Marching under temperatures that exceeded 120 degrees Fahrenheit, a group of farmers from Iraq’s southern marshes joined July’s Muharram processions in Maysan with the massive skulls of water buffalos strapped to their shoulders and backs. The display was both an expression of mourning as well as an indictment of the ecological disaster unfolding across agricultural areas of the water-scarce south. Water buffaloes are increasingly dying of thirst and disease, which in turn impacts the livelihoods, health, and well-being of their human companions.

Iraqis are increasingly faced with the reality that the health and well-being of humans and animals are deeply intertwined. It is no longer possible, for citizens and government authorities alike, to imagine that the environment is merely an empty container for human life. Multi-species ecologies have been impacted by years of war and industrial pollution, and they will become increasingly fraught in an era of water scarcity and rising temperatures. Decreased water flow from upstream damming and failed water governance has already contributed to higher concentrations of toxins in the country’s waterways, which in turn leads to mass fish die-offs, water buffalo deaths, and harmful health impacts for humans. Climate change will further imperil water supply and transform local ecologies.

Plants are also an important part of the multi-species systems that support—or threaten—human health. In Basra, the toxic mixture of organic material dumped into local waterways (including sewage, garbage, soil runoff tainted with agricultural fertilizers, and oil residues) promotes the proliferation of harmful algae, which can lead to sickness in humans. In 2018, over 100,000 people were hospitalized in Basra with rashes, vomiting, and diarrhea. Human Rights Watch later found that the illness was likely the result of a massive and irregular algal bloom in the city’s main water source.

In the coming years, it will be essential for both the Iraqi government and the international community to develop a policy framework for climate change that includes careful attention to the implications for health defined in multi-species, ecological terms. One way to think through the pathway forward from a policy perspective is through the framework of “One Health.” One Health is a term that has been popularized in global public health circles over the last decade out of a recognition that infectious diseases and pathogens often spread due to the complex and changing interactions between humans, plants, and animals. One Health seeks to develop policy approaches to public health that attend to this interconnectedness across species, which is especially important in an era of climate change. Climate change and rising temperatures will alter the ways diseases are passed between animals and humans, intensify the threat of antimicrobial resistance, and threaten the safety of food chains and water supply.

System-Wide Approaches

For multi-species public health approaches like One Health to function well, government institutions with relevant jurisdictions must collaborate and share information seamlessly. This level of cross-governmental integration is a major policy challenge in any context, but is especially a challenge in a country like Iraq, affected by decades of ecologically disastrous international military interventions, political violence, and the resulting erosion of state institutions.

Recent history suggests that Iraq’s various environmental management and health agencies often do not collaborate effectively. During the 2018 health crisis in Basra, the provincial water department’s laboratories generated faulty readings and failed to communicate warning signs with health authorities, who in turn failed to work with the local government to alert and advise the populace on ways to avoid contaminated water. Iraqis pouring into hospitals were never given definitive answers about the identity of their condition. In the ensuing months, no national or local government agency released any official comprehensive account of the cause of the crisis. The authorities left Basrawis to speculate about the outbreak on their own.

In 2018, over 100,000 people were hospitalized in Basra with rashes, vomiting, and diarrhea. Patients were never given definitive answers about the source of their illness—but it was likely a tainted public water supply.

Government responses to animal diseases and deaths have been similarly dysfunctional. Thousands of fish recently perished across an enormous area in Maysan and Dhi Qar, raising grave concerns among residents about the impact on local ecologies and the implications for human health. Instead of a coordinated government response, different departments issued a series of contradictory statements. The Veterinary Department of the Ministry of Agriculture blamed the Ministry of Water Resources’ insufficient water allocations to the affected areas and the resulting high concentration of pollutants. The Ministry of Water Resources then blamed poor fish farming practices outside designated areas, effectively shifting blame to the Ministry of Agriculture. Meanwhile, no government entity gave constructive public health advice to citizens living in the vicinity of the fish die-off.

Governance without Science

The lack of cooperation between the relevant government agencies often has to do with the competitive structure of the post-2003 political arena and imbalances of power between ministries. With each ministry under the influence of different political parties and official procedures mired in a complex bureaucracy, meaningful collaboration and exchange of information is exceedingly rare. The Ministry of Environment, which is technically responsible for monitoring violations of industrial waste and emissions limits, is a politically marginal ministry with a small budget, and would not have the weight to demand sensitive data—on air emissions and the use of fresh water—from the far more powerful Ministry of Oil. Perhaps more troublingly, it appears that the Ministry of Environment struggles to demand the most basic levels of compliance from other government entities. By law, the Ministry of Environment has the authority to delineate the levels of untreated waste that can be dumped into waterways, but these limits are almost entirely ignored by government ministries and private industries alike. As a result, Iraq’s waterways have become replete with human, animal, industrial, and agricultural waste.

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This chronic dysfunction erodes trust between state and citizens, especially those who are sick. Iraqis suffering from various health conditions are keenly aware of the fact that the potential environmental causes of their health conditions are not adequately monitored by the government and therefore remain largely unknown. In the waiting rooms of medical clinics and hospitals, patients and families suffering from any number of communicable and noncommunicable diseases—from stomach bugs to skin rashes to cancers—share theories about different possible environmental causal agents, and lament the inability of the government to provide clear, evidence-based answers. For a society that had grown accustomed to high standards of medicine and science from the 1960s to 1980s, the loss of scientific rigor is a source of collective frustration that signals the decline of the state.

And yet Iraq has highly capable scientists with relevant competencies. Many Iraqi public health experts, epidemiologists, environmental scientists, and water management specialists currently serving in government ministries would be the first to agree that the country needs to place science at the center of governance. They would also acknowledge that the environment and health are deeply intertwined, especially in an era of climate change. In a nod to the One Health approach, Iraqi medical schools already incorporate experts in veterinary health into course modules on infectious diseases.

But the usage of scientific knowledge for the purpose of meaningful accountability—especially when data might challenge powerful institutions—is discouraged and sometimes actively suppressed. Too often, government officials treat environmental health data as a political threat rather than a resource for accountability. Iraqi environmental scientists and epidemiologists who speak out about the potential health impacts of any number of politically sensitive toxins and pathogens (for example, depleted uranium, heavy metals, industrial emissions, oil residues, and bacteria such as Acinetobacter baumannii) often become targets of intimidation and threats. In short, scientific expertise and authority have been relegated to the periphery of governance.

The international community is deeply implicated in the sidelining of the environmental and health sciences.

The sidelining of the environmental and health sciences is a reality in which the international community is deeply implicated. After the U.S.-led invasion of 2003, the Coalition Provisional Authority and the broader international humanitarian sector—which championed the cause of rebuilding Iraq according to the principles of “good governance”—paid little or no attention to funding and supporting governance systems in which science and accountability meaningfully intersect. The Iraqi government followed suit, chronically underinvesting in the governmental institutions that are essential for tracking and responding to toxic spills and emissions, in addition to the pathogens (including bacterial, viral, parasitic, and fungal pathogens) that can cause diseases and epidemics in humans, animals, and plants.

The Nexus of Climate and Health

Is the tide turning? Over the past twelve to eighteen months, climate change has become the buzzword in Iraq’s continual parade of policy conferences, with the administration of Mohammed Shia al-Sudani making commitments to enhancing coordination on addressing water scarcity and climate adaptation. For the most part, the embrace of climate change adaptation has remained limited to strategizing, with little tangible evidence of significant investments on the ground. The major international organizations and donor countries are funding small-scale efforts in government capacity-building and civil society programming, but diplomats and humanitarian workers alike admit that the scale of international climate change funding in Iraq will remain tiny relative to the scale of the mitigation and adaptation challenges ahead.

Amidst this uptick in attention to climate change, the nexus of health and the environment has slowly started to gain more traction. It is promising that the Ministry of Environment and the World Health Organization are in dialogue about ways to integrate public health into the government’s ongoing process of developing climate change adaptation plans. And yet, the scientific institutions, equipment and resources needed to monitor and address the complex intersections between the environment and health are sorely lacking. Neither the Iraqi government nor the international community has invested adequately in initiatives that build up this interdisciplinary scientific capacity.

One notable exception is Médecins Sans Frontières (MSF), which has been funding and overseeing a microbiology laboratory. The program has provided Iraqi physicians and researchers with tools needed to track antimicrobial resistance (AMR)—in other words, when bacteria in the environment develop resistance to antimicrobial drugs such as antibiotics. Iraqi doctors working with MSF recently published a study that detailed alarmingly high rates of AMR in Mosul. Because AMR pathogens can pass between humans, livestock, and the environment and seriously exacerbate epidemics, countering them is a core priority of One Health agenda. With AMR rates already high in Iraq, it is doubly concerning that climate change and rising temperatures will likely alter environmental conditions and may increase the presence of pathogens with resistance to antibiotics.

But despite the severity of the AMR situation and the critical importance of MSF’s role in building environmental health surveillance, government authorities have evidently failed to protect the organization’s operations from the interference and delays that are defining features of a post-2003 governance system, which is fueled by graft and politically sanctioned corruption. In July 2023, MSF announced the suspension of operations due to “lengthy, complicated, and opaque official procedures” that made it impossible to import supplies for the microbiology lab.

If Iraq is to stand a chance in combating health risks exacerbated by environmental degradation and climate change, the Sudani administration will have to do more to ensure that Iraqi scientists have the operational freedom to run and maintain independent research facilities, and to channel findings into enhanced public health awareness and warning systems. Government agencies with a role in environmental monitoring and health surveillance in humans and animals (such as the Ministry of Environment, the Ministry of Health, and the veterinary services of the Ministry of Agriculture) will need resources, equipment, training, and most importantly, the formal authority and political backing to demand data and enforce violations across different ministries and industrial sites. In sum, the government must urgently invest in supporting cross-governmental coordination and scientific capacity guided by One Health principles, with careful attention to the ways in which environmental degradation and climate change may alter the landscape of human, plant, and animal diseases.

A realistic assessment would suggest, however, that systems-wide and coordinated action will not be forthcoming anytime soon. If the status quo holds, incidents like the Basra health crisis of 2018 will continue to repeat themselves. Meanwhile, the farmers of Maysan will be compelled to join Muharram processions wearing the skulls of water buffaloes next year and for many years to come—until there are none left to mourn. For marsh communities that treat such animals not only as sources of livelihood and sustenance but also as cherished family members, the toll to human health and well-being will be immense. Inaction on the environment-health nexus is a global problem, to be sure, but in Iraq the time for waiting has long since run out.