Casualties

Casualties Overview

Details and trends

In 2011, the Monitor identified 141 mine/explosive remnants of war (ERW) casualties in Iraq.[1] Of these, 56 occurred in the Iraqi Kurdistan region in northern Iraq (Kurdistan) with the remaining 85 in central and southern Iraq.

Media monitoring identified 85 casualties in central and southern Iraq. In 2011, the Directorate of Mine Action (DMA) established a new casualty data collection mechanism which recorded 46 casualties in the same geographic areas of Iraq during the year.[2] However, due to the lack of detail available from the DMA data, it was impossible to distinguish those casualties from the casualties identified through media reports. It is certain that there are many more casualties in Iraq that are not identified due to the limited capacity of the newly established casualty data collection mechanism and because media coverage of casualties is far from comprehensive.[3]

Children made up at least 41% of civilian casualties for which the age was known (50 of 121), a significant increase from the 32% of casualties identified in 2010.[4] Of the total child casualties, most (29) were known to be boys; at least four were girls.[5] Two thirds of child casualties (33) were caused by ERW, including unexploded submunitions (11). As in previous years, men made up the single largest casualty group, representing 44% of civilian casualties for which the age was known; 13 casualties were women. There were 20 casualties among deminers,[6] a significant increase from the five in 2010. Of these, 10 occurred in Kurdistan, including a female deminer. Mines, including victim-activated IEDs, caused 16 of the 20 demining casualties.[7] Non-deminer civilians made up the majority of reported casualties (119) with just two casualties confirmed among security forces.

The 141 casualties identified in 2011 represented a significant increase in the number of reported annual casualties as compared with the 82 casualties identified for 2010.[8] The increase was due to a significantly higher number of casualties identified in central and southern Iraq, from 16 in 2010 to 85 in 2011, whereas the total number of casualties recorded in Kurdistan declined from 66 in 2010 to 56 in 2011. The increased casualty rate in central and southern Iraq was likely due to an improved security situation which enabled greater access for the media to larger areas of the country, rather than an actual change in the number of casualties occurring.[9]

The total number of casualties in Iraq remained unknown, though there were known to be many thousands. By the end of 2011, 20,300 casualties were confirmed, including 14,500 casualties registered in Kurdistan (6,000 killed; 8,500 injured).[10] In central and southern Iraq, 5,800 casualties were identified in Maysan province, the first province completed through the Iraqi survivor needs assessment launched in 2011.[11] It was estimated that 25% of all mine/ERW casualties were children under the age of 14 at the time of the incident.[12]

By the end of 2011, 1,688 casualties of cluster munition remnants were reported (754 killed; 930 injured; four unknown) and submunitions caused another 935 casualties with no further details on use (411 killed; 507 injured; 17 unknown). At least 388 cluster munition casualties occurred during strikes (128 killed; 260 injured).[13] However, due to the level of contamination, it was 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 children made up one quarter of these casualties.[14]

Victim Assistance

The total number of mine/ERW survivors in Iraq is estimated to be 48,000–68,000.[15] There were 8,500 survivors identified in Iraqi Kurdistan.[16]

Victim assistance since 1999

Decades of armed conflict prior devastated the formerly well-functioning medical system in Iraq. The 10 major hospitals and 15 primary health care centers renovated and supplied by the ICRC between 1999 and the start of the Iraq war in March 2003 were damaged again during the related period of civil unrest. Continued armed violence prevented the rebuilding of critical victim assistance services and contributed to the emigration of some 75% of qualified medical personnel; by 2008 healthcare had deteriorated to being in “worse shape than ever.”[17] The situation worsened as the growing number of mine/ERW survivors and other war-wounded increased the use of the deteriorating services available.

Starting in 2009, a slowly improving security situation allowed for some renovations to medical facilities and the building of one new physical rehabilitation center. Survivors were more able to access available services, and some survivors in central and southern Iraq with the means to cover transportation costs could access free victim assistance services in Kurdistan. However, through to the end of 2011, the volatile security situation in many areas continued to prevent many survivors from having access to needed services.

In 2006, the national Directorate for Mine Action (DMA) appointed a Victim Assistance Director to address the absence of national victim assistance coordination, but harmonization with relevant ministries remained essentially nonexistent up until 2010 when the first national victim assistance meeting was held. Iraq had no victim assistance plan throughout the period. In 2011, however, the second annual national victim assistance meeting resulted in a set of recommendations for improving victim assistance.

The situation for survivors in Kurdistan was significantly better than in the rest of Iraq throughout the period. 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. Victim assistance services were coordinated, together with the regional Ministry of Health, by the two mine action authorities operating in the Kurdistan region, the Iraqi Kurdistan Mine Action Authority (IKMAA) and the General Directorate for Mine Action (GDMA), which had merged into the IKMAA by 2012. Nevertheless, available services were not fully able to address the needs of the large number of survivors in the region, a situation worsened by the arrival of survivors from the south starting in 2009.

Victim assistance in 2011

In 2011, the collection of data relevant to victim assistance improved significantly in Iraq with the launch of a mine/ERW survivor needs assessment, the establishment of a casualty data collection system through the DMA for central and southern Iraq, and the expansion of a pilot injury survey. A set of recommendations for improving victim assistance (“VA recommendations”) was developed, though this fell short of a comprehensive victim assistance plan. There were no significant changes in access to or availability of services in 2011 in southern and central Iraq, though improvements in the security situation in 2010 were sustained. These constant improvements made possible the continued reconstruction of medical and rehabilitation centers and greater mobility for mine/ERW survivors. In Kurdistan, the establishment of “Disability Information Points” increased knowledge of services available for mine/ERW survivors.

Assessing victim assistance needs

In 2011, the DMA launched a survivor needs assessment survey that was planned to cover the 15 provinces of central and southern Iraq by February of 2015. The survey in the first province, Maysan, was completed by January 2012. The needs assessment was designed to identify survivors, determine their needs, and connect survivors to available medical and rehabilitation services.[18] The DMA casualty data collection system, launched in 2011, collected information from medical facilities, individuals, and NGOs including mine clearance operators.[19] However, the detailed data was not shared for victim assistance purposes.

The national Ministry of Health expanded the national injury surveillance system, started in 2010, to cover eight of Iraq’s 18 provinces/governorates in 2011.[20] The surveillance system recorded injuries caused by mine/ERW among other causes.[21]

In 2011, the Ministry of Health launched the national disability registry which covered eight of Iraq’s provinces/governorates, including all of Kurdistan, by the end of the year. Data was collected from rehabilitation centers and all relevant ministries and was to be used to develop a plan for improving services for all persons with disabilities.[22]

No specific needs assessment for mine/ERW survivors was undertaken in Kurdistan during 2011, though service providers continued to collect data when survivors accessed services. The GDMA and IKMAA provided data on mine/ERW survivors to the national disability registry of the Ministry of Health. Both of Kurdistan’s mine action centers made casualty data available based upon written request from relevant government ministries and service providers.[23]

Victim assistance coordination[24]

The second annual National Victim Assistance meeting, held in September 2011, was the only instance during the year where victim assistance stakeholders from both Kurdistan and from central and southern Iraq met to discuss victim assistance through the whole of Iraq. The meeting developed a set of 32 VA recommendations to improve victim assistance in Iraq.[25] The VA recommendations covered specific suggestions to improve interministerial coordination, enhance the capacity of medical and rehabilitation professionals, increase the availability of emergency medical care, enhance the implementation of existing laws and policies to promote the rights of persons with disabilities, and dedicate funding for ministerial budgets to increase economic inclusion opportunities for mine/ERW survivors.[26] VA recommendations were distributed to relevant government ministries in Kurdistan, central and southern Iraq, and to UN agencies.[27]

In the absence of a comprehensive national victim assistance plan, the DMA used the VA recommendations as its work plan. As of May 2012, eight of the 32 recommendations had been completed.[28] The Iraq Mine Action Strategy 2010–2012 included as its third objective to “establish an integrated and capable programme for mine/UXO victims rehabilitation and reintegration in the society.”[29] However, in 2011, Iraq continued to lack a mechanism to monitor progress toward that objective within a given timeframe.[30] The national Ministry of Health’s plan included objectives designed to improve medical and physical rehabilitation services for all persons with disabilities throughout Iraq.[31]

Victim assistance coordination had improved and was more effective throughout Iraq in 2011,[32] though it still required an increase in strengthening both in Kurdistan and in the rest of Iraq.[33] The community liaison department of the DMA served as the focal point for victim assistance coordination for south and central Iraq, though no coordination mechanism existed nor were regular coordination meetings held.[34]

Throughout 2011, there remained a lack of clarity on the roles and responsibilities of different Ministries to address the needs of mine/ERW survivors. The DMA developed a proposed coordination mechanism to clarify roles of all relevant actors, including ministries, service providers and NGOs. The proposed mechanism was “in the final stages of approval” in May 2012.[35] During 2011, the DMA coordinated bilaterally with the national Ministry of Health and several other Ministries to implement the VA recommendations.[36]

In May 2012, the merger of GDMA and IKMAA, which had been underway since 2009, was completed to form a single mine action authority for the region of Iraqi Kurdistan. The merged mine action authority retained the name Iraqi Kurdistan Mine Action Agency (IKMAA).[37] Throughout 2011, GDMA continued to hold regular meetings to share information about victim assistance activities and planning.[38]

In Kurdistan, a Protection Working Group was established by the United Nations Assistance Mission to Iraq (UNAMI) in anticipation of the approval of a law on the rights of persons with disabilities. The working group, which included both the regional mine action centers and survivor organizations, was to determine the needs of persons with disabilities and fill gaps in available services. Monthly meetings began in mid-2011.[39]

In southern and central Iraq, the Higher Committee for Physical Rehabilitation (HCPR), a branch of the Ministry of Health, held several coordination meetings in 2011 involving relevant stakeholders.[40] The Iraqi parliament approved the establishment of a national disability council that would include all relevant stakeholders such as victim assistance coordinators from the mine action authorities, but as of May 2012 it had not yet been formed.[41]

Iraq provided updates on progress and challenges for victim assistance at the Eleventh Meeting of States Parties to the Mine Ban Treaty in Phnom Penh on 29 November 2011, at the Convention on Conventional Weapons (CCW) Amended Protocol II Group of Experts meeting on 24 April 2012, and at the Mine Ban Treaty intersessional meetings in Geneva in May 2012.[42] Iraq also provided limited casualty data through form J of its Article 7 report.[43]

Inclusion and participation in victim assistance

Mine survivors and other persons with disabilities participated in the annual national victim assistance meeting and contributed to the VA recommendations.[44] In Kurdistan, survivors and other persons with disabilities and their representative organizations participated in monthly meetings of the Protection Working Group.[45]

In Kurdistan, disabled persons organizations (DPOs) and survivors implemented physical rehabilitation programs and peer support; they also participated in projects to raise awareness of the rights of persons with disabilities and provide information on available services.[46] No information was available regarding the involvement of mine/ERW survivors in the implementation of victim assistance in central and southern Iraq.

Service accessibility and effectiveness

Victim assistance activities[47]

In 2011, information about services available to persons with disabilities in Kurdistan, including mine/ERW survivors, increased through the opening of “Disability Information Points” in each of the three governorates of the region. With support from Handicap International, local DPOs managed the information points providing service referrals and information about the rights of persons with disabilities.[48]

The Ministry of Health was better able to provide the supplies necessary for emergency medical attention; a decrease in the level of armed violence also resulted in a small reduction in the need for emergency care. The ICRC completed its three-year project to strengthen emergency medical response throughout Iraq and was able to expand its activities into areas that had previously been restricted due to ongoing conflict. Hospitals relied less on ICRC emergency medical supplies.[49] However, Iraq still lacked both sufficiently trained staff and the ability to provide prompt evacuations of mine survivors. This resulted in some amputations and medical conditions which may have been avoided with a rapid medical intervention.[50]

The ongoing improved security situation and communications allowed survivors from southern and central Iraq to continue seeking physical rehabilitation services in Kurdistan. The Kurdistan centers offered free transportation and accommodation that were not available in centers in the south. Waiting lists that had grown in 2010 had been reduced somewhat by early 2012.[51] A newly built rehabilitation center, with accommodation, was opened in January 2012 in Nasiriyah, southeastern Iraq.[52] Construction of three additional rehabilitation centers by the Ministry of Health in three mine/ERW affected provinces was in progress throughout 2011.[53]

Despite these improvements, available rehabilitation services remained insufficient to meet demand. In 2012, the Ministry of Health estimated that existing rehabilitation centers produced just 25% of the prosthetics needed for the population due to a lack of materials and trained staff.[54] Access to medical facilities and rehabilitation centers for survivors in rural areas, especially those living close to the Iraq/Iran border, remained difficult due to the distances to services and a lack of affordable transportation.[55] To address the lack of trained medical and physical rehabilitation specialists, the Ministry of Health and the ICRC supported the training of hundreds of technicians.[56]

Economic inclusion activities continued to be carried out on a limited basis in Iraqi Kurdistan by NGOs[57] and by the ICRC through the rehabilitation center in Erbil.[58] In south and central Iraq, the Ministry of Labor and Social Affairs began a new program to find job placements for persons with disabilities; the Iraqi Red Crescent Society continued to provide seed support to mine survivors to start small businesses and to provide psychological support through door-to-door outreach.[59] As with medical care and physical rehabilitation services, Iraq lacked sufficiently trained professionals to provide appropriate psychological support to mine survivors during and after their medical treatment.[60] Participants in the second annual National Victim Assistance meeting highlighted the importance of increasing the number of psychologists working in rehabilitation centers and the need for increased opportunities for social inclusion, including through disability centers and sports and recreation programs.[61]

Iraq had no legislation prohibiting discrimination against persons with disabilities; access to public buildings, schools and places of work was very limited.[62] In December 2011, the Iraqi Kurdistan parliament approved a law protecting the rights of persons with disabilities. DPOs in the region advocated for the effective implementation of the new law.[63]

On 23 January 2012, the Iraqi Council of Representatives passed a law ratifying the Convention the Rights of Persons with Disabilities.[64]