Healthcare and Nutrition in Camps/Urban Settings

Immunizations

In a rapid survey by the Syrian Ministry of Health  and the United Nations Children’s Fund (UNICEF) in 2007, the immunization coverage among Iraqi children <5 years old in Syria was 89% for diphtheria-pertussis-tetanus (DPT) and Haemophilus influenzae type B (third dose), 82% for measles, and 81% for hepatitis B ²⁰. Upon arrival in Jordan, 52% of Iraqi refugees with children <5 years reported receiving vaccinations ²¹. Some immunizations that are currently given to refugees in Iraq, Syria, and Jordan can be found in the Current Immunization Schedules.

Reproductive Health

In Iraq, approximately 80% of babies were delivered by skilled attendants (doctor, midwife, or nurse), and 18% by traditional birth attendants ⁹. In Syria, close to 70% of expectant Iraqi mothers delivered in hospitals in 2006, and 93% of births were attended by a physician ²². The information from Syria states the situation before the current civil war, and may not reflect the current situation there. Over 15% of expectant Iraqi mothers in Syria did not receive antenatal care, and 40% of expectant Iraqi mothers in Syria also did not receive tetanus vaccine ²². In Jordan, 94% of Iraqi women who gave birth delivered in a health care facility. Ninety-one percent of pregnant Iraqi women sought antenatal care during their most recent pregnancy, and 48% of them also sought postnatal care. Among the women who did not seek postnatal care, the most common reasons included not perceiving a need for a postnatal visit or not wanting care ²¹. Knowledge of family planning methods and birth spacing was shown to be high among adult Iraqi refugees in Jordan ²³. However, knowledge of family planning and general reproductive health among adolescent Iraqi refugees was low; most group discussions with adolescents yielded knowledge of only one contraceptive method or way to prevent sexually transmitted infections (STIs) besides abstaining from sex ²³.

The most commonly used method of family planning among Iraqi refugees interviewed in Jordan was withdrawal (32%), followed by oral contraceptive pills (30%), IUD (22%), rhythm/calendar (21%), and the male condom (21%) ²³. Access to family planning is almost nonexistent for poor, unmarried, and adolescent Iraqi refugees. This leads to unsafe abortions or abortions illegally performed by doctors ⁷. Little information is available regarding the family planning situation for Iraqi refugees in Syria.

Gender-Based Violence

Iraqi refugee women living in Jordan reported domestic violence as a common occurrence. The stress of living in cramped quarters, the trauma of violence and loss experienced in Iraq, and a lack of employment have all contributed to extensive domestic violence. Additionally, marital rape was reported ²⁴.

Many Iraqi refugee women and girls witnessed or are survivors of sexual violence in Iraq, especially rape by armed groups and civilians ²⁴. Since the Second Gulf War, there has also been an increase in trafficking and sexual exploitation. As many as 15% of Iraqi widows seek “temporary marriages” or transactional sex work for protection and/or financial support. Additionally, approximately 4,000 Iraqi females, many of whom are children, have disappeared and are believed to have been forced into sex work ²⁴.

In Iraq, medical care and psychosocial support for the survivors of sexual violence are not available, so most rapes go unreported ²⁴. Cultural barriers such as stigma and shame also impede Iraqi rape survivors from reporting their attacks ⁷.

Malnutrition and anemia

Since the Second Gulf War, chronic food insecurity has become one of the biggest issues affecting Iraqis. As of 2007, only 32% of Iraqis had access to safe drinking water, and lack of adequate sanitation has contributed to diarrheal disease outbreaks, including typhoid and a large outbreak of cholera in October 2007 and more recently ³.

The Iraqi Ministry of Health reported that over half of Iraqi women and children suffer from malnutrition and anemia, contributing to high maternal and infant mortality ³⁰. In 2011, prevalence of acute malnutrition measured by mid-upper arm circumference among Iraqi refugee children <5 years old was 1.7% in Jordan and 4.5% in Syria ⁵. Food insecurity seems to be of greater concern in Syria than in Jordan. Among Iraqi refugees resettled in San Diego from 2007-2009, 16.5% of children <5 years old and 29.6% of women of childbearing age were anemic ²⁶. In 2012, a CDC survey of Iraqi refugees in 4 US states showed that 9% of participants and 13% of their household members reported having anemia ⁸.