April 26, 2003
Members of DART Field Team West traveled from Jordan to Ar Rutbah in western Iraqi on April 26. The team met with local officials including the newly selected mayor, health officials, public distribution system (PDS) food agents, education officials and local community members. CARE sent two water engineers to Ar Rutbah who provided a detailed brief of the water and sanitation system and needs assessment to the DART. The DART also met with Coalition forces who have been present in Ar Rutbah for the past several weeks. Immediate needs could be met with specific, targeted interventions so that the stable atmosphere of the town can be maintained.
Water
There are approximately 25,000 people in and around Ar Rutbah, which normally receives its water from three different water treatment plants (WTP). The main source is a group of 12 wells that are located approximately 15 kilometers (km) south of town. Other sources are the WTP located about 25 km south of Heet, and the WTP near Al Qa'im that draws from the Euphrates. Water is piped through the desert, and there are several points in the pipeline where the Bedouin population can draw water out for themselves and their sheep. (There are approximately two million sheep in this region that each require between three and four liters of water per day.) The pipeline running from Al Qa'im is not operational. The pipeline running from near Hit is providing water about only half of the way through the desert to Ar Rutbah.
Electricity has not been restored to the town and, therefore, the normal water system is still down. However, residents are receiving untreated water that is being tanked to residences. Coalition forces acquired generators that are being used to pump water from eight of the 12 wells, although four are at low efficiency. The WPT is not receiving power, and the two 525 kilovolt-ampere generators needed to operate the plant are beyond repair.
The DART discussed several immediate emergency interventions to activate the WTP south of town and increase capacity at the wells. Interventions were also discussed for improving the operability of the pipeline running from the WTP south of Hit. The DART will continue to coordinate with CARE to develop implementation plans to address these immediate needs.
Food
The PDS, which serves approximately 26,000 beneficiaries, is functioning in Ar Rutbah. All 63 Wakhils (PDS agents) are accounted for and working. The DART witnessed PDS Oil for Food (OFF) food deliveries to Wakhils consisting of dry milk, tea, salt, beans, sugar, soap and detergent. This eight to ten truck shipment did not contain flour, rice, oil or infant formula. Food supplies are adequate; however, the Wakhils expressed concerns regarding future deliveries of flour, beans, and oil. Beneficiaries had maintained ration cards, and no PDS system problems were reported. Food was also available in the market. The Head of Wakhils stated that the last food delivery from Ar Ramadi was on March 16, and the last flour distribution was sometime before that, but still in March. He expects an unknown quantity of flour to be delivered from Ar Ramadi on May 1. Current private stocks are probably adequate, but a more extensive assessment is needed to confirm this.
The Head of Wakhils also reported that the mill in Ar Ramadi was recently made operational, but had limited milling capacity. This needs to be confirmed. The shortage of cooking fuel for private homes and businesses is a concern as is security for food trucks on the main highway.
Health
Following the aerial bombing of Ar Rutbah's 40-bed hospital during the war, some of the 50-member staff moved to the city's remaining health facility, the Primary Health Center (PHC). According to its director, a pediatrician, the PHC receives 500 patients per day. It is short on essential drugs, although there are enough basic stocks to last another month. Lactose milk is used for supplementary feeding, but supplies are low and too expensive for purchase on the local market. There is no therapeutic feeding program. Staff estimated the malnutrition rate at ten percent. The Center has depleted its available oxygen, which had been of low quality.
Due to water shortages in Ar Rutbah, the health staff has seen an increase in diarrhea cases, though they could not provide statistics. (Medical records were lost during the war.) They have also treated children injured by unexploded ordnance (UXO). Again, no numbers were provided, but two children were seriously injured and another killed by a UXO incident two days prior to the DART visit.
A surgeon and the former director of the destroyed hospital said that because the PHC is not suited for surgery or in-patient care, patients are transferred by ambulance to the nearest hospital, 300 miles away in Ar Ramadi. Before the war, the PHC had seven staff members. It now has between 30 and 35 staff. The remains of the hospital were also looted and all administrative and medical records were lost or destroyed. Most patients in the hospital had been deliberately vacated for precautionary reasons before the bombing. One patient and his father, who elected to stay in the hospital overnight, were killed in the bombing.
The PHC has intermittent electricity, provided by a generator, and water and no communication capabilities. Staff sent letters to Ministry of Health (MOH) officials in Ar Ramadi, requesting drugs and supplies, but were told they would have to pay for them in advance as they had in the past. There are two public-private pharmacies in town, in addition to the pharmacy at the PHC. Many of the eight MOH doctors in Ar Rutbah (seven men and one woman) also maintain a private practice.
To date, the International Committee of the Red Cross (ICRC), MDM-Greece, and World Vision International (WVI) have visited the PHC and provided small quantities of drugs. World Vision, working with PHC staff, ICRC and MDM, plan to deliver a supply of essential drugs on 28 April, and would like to offer ongoing health-sector support to Ar Rutbah over several months. The DART has encouraged WVI to submit an implementation plan for emergency health intervention in Ar Rutbah.
Schools
There are eight primary, three secondary, and one intermediate school in town. None of the schools suffered damage related to combat, but several were looted. Teachers and school officials protected most of the schools from looters, and the majority of teachers and students are eager to get back to school. Some schools have started back up. However, a rumor recently spread that the Coalition forces had said that schools nationwide would not start for three months, so some teachers and many students
stopped attending. Coalition forces and the mayor are planning to get the message out to the community through the mosques that those schools that can open, should open.
UXOs
Community members report the existence of numerous UXOs around town, some dating back to the 1991 war. Several injuries have been reported over the past week. While visiting the former Baath party HQ (site of the proposed temporary hospital), the DART witnessed a group digging up a site in the compound that was full of UXOs. Coalition forces intervened to stop the activity.
Local Government
The town has selected a mayor and representatives for the various government ministries. Police have begun patrols, and are manning checkpoints at the entrances to the town. Pay is becoming an issue. Officials are recommending that civil servants keep records of their time in order to submit it to the relevant ministries once the national government is stood back up.
