Potential Humanitarian Issues in Post-War Iraq: An Overview for Congress

Potential Humanitarian Issues in Post-War Iraq: An Overview for Congress

Order Code RL31814
Report for Congress
Received through the CRS Web
Potential Humanitarian Issues in Post-War Iraq:
An Overview for Congress
March 18, 2003
-name redacted-
Foreign Affairs Analyst
Foreign Affairs, Defense, and Trade
-name redacted-
Research Associate
Foreign Affairs, Defense, and Trade
Congressional Research Service ˜ The Library of Congress

Potential Humanitarian Issues in Post-War Iraq:
An Overview for Congress
Summary
Since 1996, the Oil For Food Program (OFFP) has alleviated some of the worst
effects of the 1991 Gulf-War international sanctions regime, but the humanitarian
situation in Iraq (defined as an urgent need for food, shelter and basic health care)
remains serious. While some improvements have been seen in nutrition, health
services, water supply and sanitation, there is greater dependence on government
services, and observers of the Iraq situation have identified disturbing health and
nutrition problems affecting the civilian population. These have been tied to the
consequences of war, sanctions, shortcomings of assistance, and the deliberate
policies of the Iraqi regime.
There seems to be a consensus that the current poor humanitarian situation
inside Iraq could worsen during a conflict, though this would likely depend on the
nature and duration of the conflict and the extent and quality of humanitarian
assistance. Problems could arise from the following: malnutrition and disruption of
food supplies, inadequate sanitation and clean water, and reduced health and medical
care. The consequences of war in Iraq could also include a potential humanitarian
emergency with population movements across borders or within Iraq itself.
Given the challenge of current conditions in Iraq, U.N. agencies indicate that a
conflict in Iraq would disrupt critical infrastructure, delivery of basic services, and
food distribution with the potential of severe humanitarian consequences. Relief
agencies are having to plan for humanitarian needs amid great uncertainty about
conditions in the aftermath of conflict. In recent months many have continued to
reiterate that contingency planning does not mean they assumed war was inevitable.
The Department of Defense (DOD) has set up an Office of Reconstruction and
Humanitarian Assistance as a central point for those involved in humanitarian and
reconstruction efforts. The group has developed an operational concept for the
delivery of aid, relief coordination, and a transitional distribution system. This office
is coordinating efforts with other U.S. agencies, including USAID and the State
Department. U.S. forces are pre-positioning food and relief aid near Iraq and making
plans to deal with a possible humanitarian crisis.
Several issues are of critical interest to Congress, including food security,
implementation and coordination of assistance, humanitarian relief activities during
war, the impact of population movements, and humanitarian and reconstruction
efforts after war. The information in this report reflects the situation prior to the start
of the war in Iraq and is current as of March 18, 2003. This report will not be
updated. For further information, please see CRS Report RL31833, Iraq: Recent
Developments in Humanitarian and Reconstruction Assistance.

Contents
Current Humanitarian Situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Latest Developments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Malnutrition and Lack of Food Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Inadequate Sanitation and Clean Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Basic Health and Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Potential War-Related Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Food Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Sanitation and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Other Humanitarian Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Contingency Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Aid Agency Preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Initial DOD Lead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
USAID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
International Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
NGO Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Concerns of Relief Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Preparation for Refugees and IDPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Considerations for Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Food Security and the OFFP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Implementation and Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Humanitarian Relief Activities During War . . . . . . . . . . . . . . . . . . . . . . . . 11
Impact of Population Movements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Humanitarian and Reconstruction Efforts After War . . . . . . . . . . . . . . . . . 12
List of Tables
Comparative Population Statistics: Iraq, Afghanistan, and Saudi Arabia . . . . . . . 4

Potential Humanitarian Issues in Post-War
Iraq:
An Overview for Congress
Current Humanitarian Situation
Latest Developments
With the Administration’s announcement on March 17, 2003 giving Iraq a final
48 hour ultimatum and bringing a close to U.S. diplomatic efforts, the humanitarian
situation appears to have shifted into a new phase. There are reports of Kurdish
civilians either leaving cities located in possible combat zones or safeguarding their
homes with sheets of plastic in the event of a chemical attack by Hussein. In
Baghdad, civilians bought water and canned food, converted currency, and filled gas
tanks in preparation for war. On March 18, 2003, the U.N. Secretary-General Kofi
Annan authorized an immediate withdrawal of United Nations (U.N.) personnel from
Iraq and suspended the Oil-for-Food Program (OFFP).1
Background
During 1991-1996, surveys and studies suggest a precipitous continuing decline
in the health and nutrition status of the Iraqi civilian population, especially among
children and the elderly. However, because much of the information available on the
conditions within Iraq is considered unreliable, it is difficult to determine how much
of the suffering is due to the sanctions imposed on Iraq and how much is due to other
factors, such as government policies.2 In general, there seems to be a consensus that
the humanitarian situation remains precarious, and to some observers, a humanitarian
crisis could arise from war.3
Iraq’s population is estimated at between 24 and 27 million, which includes
approximately 3.5 million children.4 According to the U.S. Committee for Refugees,
there are more than 300,000 Iraqis living with refugee status in other countries; there
1 Iraq appears to still be allowed to export oil via Turkey as U.N. staff were evacuated only
from inside Iraq.
2 Some groups question the accuracy of statistics published by the government, but have no
independent sources of information. All estimates of the number of deaths due to lack of
food or medical care vary widely based on the source.
3 “U.N. Official Warns of Iraqi Food Crisis,” Washington Post, February 28, 2003.
4 Total population numbers for Iraq vary by source. UNICEF Humanitarian Action: Iraq
Donor Update January 14, 2003. See [http://www.reliefweb.int].

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are similar numbers of other Iraqis living elsewhere who have not been granted
refugee status. Within Iraq, there are also possibly 700,000 internally displaced
persons (IDPs).5 In addition, Iraq hosts refugees from other countries. The United
Nations High Commissioner for Refugees (UNHCR) has four offices inside Iraq, and
works primarily with 100,000 Palestinian, 23,000 Iranian and 13,000 Turkish
refugees.6
Imposition of U.N. sanctions in 1991 followed a nearly decade-long war
between Iraq and Iran, during which spending on the social welfare system declined.
Decades of conflict, including the Iran-Iraq war and the bombing during Desert
Storm, damaged or destroyed much of the Iraqi public infrastructure such as water
and sewage plants and many public buildings. In response to these concerns, the
United Nations and other humanitarian agencies have been providing aid to Iraq
through the Oil-for-Food Program (OFFP), which uses revenue from Iraqi oil sales
to buy food and medicines for the civilian population.7 Both bilateral and
multilateral aid have continued to flow into the country since the end of the war,
although it is difficult to assess the total amount provided by all donors outside the
OFFP.
Since 1996, the OFFP has alleviated some of the worst effects of the sanctions,
but the humanitarian crisis (defined as an urgent need for food, shelter and basic
health care) remains serious. While some improvements have been seen in nutrition,
health services, water supply and sanitation, there is greater dependence on
government services. Observers of the Iraq situation have identified disturbing
health and nutrition problems affecting the civilian population. These have been tied
to the consequences of war, sanctions, shortcomings of assistance, and the deliberate
policies of the Iraqi regime. Some argue that supplies of water, food, medicine, and
electricity are now a matter of urgent concern.8
Malnutrition and Lack of Food Security
In part as a response to the devastation of the 1991 Persian Gulf War, the Iraqi
government expanded its food distribution system to work in conjunction with the
OFFP. Nearly 60 percent of the Iraqi population has been receiving monthly food
distributions at a total cost of $290 million per month under the OFFP.9 As a result,
5 “Overview of Numbers and Conditions of Iraqi Refugees in the Middle East and Internally
Displaced Persons in Iraq,” U.S. Committee for Refugees, January 27, 3003.
6 “U.N. seeks $37.4 million Humanitarian Supplies in Case of Iraq War.” Dow Jones
International News, December 23, 2002.
7 For more information about the Oil-for-Food Program (OFFP) see CRS Report RL30472,
Iraq: Oil-for-Food Program, International Sanctions, and Illicit Trade, by (name r
edacted).
8 “Agencies Fear Consequences But Plan for War in Iraq; Iraq stocks up food ahead of
possible US War.” Turkish Daily News, December 27, 2002.
9 “U.N. Sees Huge Aid Need in Case of War on Iraq,” Reuters, December 23, 2002; “War
could cut Iraqis’ food lifeline - AID agencies mobilizing,” Atlanta Journal and Constitution,
(continued...)

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the minimum nutritional requirement per person/per day set by the U.N. Secretary
General is nearly being reached. While this program has improved the situation,
malnutrition remains a serious problem throughout the country, especially for
children and other vulnerable groups. The rates of malnutrition in Iraqi children have
reportedly increased from 18.7 percent in 1991 to 30 percent a decade later.10
Observers indicate that families cannot make their rations last the full month or need
to sell part of them for other necessities. This leaves many people without any food
stored in reserve and makes them vulnerable to food distribution disruptions, now
more likely with the March 18 suspension of the OFFP.11 Furthermore, most of the
warehouses that store food in OFFP are thought by some to be empty, which means
there are few reserves within Iraq.12
Inadequate Sanitation and Clean Water
A major cause of unnatural deaths noted by the United Nations High
Commissioner for Refugees (UNHCR) and the World Health Organization (WHO),
especially among children, is intestinal disease due not only to lack of common
medicines and medical equipment shortages, but also to unsafe drinking water and
inadequate sanitation. The United Nations Children’s Fund (UNICEF) reports that
approximately 5 million people are at risk from these factors alone. Health experts
and Iraqi doctors say malnutrition and increased early childhood deaths are no longer
primarily the result of lack of food, as they were before the Oil-for-Food program.13
Intestinal disease can dehydrate children and leave them far more vulnerable. This
problem is especially severe in rural areas where people are poor and have little
knowledge of prevention. Part of the problem arises from the fact that many of the
electrical generators that run water and sewage treatment plants do not work either
due to war damage or lack of spare parts. Decaying electric generators are available
for only 70% of the urban water treatment plants and 10% of the rural units. As a
result, sewage may be dumped directly into rivers, which may also supply drinking
water, leading to a lack of clean water, inadequate sanitation, and possible public
health crises.
Basic Health and Medical Care
In general, there is great concern about the health status of Iraqis and the
available medical care in Iraq. For the South/Center regions of Iraq, the mortality
rate for children under five is 136 per 1,000 live births (2.5 times worse than in
1990); in the northern regions it has shown some improvement from 80 to 72 per
9 (...continued)
December 20, 2002.
10 “War could cut Iraqis’ food lifeline - AID agencies mobilizing,” Atlanta Journal and
Constitution, December 20, 2002.
11 UNICEF Humanitarian Action: Iraq Donor Update January 14, 2003.
12 “U.N. Official Warns of Iraq’s Food Crisis,” Washington Post, February 28, 2003.
13 Struck, Doug. “Iraqi Ingenuity Aids Survival.” Washington Post, May 3, 1988, A22.

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1,000 live births.14 UNICEF reports that maternal mortality rates have more than
double at 294 per 100,000 births in the South/Center and 120 in the North. The
Agency indicates that approximately one third of deaths among women aged 15 to
49 years can be attributed to childbirth.15 More than 50 percent of pregnant women
are anemic; 30 percent of babies born weigh less than 5.5 pounds.16 The key sources
of mortality are malnutrition and disease–both diarrheal and respiratory. Measles
outbreaks in older children are attributed to a lack of immunization coverage
(vaccination rates are at about 80%). Shortages in medical supplies, drugs and
vaccines have also been reported.17 Current stocks are predicted to last 4 months at
current consumption rates.
A comparison of basic health statistics for the populations of Iraq, Afghanistan,
and Saudi Arabia, chosen for their similar size and location, provides a general
contextual framework for Iraq’s problems.18 Interestingly, although this data shows
that Iraq is much better off than Afghanistan, it is about on par with Saudi Arabia for
these criteria.
Comparative Population Statistics:
Iraq, Afghanistan, and Saudi Arabia
Iraq
Afghanistan
Saudi Arabia
Population
24,001,816
27,755,775
23,513,330
Population growth rate
2.82%
3.43%
3.27%
Birth rate
34.2 births/
41.03 births/
37.25 births/
1,000 population
1,000 population
1,000 population
Death rate
6.02 deaths/
17.43 deaths/
5.86 deaths/
1,000 population
1,000 population
1,000 population
Infant mortality rate
57.61 deaths/
144.76 deaths/
49.59 deaths/
l,000 live births
1,000 live births
1,000 live births
Life expectancy at birth
67.38
46.6
68.4
(total population
(total population)
(total population)
Fertility rate
4.63 children
5.72 children
6.21 children
born/woman
born/woman
born/woman
Source: CIA, The World Fact Book 2002–Iraq; CIA, The World Fact Book 2002–Afghanistan; The
World Fact Book 2002–Saudi Arabia. [http://www.cia.gov]
14 UNICEF Humanitarian Action: Iraq Donor Update January 14, 2003. UNICEF reportedly
says that under the sanctions regime, mortality rates in young children have increased by
500,000.
15 UNICEF Humanitarian Action: Iraq Donor Update January 14, 2003
16 “Wartime Iraq Aid Calamity feared.” San Francisco Chronicle, January 5, 2003.
17 “Supplies Amassed Along Front Line of Iraq’s ‘Other’ war; As U.S. Military Prepares for
Fighting, Relief Groups Mobilize to Save Lives,” Washington Post, January 5, 2003.
18 These statistics reflect the average for the entire country; numbers in specific regions may
vary.

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Potential War-Related Concerns
Overview
It is widely believed that the current humanitarian situation inside Iraq could
worsen during a conflict, though this would likely depend on the nature and duration
of the conflict and the extent and quality of humanitarian assistance.19 Problems
could arise from malnutrition and disruption of food supplies, inadequate sanitation
and clean water, and reduced health and medical care. The impact of war in Iraq
could also include a potential humanitarian emergency with population movements
across borders or within Iraq itself. The United Nations and others have explored the
likely humanitarian situation in Iraq in the event of a war.20 Although any predictions
are highly speculative without a sense of the extent and duration of a war, the United
Nations reportedly expects that 600,000 to 1.45 million refugees and asylum seekers
might flee Iraq, 2 million could become internally displaced, and 4.5 to 10 million
inside Iraq (nearly 40% of the Iraqi population) could require food assistance within
weeks after the onset of hostilities.21 Leaked U.N. documents reportedly show that
the organization is expecting 100,000 immediate casualties in Iraq and increased risk
to children due to malnutrition.22 However, some analysts believe that if the war is
a brief one, casualties could be considerably fewer.
Food Security
During a conflict, food security would remain a critical concern because of the
dependence of the population on the food distribution network. With more than two
thirds of the country receiving food assistance and many suffering from malnutrition
and other health problems, this situation could get worse if parts of Iraq became
isolated and humanitarian agencies could not gain access to these areas. Military
destruction of roads or railways could also destroy the food distribution systems
within Iraq and disrupt the assistance plans of the international community.
Furthermore, in addition to functioning roads, fuel would be essential for
humanitarian food distribution.
19 For additional information on a post-war Iraq, see RS 21454, Iraq: Potential Post-War
Foreign Aid Issues by (name redacted). See also RL31766,
Iraq: United Nations and
Humanitarian Aid Organizations by Tom Coipuram.
20 Strictly confidential U.N. document “Likely Humanitarian Scenarios,” Dec. 10, 2002,
[http://www.cam.ac.uk/societies/casi/pr/pr030107undoc.html].
21 Over time sources have referred to approximate numbers (with a degree of variation) of
Iraqis requiring assistance. “Supplies Amassed Along Front Line of Iraq’s ‘Other’ war; As
U.S. Military Prepares for Fighting, Relief Groups Mobilize to Save Lives,” Washington
Post, January 5, 2003.”Shortfall Imperils U.N.’s Iraq Aid; Funds Sought for Humanitarian
Work,” Washington Post, February 14, 2003. U.N. Official Warns of Iraqi Food Crisis,”
Washington Post, February 28, 2003.
22 “‘Grim Picture’ Seen for Iraqis,” Los Angeles Times, February 14, 2003.

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Sanitation and Health
If power stations were hit, the already damaged water and sanitation systems
could be further damaged, which might lead to epidemics, such as cholera and
hepatitis. According to the United Nations, “the outbreak of diseases in epidemic if
not pandemic proportions is very likely.”23 Water and sanitation are of greatest
concern.24
Other Humanitarian Concerns
A particular area of concern is the possibility of large-scale population
movements. An increase in displaced populations could quickly multiply the rates
of disease and infection to epidemic proportions. There are already displaced persons,
refugees, and other vulnerable groups within Iraq who currently require humanitarian
assistance and for whom lack of food, poor health, and other problems would only
be intensified.
Some observers have suggested that in the confusion of war or in the context of
a power vacuum, Iraqis may initiate revenge killings and seek to resolve grievances
through violence or some form of revolt. In 1991, some Shiites executed Baath party
officials. A breakdown of the social order could have serious humanitarian impacts,
bringing increased mortality and serious human rights abuses. Women could be
particularly vulnerable.25
Depending on the type of warfare, many Iraqis could suffer the unintended
consequences of military action or the effects of chemical and biological weapons if
used by their government. If units of the Iraqi army undertook a scorched earth
policy, as they did with the Kuwaiti oil wells in the Gulf War, there could be serious
environmental and health consequences.
Contingency Planning

Aid Agency Preparations
Given the challenge of current conditions in Iraq, relief agencies indicate that
a conflict there would disrupt critical infrastructure, delivery of basic services, and
food distribution. They are planning for humanitarian needs amid great uncertainty
about conditions in the aftermath of conflict. Although the humanitarian issues in
Iraq have in recent weeks been getting much more attention in the United States and
abroad, the state of preparedness for humanitarian contingencies, degree of
transparency over planning, and possible lack of funding have many concerned about
23 Ibid.
24 “Supplies Amassed Along Front Line of Iraq’s ‘Other’ war; As U.S. Military Prepares for
Fighting, Relief Groups Mobilize to Save Lives,” Washington Post, January 5, 2003.
25 “Statement on War with Iraq,” Women’s Commission for Refugee Women and Children,
International Rescue Committee, [http://www.womenscommission.org].

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the impact of war and capacity of the international community to meet the
humanitarian needs on the ground. A U.N. official has said that preparations so far
by the U.S. military and the World Food Program (WFP) are “grossly inadequate.”26
Initial DOD Lead. On January 20, 2003, a presidential directive established
the Office of Reconstruction and Humanitarian Assistance in the Pentagon to prepare
for war and post-war aid needs. The Office, headed by retired Army Lt. Gen. Jay M.
Garner, is set up under the Department of Defense (DOD) but staffed by officials
from agencies throughout the U.S. government, including the United States Agency
for International Development (USAID) and the State Department. Civilian
coordinators in charge of three substantive areas – humanitarian relief,
reconstruction, and civil administration – and a fourth coordinator, responsible for
communications, logistics, and budgetary support, are expected to work on the
planning and implementation of assistance programs.27
According to Pentagon planners, U.S. armed forces would initially take the lead
in relief and reconstruction, later turning to Iraqi ministries, nongovernmental
organizations (NGOs), and international organizations to assume some of the
burden.28 The group has developed an operational concept for the delivery of aid,
relief coordination, and a transitional distribution system. U.S. forces are pre-
positioning food and relief aid near Iraq and making plans to deal with a possible
humanitarian crisis. How long the civil affairs teams (a special section within each
of the armed services) will be leading the relief efforts remains to be seen.
DOD is taking an inter-agency approach to the potential need for humanitarian
assistance. On February 11, in congressional testimony, Marc Grossman, Under
Secretary of State for Political Affairs, stated that USAID and the Department of
State were working with NGOs and international organizations, which would be
“important partners in addressing Iraq’s humanitarian needs,” adding “civilian and
military officials regularly consult and coordinate plans.” With funding from
USAID, U.S.-based NGOs have formed a consortium, the Joint NGO Emergency
Preparedness Initiative, for better coordination. Grossman noted that the United
States had allocated $15 million for planning, and $35 million was being made
available from other accounts.29
USAID. Since October 2002, USAID has been putting a Disaster Assistance
Response Team (DART) together and is making preparations to deal with the basic
needs of one million people. There will be a core office in Kuwait City and three
mobile field offices. Planning has included assembling and training the response
team; stockpiling emergency supplies and commodities; and communicating with
U.S. and international organizations. According to USAID, so far it has spent $26
26 U.N. Official Warns of Iraqi Food Crisis,” Washington Post, February 28, 2003.
27 General Garner arrived in Kuwait on March 18 to oversee the potential postwar Iraq
effort.
28 “U.S. Military Lays Out Postwar Iraq Plan,” Washington Post, February 12, 2003.
29 Senate Foreign Relations Committee Hearing, February 11, 2003. Transcript provided by
Federal Document Clearing House.

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million from contingency planning funds. Another $56 million will be drawn from
existing funding sources within USAID.
Whether or not adequate preparations are being made by the U.S. government
to meet the needs of enough people is difficult to predict. Still, the total amounts
being spent by the United States on contingency planning for humanitarian assistance
and the projected funds required are not yet clear. The Administration’s request for
an FY03 supplemental appropriation including additional aid for Iraq is expected
shortly.
International Organizations. Until quite recently, U.N. agencies continued
to reiterate that contingency planning did not mean they assumed war was inevitable.
Some international organizations, such as the International Committee for the Red
Cross, stockpiled supplies in and around Iraq, but others have been concerned that
such action would send a message that they believed conflict to be unavoidable.30
U.N. humanitarian agencies have met with key donors to develop possible
humanitarian scenarios and contingency plans. UNHCR has been putting together a
contingency plan to address the potential for large-scale population movements with
an initial working figure of 600,000 refugees. Emergency stocks are being
prepositioned around the region. The United Nations Department of Peacekeeping
is reportedly planning to establish an office that could help with the coordination and
distribution of humanitarian aid.31 Other agencies such as the World Health
Organization (WHO) and WFP are also developing plans for emergency relief.
The United Nations is appealing for $123 million to provide humanitarian
assistance and food, increase staffing for relief operations, develop joint services for
the aid community, and prepare for post-war Iraqi relief. So far, it has received
pledges of about $30 million. In addition to the United States, other international
donors are also responding to the U.N. request for support.
NGO Challenges. Unlike the extensive NGO and international organization
(IO) networks working in and around Afghanistan before Operation Enduring
Freedom, only a handful of NGOs have a presence in Iraq. The Iraqi regime restricts
the territories in which NGOs can operate–for example, NGOs that work in the North
cannot have offices in the South. In addition, U.S.-based organizations are required
by the U.S. government to have a license to operate in Iraq.32 NGOs complain that
the U.S. government has delayed approval of licenses required for U.S. agencies in
Iraq, Iran, and Syria because of U.S. sanctions and licenses required for organizations
not already present in Iraq to set up operations.33 However, as of March 13, new
30 “This Time Around, War Would Hit Iraq Harder,” The Washington Post, Oct. 29, 2002.
31 “Iraq War Could Put 10 Million in Need of Aid,” The Washington Post, January 7, 2003.
32 “U.S. Plans Humanitarian Assistance for Iraqi People in Case of War,” January 16, 2003,
[http://usinfo.state.gov/regional/nea/iraq]. “Uncertainty Dogs Relief Groups’ Plans to Care
for Iraq Refugees,” Financial Times, January 6, 2003.
33 “Aid agencies accuse US of hindering war relief preparations in Iraq,” Agence France-
(continued...)

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interim regulations on humanitarian aid to Iraq have been established that are more
relaxed. U.N. sanctions still require licenses for certain “dual-use” medical items,
such as chlorine bleach. The absence of international organizations and NGOs
operating in and around Iraq means there are few networks in place and there is little
experience in the area.34
Concerns of Relief Agencies. Among relief organizations there remains
a concern that U.S. and other military leaders underestimate the potential
humanitarian crisis in Iraq35 and the large-scale humanitarian operation required in
the case of conflict. Questioning whether adequate plans for dealing with that crisis
have been developed, some complain that, despite U.S. statements to the contrary,
they are not being adequately consulted on relief plans and at present lack the
resources to send into Iraq behind advancing U.S. forces, as projected by military
planners.36
Preparation for Refugees and IDPs
There are also concerns about the absorptive capacity of neighboring countries,
whether they can provide adequately for these populations, and the impact of refugee
flows on stability in the region. Iran, Turkey, Jordan, Syria, and Kuwait have
publicly stated that they will prevent refugees from entering their countries.37 Iranian
leaders, already dealing with a large refugee population, have stated that refugees will
not be allowed over Iranian borders, but refugees would be provided assistance in
Iraq, which is a similar strategy used by Iran in Afghanistan.38 However, Iran is also
setting up 19 camps within its borders just in case. Turkey has said that it would
prefer not to allow refugees over its borders and is planning to build 13 camps in
northern Iraq. However, Turkey is also planning five more camps within its borders
and has started preparations to build one camp of 24,000 tents. The Red Crescent
team in Iraq is making preparations to accommodate up to 100,000 people and treat
33 (...continued)
Presse, Jan. 17, 2003.
34 Interaction, U.S. Relief and Development Organizations Concerned Over Potential
H u m a n i t a r i a n C o n s e q u e n c e s o f W a r i n I r a q , N o v e m b e r 2 0 0 2 ,
[http://www.interaction.org/media/Hot_Iraq.html]. Within Iraq, relief agencies are
stockpiling supplies of food, water, hygiene packets and medical supplies for approximately
250,000 people.
35 AlertNet, “Agencies Should Resist Being Taken for Granted,” January 17, 2003,
[http://www.reliefweb.org].
36 “AID Groups Say U.S. Shut Them Out of Post-Invasion Plan,” Boston Globe, February
18, 2003.
37 “Aid groups cagey on contingency plans for Iraq war,” Reuters, Jan. 15, 2003.
38 Iranian police chief Mohammad Baqer Qalibaf recently said, “No refugees will be
allowed into our territory if America attacks Iraq.” “Tehran sends mixed signals on Iraqi
refugees,” RFE/RL, Jan. 16, 2003; “Iran prepares for possible Iraqi refugee influx,” Reuters,
Jan. 16, 2003.

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up to 7,000 injured by bombs and fighting.39 It is also prepared to provide assistance
to up to one million refugees crossing into neighboring countries. Kuwait’s
government has said it will not let refugees enter the country from Iraq but that
displaced people could be cared for on the Iraqi side of the demilitarized border zone
between the two countries.40 The government is also preparing to establish a camp
for refugees.41 According to relief agency officials, although Jordan is also reluctant
to accept Iraqi refugees, it is preparing one site 60 kms from the Iraqi border and
establishing a possible transit area at a border crossing point. A camp is also being
constructed in Syria 100 kms from the Iraqi border. Saudi Arabia has not publicly
discussed the need for preparation for refugees, but there have been reports that the
government is making some plans.42
With regard to the U.S. position on Iraqi refugees, according to the U.S.
Committee for Refugees, the U.S. Immigration and Naturalization Service (INS) has
stated that there was a ‘temporary interruption’ on the admission of Iraqi refugees
into the United States in mid-January. This was apparently due to the
implementation of new security procedures introduced after September 11, 2001.
The suspension has since been lifted. The Administration has authorized the
admission of a total of 70,000 refugees in FY2003.
Considerations for Congress
Several humanitarian issues could receive near-term attention from Congress.
Except for the funding provided in the foreign operations bill, few of these issues
appear to be directly addressed by pending legislation.

Food Security and the OFFP
It is unclear what assumptions are being made about estimates of food aid and
the cost per Iraqi citizen–how much will be required for how many people over what
period of time? There is concern about whether food delivery will be dependent on
keeping the OFFP distribution network in place. The United Nations has an
extensive infrastructure in Iraq to oversee the OFFP,43 but expatriate staff, some of
whom have been leaving voluntarily in recent weeks, are now being evacuated.
Those who leave would not be available to administer assistance while the fighting
39 “Turkey to set up 24,000 tents at Iraq border for possible refugee influx,” Agence France-
Presse, Jan. 15, 2003; “Supplies Amassed Along Front Line of Iraq’s ‘Other’ war; As U.S.
Military Prepares for Fighting, Relief Groups Mobilize to Save Lives,” Washington Post,
January 5, 2003.
40 “Aid groups Cagey on contingency Plans for Iraq war,” Reuters, Jan. 15, 2003.
41 “Hoping for Peace but Preparing for War,” The Washington Post, Jan. 12, 2003.
42 “Hoping for Peace but Preparing for War,” The Washington Post, Jan. 12, 2003.
43 The United Nations High Commissioner for Refugees (UNHCR) has four offices inside
Iraq, and works primarily with 100,000 Palestinians, 23,000 Iranians, and 13,000 Turks–all
of whom are refugees. “U.N. Seeks $37.4 Million Humanitarian Supplies in Case of Iraq
War.” Dow Jones International News, December 23, 2002.

CRS-11
lasts.44 It is unknown to what extent contingency plans are being coordinated and
implemented with the OFFP. Reportedly, Administration officials have indicated
that once the military gains control, the OFFP will be restarted.45
Future control over the OFFP remains a question. In the event of war, and to
ease emergency relief, it would appear that some sort of new U.N. action could be
required to transfer control over Iraq’s oil revenue and purchase of food and supplies.
The OFFP, set up as a temporary measure until Iraq fulfills its obligations under
specific Security Council resolutions, might be amended or replaced. A new
resolution could form the basis of post-invasion assistance and reconstruction. The
current phase of the OFFP expires in June 2003, when another resolution for the
current program is required. The June rollover could be the time for the Security
Council to change the terms of the OFFP in response to a U.S. occupation.
Implementation and Coordination
How the war is fought and for how long – whether it will be a protracted, urban
war with heavy civilian casualties or a shorter war with less impact on the Iraqi
people – will in part determine the scale of the humanitarian problems. How
assistance is to be implemented – through U.S. occupation, U.N. administration, or
donor assistance – could affect the response to humanitarian problems. Within this
context, the type of humanitarian assistance provided can also determine the scale of
the problems. DOD has clearly stated that it is not the lead agency for humanitarian
relief beyond “creating humanitarian space,” but it is not known how assistance will
be implemented in a postwar Iraq, the role of the U.S. government, U.N. agencies,
and NGOs, and what agencies will coordinate this effort for the United States and the
international community.46
Humanitarian Relief Activities During War
The Pentagon has stated that humanitarian agencies may not have access to Iraq
immediately. In the absence of relief agencies, the military would have to be
prepared to handle the humanitarian issues that may arise. Further, for more
effective planning, policymakers may need to consider whether humanitarian
agencies will have access to all of Iraq, even those areas experiencing continued
fighting. Other NGOs have questioned whether military operational security will
impair the communication necessary to evaluate the humanitarian situation and
provide assistance. Humanitarian assistance is usually based on non-partisan need-
based criteria, which can come into conflict with military goals. Ensuring civilian
security and establishing coordination of programs with the military are key issues
that must be addressed.
44 “Hundreds of U.N. Workers Leave Iraq Voluntarily,”Washington Post, February 22, 2003.
45 “U.S. Business Will Get Role in Rebuilding Occupied Iraq,” New York Times, March 18,
2003.
46 “Pentagon News Briefing on Humanitarian Assistance for Iraq,” February 25, 2003.

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Impact of Population Movements
Many organizations have predicted that a conflict would initiate large-scale
population movements across borders or within Iraq itself. Considering the scope of
the conflict, in recent weeks questions have been raised about the level of
preparedness on the part of the United States and the international community for the
humanitarian consequences likely to result. In Iran, there are already large refugee
populations. There are also concerns about the absorptive capacity of neighboring
countries, whether they can provide adequately for these populations, and the impact
of refugee flows on stability in the region.
Humanitarian and Reconstruction Efforts After War
Congress has been concerned about burden sharing, about how much the United
States should pay in relation to other donors, the aid priorities, and the possible use
of oil revenues to offset humanitarian and reconstruction costs. Still to be
determined is the role of the international donor community and neighboring
countries in contributing to immediate post-war efforts. Another area of concern is
the time required to transition from humanitarian assistance to reconstruction.
Frustration with slow progress on the ground and growing disinterest on the part of
the international community are risks in any conflict, but particularly in Iraq where
there is broad international opposition to intervention in the first place.47
47 For example, the European Union has stated it might be unwilling to fund the
reconstruction of Iraq if war is declared on Iraq without U.N. authority. “EU Might not
Fund Iraq Aid if War Illegal,” Reuters, March 12, 2003.

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