IV. NUTRITION AND HEALTH

Government Food Ration

Because of difficulties reflecting both production and the limited availability of foreign exchange the quantity of food in the ration was reduced significantly in September 1994. The composition of the ration is shown in Table 13. Despite the fundamental importance and wide availability of the ration, such a ration provides only about one-third of the food energy that was available prior to the war and is of poor nutritional quality with a lack of animal proteins and micronutrients.

The rationing system is a highly centralized system in terms of its design. Distribution of rations, however, is decentralized through distribution centres that provide rations to 50,000 private retail stores which in turn distribute monthly rations to households within their area. Transportation of these rations from the warehouse to the retail store is provided by the private sector, and paid for by the government. The warehouses are government owned, and scattered throughout the country.

The system is highly effective in reaching the population; according to the Minister of Trade errors of duplication or omission occur only in 1.7% of cases. Each Distribution Centre is equipped with a computerized list of those entitled to receive rations. These lists are periodically updated to take into account changes in household structure and location. Most persons reported receiving rations on a timely basis with allocations corresponding to the number of persons in the household. For example, those households involved in the nutrition survey in the Baghdad area, women in the market place, and farmers in areas as far apart as Basrah and Mosul all reported receiving their rations. In the autonomous region of the north government rations were now virtually non-existent but, surprisingly, at several meetings with officials in the Northern Governorates the Mission was requested that the ration be restored. This was almost certainly because of the high prices for food, the lack of work availability and the reduction in WFP and NGO assistance to the north.

The ration is heavily based on cereals and requires supplementation with other foods to meet average nutritional needs. The highly subsidized ration represents a very large income supplement and represents an enormous cost to the GOI. The original ration contained more food items and provided more nutrients than the present ration. It should be noted that infant formula is only supplied when there is a child below 1 year of age in the household.

The comparison between the average daily supply of selected nutrients from the baby food supplied in the ration (1,800 g per month) with the daily requirements of selected nutrients for 0–6m and 6m–lyr child is shown in Table 17. It will be seen that these average about half the requirements or less, depending on age, for food energy and protein but can be somewhat higher for certain micronutrients because of the generally high level of fortification in the baby food products. Meeting the full needs for protein and for food energy is important for optimal growth of the young infant and for the prevention of malnutrition. Breast-feeding is always desirable and the very high cost of breast-milk substitute products in the market makes it very difficult for the poor to meet the nutritional needs of their infants when mothers do not breast-feed.

The nutritional value of the government food ration has been calculated using the most appropriate values for food composition of the items concerned with wheat flour reflecting the nominal composition of 60% wheat and 40% barley. Actual composition is poorer than this since the grain is contaminated with a mixture of weed seeds and non-food material. The nutrient composition from food balance sheet data (53 food items) for Iraq (1988–90 average) was also calculated using appropriate food composition data. Comparison is also made with adult requirements. The United States recommended daily allowances for an adult male are, of course, not fully appropriate for the Iraqi population but they do serve as a convenient yardstick for comparing nutritional availabilities. These values are shown in Table 18.

It will be seen that the ration, being heavily based on cereal products, is not nutritionally balanced in relation to daily needs. While the food energy of the ration supplies 38% of adult needs and 43% of total protein, other nutrients, in particular vitamin A and vitamin C are almost completely deficient in the ration. The protein, mainly originating from cereal, is also low in lysine and hence utilizable protein would be low. Even the pre-war diet, also heavily based on cereals as is typical for much of the Near East, was low in lysine but was considerably higher than the present ration and would have needed less supplementation to meet daily utilizable protein needs.

Other nutrients such as iron and thiamine, which are adequately present in cereal grains, may approach daily needs even at the low level of food energy supplied. For iron the bioavailability would be low and the needs for females would unlikely be met. When compared to the nutrient availabilities immediately pre-war, the deficits in the ration are also clearly apparent. This is especially the case for vitamins A and C but calcium, folate and vitamin B-6 are also low. The inclusion of fruits, vegetables and animal foods in the diet is essential for meeting nutritional needs and agricultural production goals should be aimed at increasing the availability of these foods and reducing their cost.

The very low level of fat is also obvious despite the small increase in vegetable oil. Fat has a high food energy content and low bulk and is useful in increasing the energy content of cereal based diets and improving the bioavailability of vitamin A. There is no recommended daily allowance for fat but in order to supply 30% of the food energy as fat at 2,900 kcal/day some 97 g/day would be needed; the 22 g/day in the ration thus falls far short of this value.

The ration supplies a very important part of daily dietary needs, especially for food energy and protein and has prevented catastrophe for the Iraqi people over the five years of the embargo. It is, however, far from being nutritionally balanced both in relation to daily needs and also in comparison with what was available in 1988–90. The foods needed to bridge the gap between the ration and daily needs are mainly fruits, vegetables, oil, dairy products, legumes and animal protein, all of which are expensive in the market place and, as a consequence of the reduced purchasing power for the majority of the population, are unable to be obtained in adequate quantities.

Next: General Health and Nutrition Background

FAO REPORT TABLE OF CONTENTS

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