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While companies slaver over the multimillion dollar building contracts that seem to be the most immediate spoils of the war in Iraq, there are quieter, more seemly, preparations being made that will have just as much impact on the country's long-term reconstruction. Child protection schemes and home visiting for older people might not be making the headlines, but it is projects like these that will ultimately help repair the social fabric of a country whose welfare system was once the envy of the Arab world, but has now been torn apart by the recent hostilities and years of conflict, sanctions and deprivation.

For the local social care professionals, volunteers and expatriate aid workers who are struggling to help Iraq's most vulnerable people, the challenge is immense. Security is still uncertain, much of the country's infrastructure has been destroyed and many social care projects have stalled through lack of staff, loss of equipment and a displaced clientele. Others have managed to continue throughout the conflict. And with parts of the country previously controlled by the government of Iraq soon expected to open up to aid agencies, many are planning to expand their activities.

In the northern Iraqi region of Dohuk, Christine Smith has been back at her desk for just two days. Pulled out of Iraq just before the war on advice from the Foreign Office, she has returned to continue her work as a project manager for an innovative home visiting programme funded by HelpAge International.

The scheme, which has been running since 1997, aims to provide psychosocial support, health care and other forms of practical help to the region's most vulnerable older people and their families.

"As in any region affected by war, the elderly here are particularly vulnerable," says Smith. "They may become isolated, lose access to essential health care and, due to frailty, be unable to displace themselves to safer areas. Many have lost family members in previous conflicts and are now caring for their orphaned grandchildren. About 20 per cent of older people here are responsible for children."

Older people in northern Iraq have also been particularly affected by the years of economic sanctions imposed since the last Gulf war ended in 1991. Economic collapse has led to high unemployment and a severe reduction in pension provision. Many older people have lost their property and livelihoods at least once in their lives and the United Nations' Oil for Food programme has reduced agricultural activities on which many older Kurds depended. Two-thirds of the population of northern Iraq now survive on the monthly food ration. Although social services do exist they are limited and are usually targeted at children and families.

To help address these issues the HelpAge International programme uses community-based staff and organisations to visit older people in their homes and assess their needs for social support and access to health care. The programme can then offer practical assistance, for instance by supplying a wheelchair, delivering medicines or helping renovate a dilapidated property. The programme has also conducted a three-year project to raise the profile of older people and ensure that they are actively included in the social and economic life of their community.

Smith is one of two international managers of the programme which also employs 88 national staff and 660 volunteers in the Kurdish regions of Dohuk and New Kirkuk. The international staff were moved from the areas during the war, but the national staff and volunteers remained and tried to keep the programme running.

"Dohuk wasn't really affected by the war so, other than having to deal with a lot of extra people who moved into the area to get away from the fighting, our volunteers were able to continue the home visiting programme without too many problems," says Smith. "On the eastern side, however, most people left the area during the early stages of the war so the programme was suspended. Most of the volunteers and clients are back now so things should be returning to normal."

Indeed, war and displacement have become such a way of life for people in this troubled region that many of those returning home have been able to take the disruption in their stride.

"Many of these older people have experienced a number of conflicts in their lives so this is more of what they have lived through many times," says Smith.

Now that the war is over it is possible that HelpAge International may extend its activities into previously inaccessible areas, although Smith emphasises that it is still too early to make any firm commitments. "At the moment the situation is unclear and the HelpAge future programme is being reassessed," she says. "We are planning to conduct a security assessment of the situation in Mosul and to assess the needs of elderly people there. But it is too early to say what happens next. I'm just pleased to be back and I would say I'm fairly hopeful for the future."

Like HelpAge International, most aid agencies have been prevented by the unstable security situation and uncertainty over the establishment of an interim government of Iraq from making plans beyond the immediate need for emergency relief. Denied access to government-controlled areas of the country, most of the pre-war programmes were based in Kurdish controlled northern Iraq. As the rest of the country opens up, however, many will be seeking to address the huge need for social care projects throughout Iraq (see panel, overleaf).

Save the Children is keen to extend the child protection work it has been carrying out with sections of the de facto Kurdish government, focusing on children in institutions and the juvenile justice system. The charity's own research has identified a significant problem of institutionalised abuse in Iraqi children's homes and it is offering training in child protection to government staff, non-government organisations, the UN and the military. Other projects include a scheme to train teachers in supporting children who have been traumatised by the war.


Care International is also planning to develop social care programmes. Middle East project officer Mara El Ansary says: "We expect the emergency situation to last at least another two months and our main priorities at the moment are water and sanitation. But once things have improved we will be looking towards more long-term sustainable projects with a focus on education and measures to strengthen civil society."

In particular the charity intends to develop programmes to improve the education of girls, long neglected under the previous Iraqi regime.

There is unlikely to be much of a role for British social care professionals in the reconstruction of Iraq. Most aid agencies are keen to stress that, although there may be a limited need for trainers and project administrators, the front-line work will be carried out by Iraqi nationals. This tallies with a Community Care website poll in which more than 60 per cent of respondents said they did not think it was feasible for British social workers to make a significant contribution to the reconstruction of Iraq (news, page 8, 17 April).

Dr Sultan Barakat, director of the post-war reconstruction and development unit at York University, says the last thing Iraq needs is for Western "experts" to start imposing new systems and structures on the country.

"Lessons learned from all over the world in the past 20 years show that running reconstruction activities like a military campaign - from the top down - is expensive, unsustainable and ineffective," he says.

Instead Barakat believes that all reconstruction activities, including re-establishing social support structures, must draw on the "expertise and enthusiasm of the Iraqi people".

"The idea that Iraq was a completely dysfunctional society is totally wrong," he says. "After the last Gulf war they virtually rebuilt the country in much less time than it has taken the international community to reconstruct places like Somalia."

Indeed, Barakat believes that one of the major challenges ahead for Iraq will be the transition from a highly centralised, socialist system to the kind of free-market economy likely to be encouraged by the US authorities and the World Bank.

The challenge is to try to marry free-market economics with the social support that Iraqis enjoyed in the early 1980s - a tricky task indeed. What is certain is that there's a long way to go before Iraq can reclaim its place as the Arab world's beacon of social care.

How social support vanished 

Iraq once offered its people some of the most progressive social support in the Middle East. During the 1980s it had an extensive and sophisticated public health care system, free access to education and a national welfare system to protect poor people. Its 1980 social welfare law made Iraq the first Arab country to recognise the medical, educational and economic rights of disabled people. Until 1991 at least 3 per cent of every employer's staff had to be disabled.  

Today, however, much of this social support has disappeared. Even before the recent conflict, the combined effect of two major wars and 13 years of sanctions had taken their toll on Iraq's most vulnerable people.   The national welfare system that guaranteed destitute people a monthly cash allowance of about £100 virtually collapsed in the mid-1990s and by 1994 the ministry of labour and social affairs had officially stopped registering new cases.  

By 1999 facilities to educate and train disabled children had been reduced to 30 per cent of their 1990 level and the number of street children referred to rehabilitation centres had increased at least five-fold since the early 1990s. 

Meanwhile, the effects of war and deprivation were exerting a telling toll on the nation's mental health. From 1990 to 1998 the number of mental health patients attending health facilities rose by 157 per cent.   But it was older people who were most severely affected by the collapse of the Iraqi economy with its attendant inflation and currency devaluation. First, the value of their life savings was eroded and many resorted to selling off their properties and household goods. 

Many also lost their sons either in the Iraq-Iran war or in the 1991 Gulf war. With no funds and no one to take care of them, many older people succumbed to hunger and disease. Little of the social support that remained in Iraq was directed towards older people and by 1999 there were only three older people's care homes left in the entire country.