Delivering Drops of Life:
Restoring Water and Sanitation Services in Iraq

Like people in so many parts of the world, Iraqi citizens face daily challenges in securing safe drinking water. Drinking water and wastewater treatment systems, already degraded before the war, were further damaged by both bombs and looters. In the aftermath of combat, frequent power outages and a shortage of chlorine threatened to usher in a public health disaster for Iraq's 24 million citizens. A broad-based effort by the U.S. government, the United Nations, and humanitarian relief organizations has restored basic water services in many areas, and appears to have headed off widespread outbreaks of cholera and other waterborne diseases. However, establishing a safe and reliable water supply remains long-term task.

Neglected Water Infrastructure Further Damaged by War

Although degraded by years of neglect in the 1990s, water and sewage treatment services were largely functional in Iraq before the war. In April of this year, however, the United Nations Children's Fund (UNICEF) and CARE conducted a survey of 177 water treatment plants in southern and central Iraq. About one quarter of these facilities were operating poorly or not at all. Treatment plants and water distribution systems appear to have suffered less direct damage than during the first Gulf War, but services were severely undermined in certain areas.

In July, none of Baghdad's three sewage treatment plants was functioning. As a result, the city's raw sewage (an estimated 500,000 tons daily) was discharged directly into the Tigris River, the primary drinking water source for millions of people.

Lack of Safe Water Spreads Disease, Threatens a Health Crisis

According to UNICEF, Iraqi children suffer from diarrhea about 14 to 18 times a year, compared to the average of two or three cases per year in areas with access to clean water. UNICEF reported that in one three hour period in May, one Baghdad hospital reported 300 cases of children admitted with diarrhea. In areas where chlorine supplies ran out, UNICEF reported a "parallel rise in diarrhea." Executive Director Carol Bellamy stated, "Young children have developing immune systems and low body weight. Add a bout of diarrhea picked up from dirty water, and we can lose them very quickly."

During the hot summer months, the specter of widespread cholera outbreaks loomed over the country. Cholera is characterized by profuse diarrhea, which can lead to severe dehydration and death if left untreated. The World Health Organization (WHO) reported a total of 73 laboratory-confirmed cholera cases in Iraq from April 28 to June 4 - 10 times more than WHO officials found during the same period last year. Most of these cases were reported in the Basra region. Other waterborne diseases, including typhoid and dysentery also rose sharply in the spring. With the hottest summer months still to come, WHO officials warned that massive outbreaks were possible.

Short and Long Term Rehabilitation Underway

Multiple organizations have focused on water and sanitation programs in Iraq. These groups include the U.S. Agency for International Development (USAID); UNICEF and other United Nations groups; and humanitarian relief organizations such as CARE, Oxfam, and the International Red Cross. With financial support from USAID, UNICEF has established a water and sanitation coordinating work group.

In recent months, relief organizations have completed emergency repairs and provided technical assistance to many water installations. CARE is working to rehabilitate drinking water treatment plants, pumping stations and distribution networks as well as sewage treatment plants throughout Iraq. This work ranges from emergency repairs to long-term, large-scale rehabilitation projects. In addition CARE has provided training and technical support to over 40 treatment plants.

UNICEF has undertaken similar repair, rehabilitation and training efforts. UNICEF has also trucked in millions of gallons of drinking water and set up community water stations at hospitals and health centers.

Multiple organizations are also working on long-term projects to improve water and sanitation infrastructure in Iraq. For example, USAID has been working with the Coalition Provisional Authority and the Iraqi General Corporation of Water and Sewage on plans to substantially upgrade Baghdad's sewage treatment plants, which only served about 30% of the city's population before the war. This work will take an estimated 12-18 months to complete.

Testifying before Congress in July, Patrick Carey of CARE USA described the multiple difficulties that have hindered progress in restoring water supplies, including electricity blackouts, security concerns for relief workers, and a failure to understand how pre-war government operations functioned in this largely isolated country.

Supplying Chlorine to Combat Disease

The safety of drinking water supplies was also threatened by a critical shortage of chlorine and other treatment chemicals. In April, UNICEF warned of rapidly dwindling supplies of chlorine gas in southern Iraq. UNICEF provided millions of dollars worth of water treatment chemicals, particularly chlorine gas and calcium hypochlorite (granular chlorine-based products widely used for sanitizing swimming pools). Arch Chemicals, a U.S.-based manufacturer of chlorine products, has supplied more than 200 metric tons of calcium hypochlorite to the U.S. Department of Defense and to UNICEF for operations in Iraq.

Disease Epidemics Prevented, but Long-Term Challenges Remain

It appears that the worst-case fears of waterborne disease in post-war Iraq have not materialized. After issuing a warning in April that a mass cholera outbreak was possible, The World Health Organization has not reported new cholera cases since early summer. While the number of diarrhea incidents among Iraqi children remains unacceptably high, the focused efforts of multiple organizations have clearly abated much suffering.

Emergency supplies of water and treatment chemicals provided immediate relief and system repairs and operator training programs have helped lay the foundation for sustainable progress. Long-term upgrades to drinking water and wastewater facilities are planned in Baghdad, Basra, and elsewhere to address chronic infrastructure problems, many of which existed before the war.

Protecting and supplying safe drinking water to Iraqi citizens remains a priority in post-war Iraq. Restoring these essential services is only part of the overall challenge. As President Bush acknowledged, post-war reconstruction represent "a massive and long-term undertaking."