Preparations for War

In January 2003, I was asked to be a member of the IRC emergency team that would respond to Iraq. We would be on call and deployed into Iraq once the inevitable invasion was winding down. I had been home from Afghanistan for just two months when I joined the team.

Although IRC expected that we would be leaving within days or weeks at the most, political posturing and the search for international support delayed the inevitable war and we waited. It haunted me that while we waited for the conflict to begin, so, too, did the women and children of Iraq. It was hard to imagine how frightening that must have been—where would we attack and how, and would it happen that day or the next, or the day after that? Impossible to imagine ourselves in their shoes, but we tried to keep that in mind as we made our own preparations.

In those early days, it was widely assumed that the greatest danger we would all face would be from chemical and biological weapons. In preparation for that possibility, an IRC physician and I were sent to a three-day intensive training seminar in Washington, D.C., where we learned to recognize, deal with, and manage casualties from those potential scenarios. As emergency team members and supplies waited around the world to be activated, we also researched the country we were about to enter. This assignment would be my first to be first in, first to assess, design, and implement the programs. In the past, I’d slid into already established roles and spent my time taking care of refugees. Iraq would be a whole different ball game.

Prior to the Gulf War and international sanctions imposed in 1991, Iraq had enjoyed a modern health care system with large, well-staffed, well-equipped hospitals complete with modern technology, where health care services were readily available to most of the population. They’d had a modern infrastructure, including an extensive network of water purification and sewage treatment systems delivering clean, safe water countrywide.¹ But the 1991 Gulf War and subsequent sanctions resulted in a complete breakdown of those systems. We would be faced with an already frailer population. In many areas, people were without access to clean water, health facilities, schools, electricity, and more. Raw sewage, at the rate of half a million tons a day, was being pumped into the country’s main water source, the Tigris River, creating an environment that fostered the spread of disease, since so many people used this as a source of drinking water. We assumed that the public health needs would be enormous, but, we were prepared. IRC had equipment and WHO emergency kits containing enough medicines to help us provide health care to ten thousand people for three months. The supplies were positioned around the world, ready to be shipped to Kuwait and on into Iraq once the team was working inside Iraq. We’d prepared for every possible scenario.

At least we hoped we had.