people have some individual reserves. Then again, the Oil for Food program was a supplement for Iraqis. Iraq is a very fertile country, perhaps the most fertile in the Middle East. It was after all, the Fertile Crescent. There is an agricultural legacy in Iraq, quite a productive one. Iraqis are net exporters of dates and some produce, even at this very moment.
Are they self-sufficient?
They have some staples— bread, meat, and a variety of other foods, most of which are grown locally.
So the idea of starving Iraqis is probably a figment of the imagination?
Its premature to use a word as severe as starvation or the word famine. They are both technical terms. For famine, you have to double the crude mortality rate. It doesnt happen very often in the world. The word starvation is a medical term. It means the body digesting itself. It is a very rare condition, even in famines. In famines, people rarely die of starvation. They mostly die of waterborne diseases, and children usually have measles.
What is the International Rescue Committee planning to do?
Our primary focus initially will be on what we call environmental health, but basically thats water and sanitation. That means improving the potability of water sources and protecting them from human waste, the sanitation part of it. Sometimes that involves the very unphotogenic building of latrines and sewage management type of facilities.
But most of press coverage of Iraqi humanitarian needs has focused on water shortages. Thats a different problem?
Yes. In fact, the problem is not so much a lack of water as it is potability, the ability to drink it. The efficiency with which waterborne diseases are communicated is haunting. We talk about weapons of mass destruction. But there is nothing like the efficiency of a contaminated water source to wipe out a population. There is a chilling precedent from northern Iraq in 1991, when the Kurds were driven by the Iraqi military into the mountains. They died at a mortality rate that was almost the equivalent to what we had seen in Goma, Zaire [in the early 1990s]. Five hundred to one thousand people died every day from waterborne diseases. They were camped along the riverbeds in northern Iraq on the mountainside. People defecated on the ground, and that got in the water source, and that caused a terrible epidemic of waterborne diseases. This is what we are afraid of.
What diseases are we talking about?
Dysentery, cholera, and other diarrheas.
And that dehydrates people?
Yes, the cause of death in waterborne disease is usually dehydration.
Back in March, when the war in Iraq began, aid groups sent a letter to the president urging that the United Nations be put in charge of humanitarian efforts.
Have you ever gotten a reply from the White House?
I am not aware of one.
President Bush and British Prime Minister Tony Blair in Belfast on Tuesday both talked of the vital role of the United Nations in postwar Iraq, and they seemed to be indicating that humanitarian efforts would be high on that list. What can you add?
Part of the discussion is focused on the reporting relationship. For civilian agencies, obviously we are uncomfortable about any appearance of a subordinate relationship to a military command, particularly an occupying force. We feel it is a corruption of our political neutrality and our operational independence, two values we hold dear.
Is that stopping you from going back into Iraq?
No. We are still presuming that because of the government grants that we got, that we are reporting to the civilian authority structure of the State Departments Agency for International Development.
Your money comes from that agency?
Some of it.
Are your people currently in northern Iraq?
We are both in the northern and southern parts of Iraq.
Where in the south?
We will be entering in through Umm Qasr. We have only done day assessments. Weve not yet established a permanent presence. We will be going in, also, through Nasiriya and Basra. And we will also be coming in from the north, through Sulaimaniya and Erbil.
Is the situation in Iraq similar to any other humanitarian crisis? Like Afghanistan, for instance?
It is important that we not use Afghanistan as a precedent. In fact, Iraq has a very high rate of college matriculation, university education, very high rates of literacy. As I mentioned, Iraq has very fertile farming soil, and it is to some extent a secular society. It is industrialized. The opportunity that Iraq brings for its own recovery is astoundingly greater than what was available in Afghanistan. So, very early on, we can look at a greater involvement of Iraqis in their own recovery. They should hold significant positions in the aid effort.
They have a trained cadre of people who are familiar with these waterborne diseases and things like that?
Thats very much the case.
So it shouldnt be a very expensive humanitarian operation?
It is hard to give it a dollar value. Because of the mechanized types of water treatment, which is a big focus, that is an expensive operation. It involves expensive chemicals and mechanical parts. In Afghanistan, for example, you were looking at not municipal water supplies but village level supplies. A lot of that was simple construction techniques to build sturdy wells, which involved more labor than assets.
The Oil-for-Food program was for food grown outside of Iraq?
Unfortunately, the Oil for Food program was not allowed to buy produce or any of the food sources from Iraqis themselves. They all needed to be imported. So the individual Iraqi farmer was unable to prosper from that and, as we know, the large-scale importation of any foreign commodity drives local market prices down. That becomes a disincentive for local farmers.
Do we have any knowledge of the present agricultural situation in Iraq?
Yes. More Iraqis derive income from farming than through the oil industry. Recovery of Iraqs agricultural sector will be more critical for the rehabilitation of this country than [recovery of] the oil industry.
What about the medical situation?
The hospitals were not doing all that well in general. Like any country thats experiencing oppression, theres been a brain drain of talented, educated clinicians. Facilities are somewhat antiquated. There are now a lot of opportunities to upgrade education. We shall be helping out medical staffs with up-to-date knowledge and training.