Nursing Personnel Convention, 1977 (No. 149) - Iraq (Ratification: 1980)

Direct Request (CEACR) - adopted 2020, published 109th ILC session (2021)

Article 2(2) of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes with interest the adoption of the first Iraqi National Health Policy (NHP), developed in collaboration with the World Health Organization (WHO), relevant ministries and key health stakeholders. The NHP covers the period from 2014 to 2023 and seeks to achieve universal health coverage for all citizens while ensuring equity, quality and cost effectiveness. The Committee notes that the NHP contemplates the adoption of measures to review health workers’ conditions of service (salary, housing, professional advancement, contractual obligations, involvement in decision making, recognition of staff contributions and other incentives) and develop appropriate recruitment and retention strategies both for national and expatriate health workers within the public sector. The Committee also notes the adoption of a national nursing and midwifery strategy, whose development was informed by the WHO regional framework for strengthening nursing and midwifery in the Eastern Mediterranean Region 2016–2025. The Committee further notes that, according to WHO’s Global Health Workforce Statistics, the number of nurses per 1000 persons increased from 1.7 in 2016 to 2 in 2018. The Committee requests the Government to provide detailed updated information on the nature, content and impacts of the policies, programmes, incentives or other measures adopted, including in the framework of the National Health Policy for the period 2014-23 and the nursing and midwifery strategy, to: (i) offer attractive employment and working conditions and reasonable career prospects to all nurses; and (ii) to ensure that foreign nursing personnel working in the country enjoy equality of treatment with national personnel. It further requests the Government to provide a copy of the national nursing and midwifery strategy.

Article 3. Nursing education and training. The Committee notes the information provided by the Government regarding measures adopted to improve the quality of nursing education. The Government indicates that, pursuant to the national strategy for the development of the nursing and midwifery profession, new higher health institutes have been established in Baghdad and all of the governorates in coordination with the Ministry of Higher Education and Scientific Research (MoHESR). These institutes facilitate access to higher education for nursing personnel who hold a preparatory nursing, midwifery and obstetrics certificate and increase the number of nursing personnel by accepting secondary school graduates who have taken the science option. The new higher education institutes include sections for nursing, midwifery and obstetrics. The Government adds that preparatory nursing, midwife and obstetrics certificates are no longer accepted and the ministry schools that provided them have been closed in order to improve educational levels and the quality of nursing services nationwide. The Government indicates that the educational process in higher health institutes has been regulated by the Institutes of Health Professions Regulation No. 3 of 2011 and the organization of nursing, midwifery and obstetrics preparatory schools by the Nursing, Midwifery and Obstetrics Preparatory Schools Regulation No. 1 of 2013. The Government also refers to the implementation of development and educational programmes for nursing and midwifery (Registered Nurse Programme and Successful Nurse Programme). The Committee requests the Government to provide detailed updated information on the nature, the content and the impact of the measures adopted with a view to ensuring that nursing personnel are provided with education and training appropriate to the exercise of their functions, including those adopted in the framework of the National Health Policy for the period 2014-2023 and the national nursing and midwifery strategy. The Committee reiterates its requests to the Government to provide updated detailed information on the study curricula and statistics on the number of persons enrolled in, or graduating from, nursing schools per year – if possible disaggregated by sex and educational level.

Article 4. Practice of the nursing profession. In reply to the Committee’s previous comments, the Government reiterates that, in accordance with Act No. 96 of 2012, authorization to practice nursing in Iraq is granted by the nursing union. The Committee notes that the NHP provides for the adoption of measures to enhance the quality of health care services through accreditation and licensing in a systemic and sustainable approach. The Committee also notes the Government’s indication that the work of nursing personnel is in the process of being regulated by the adoption of the Iraqi Nursing Council Act and the Nursing Personnel Act. The Government reports that approval is also being sought for enactment of the Nursing Trade Union Act, although it refers to obstacles to its adoption. Lastly, the Government refers to the development of manuals on the application of nursing procedures for nursing and midwifery personnel in the public health sector. The Committee therefore reiterates its requests to the Government to transmit a copy of Act No. 96 of 2012 on the practice of the nursing profession and midwifery and all relevant information of a practical nature following the implementation of the new legislation (e.g. number of authorized nurses, registered membership of Nurses’ Association and nationality and number of foreign nurses authorized to practice in the country). The Committee further requests the Government to provide information on any progress made towards the adoption of the Iraqi Nursing Council Act and the Nursing Personnel Support Act and to provide a copy once adopted.

Article 5. Participation and consultation. The Committee notes that the NHP provides for the development and implementation of measures to build the capacity of and strengthen professional associations and unions to ensure their informed involvement in decision-making and promote the amicable settling of disputes. In this regard, the Committee requests the Government to provide updated detailed information on the specific measures taken or envisaged to promote the participation of nursing personnel in the planning of nursing services and consultation on decisions concerning them, as required under Article 5.

Article 7. Occupational safety and health. The Government reports that a draft law has been developed to ensure occupational safety and health and to provide a secure working environment for nursing and midwifery personnel. In the context of the COVID-19 pandemic, the Committee notes that, on 26 March 2020, the Government established a Higher Committee for Health and National Safety to direct the country’s effort to combat COVID-19. The national Higher Committee is mandated with setting out policies and adopting the necessary measures to contain COVID-19. With respect to ensuring occupational safety and health for front line health workers, the Committee recalls that nursing personnel who, due to the specific characteristics of their work, must be in close physical contact with their patients, are at high risk of being infected while treating patients with suspected or confirmed COVID-19, especially where infection control precautions, including the use of personal protective equipment (PPE), are not strictly practiced. The Committee wishes to draw the attention of the Government to Paragraph 49 of the Nursing Personnel Recommendation, 1977 (No. 157), which provides that: “(1) all possible steps should be taken to ensure that nursing personnel are not exposed to special risks. Where exposure to special risks is unavoidable, measures should be taken to minimise it; (2) measures such as the provision and use of protective clothing, immunisation, shorter hours, more frequent rest breaks, temporary removal from the risk or longer annual holidays should be provided for in respect to nursing personnel regularly assigned to duties involving special risks so as to reduce their exposure to these risks; and (3) in addition, nursing personnel who are exposed to special risks should receive financial compensation.” The Committee requests the Government to provide detailed updated information on the nature and impact of safety measures taken or envisaged, including the provision of personal protective equipment (PPE) and training in its correct use, as well as provision of adequate rest breaks during workers’ shifts and limitations on excessive hours wherever possible, with a view to protecting the health and well-being of nurses and midwives to limit to the extent possible their risk of contracting COVID-19. The Committee also requests the Government to provide updated information on progress made towards the adoption of the draft law concerning occupational safety and health for nursing personnel, and to provide a copy once adopted.

Direct Request (CEACR) - adopted 2013, published 103rd ILC session (2014)

Article 2(2) of the Convention. National policy concerning nursing services and nursing personnel. The Committee notes the Government’s indication that nurses are granted a hazard allowance amounting to 50 per cent of their basic salary as a means to retain qualified persons in the profession. Noting that long years of violence and economic hardship have worsened the working conditions of nursing personnel, and that health care institutions increasingly depend on the recruitment of migrant health professionals to meet the challenge of nursing shortfall, the Committee requests the Government to further elaborate on policies, programmes or incentives designed to: (i) offer attractive employment and working conditions and reasonable career prospects to all nurses; and (ii) to assure to foreign nursing personnel working in the country equality of treatment with national personnel.

Article 3. Nursing education and training. The Committee notes the information provided by the Government concerning the training protocols for nursing personnel that have been concluded with Egypt, Turkey and Lebanon as well as the training protocol with a United Kingdom university now being implemented. The Committee also notes the information on the different educational levels in nursing and midwifery, the duration of studies, and the number of relevant institutions operating in the country. The Committee requests the Government to submit additional information on the organization of studies in basic and higher nursing education, including study curricula and statistics on the number of persons enrolled in, or graduating from, nursing schools per year – if possible segregated by sex and educational level. The Committee also requests the Government to elaborate on any concrete measures taken or envisaged with a view to meeting current challenges, such as improving the quality of nursing education, promoting opportunities for international collaboration and assistance and bringing the nurse-to-population ratio to levels similar to those of neighbouring countries.

Article 4. Practice of the nursing profession. The Committee notes the Government’s indication that Act No. 11 of 1962 on the practice of the nursing profession is in the process of being amended in the light of occupational developments and the provisions of Act No. 6 of 2000 on health professionals, as last amended in 2008. The Committee understands that Act No. 96 of 2012 on the practice of the nursing profession and midwifery was adopted on 4 December 2012. According to the terms of the new legislation, the practice of the nursing profession may be authorized subject to the following conditions: one-year practical experience, Iraqi nationality, completion of at least two years of nursing studies, registered member of the Nurses’ Association, clean criminal and health record and payment of fees. The new legislation requires that such authorization be annually renewed while foreign nurses may also be authorized to practice the profession based on reciprocity. The Committee requests the Government to transmit a copy of Act No. 96 of 2012 and all relevant information of a practical nature following the implementation of the new legislation (e.g. number of authorized nurses, registered membership of Nurses’ Association and nationality and number of foreign nurses authorized to practice in the country).

Direct Request (CEACR) - adopted 2012, published 102nd ILC session (2013)

Article 2(2) of the Convention. National policy concerning nursing services and nursing personnel. The Committee refers to its previous comment and notes the information supplied by the Government, according to which there are specialist institutes which award diplomas for specialists in the area of nursing care and other health professions. The Government also indicates that the competent authority has taken steps to support staff in the health professions, including nursing personnel, for example by paying them additional allowances equivalent to 50 per cent of their salaries to encourage them to work in this field. While bearing in mind the difficult situation which the country still faces, especially the problems resulting from the mass exodus of doctors and nurses and the weakened infrastructure of the health system due to 20 years of violence and insecurity, the Committee again requests the Government to provide detailed information on the current system for the remuneration of nursing personnel, taking account of the specific features of the profession, and to indicate whether conditions of employment are likely to attract persons to the profession and retain them in it.

Article 3. Nursing education and training. The Committee notes the Government’s indication that a faculty for nursing care has been established at university level in order to provide senior managerial staff with training in nursing care. The Committee understands that in various regions of the country, particularly rural regions and the areas worst affected by conflict and violence, the health services are not always in a position to meet the needs of the civilian population. Accordingly, specialist organizations such as the International Committee of the Red Cross (ICRC) organize training courses for doctors and nursing personnel, in collaboration with the Ministry of Health and regional governments. While noting the Government’s efforts to reconstruct the health system and improve nursing care in a post-conflict environment, the Committee requests the Government to supply further information on the basic requirements regarding nursing education (duration, levels of education, study programmes, in-service education and training, etc.).

Article 4. Practice of the nursing profession. The Committee again requests the Government to send copies of any relevant legislative or administrative texts relating to the conditions under which persons may be authorized – through a system of certification or licensing – to practise the nursing profession. It also requests the Government to send a copy of Act No. 6 of 2000 on health professionals, which is referred to in the Government’s report but which is unavailable to the Office.

Part V of the report form. Application in practice. The Committee requests the Government to supply up-to-date information in its next report on the application of the Convention in practice, especially statistics on the nurse-to-population ratio, the number of persons enrolled in nursing schools, the number of nurses entering or leaving the profession each year, the difficulties encountered because of the lack of qualified medical personnel and the worsening of the health situation during the last 20 years, and also copies of official reports or studies addressing the human resources problems in the health sector.

Direct Request (CEACR) - adopted 2009, published 99th ILC session (2010)

Article 2, paragraph 2, of the Convention. National policy concerning nursing services and nursing personnel. The Committee is mindful of the difficult situation that the country continues to face and appreciates the Government’s efforts to revise its labour legislation and reorganize public services and institutions. The Committee understands that in view of the protracted period of war and violence in recent years, the strengthening of the health-care sector and the improvement of the working conditions of health-care workers must be one of the key priorities of the ongoing national reconstruction. It also understands that principally, due to insecurity, there has been a mass exodus of medical staff. According to some reports, more than half of Iraq’s doctors, nurses and pharmacists have fled the country over the past four years – while many hospitals and medical teaching facilities have lost up to 80 per cent of their teaching staff. The Committee therefore requests the Government to provide a comprehensive account of any action plans, programmes or initiatives undertaken with a view to formulating a general health policy which would also include targeted action for the amelioration of the quantity and quality of nursing care. The Committee would particularly appreciate if the Government would outline the existing parameters of the health-care system (in particular, legislative framework, institutions, human resources) and elaborate on any existing framework for consulting with employers’ and workers’ organizations on policy concerning nursing services and nursing personnel. The Committee would also appreciate receiving a copy of the Health Professionals Act No. 6 of 2000, to which reference is made in the Government’s report.

Article 3. Nursing education and training. The Committee notes the Government’s reference to specialized institutes responsible for the education and training of qualified health workers. It requests the Government to provide more detailed information on the basic requirements of nursing education (duration, levels of education, study curricula, continuing education and training, etc.).

Article 4. Practice of the nursing profession. The Committee requests the Government to provide full particulars, including copies of any relevant legislative or administrative texts, on the conditions under which persons may be authorized – through a system of certification or licensing – to practise the nursing profession.

Article 6. Employment and working conditions. The Committee notes the Government’s indication that as an incentive for promoting work in the field of health care, it has been decided to support health-care workers, including nursing staff, by granting an additional allowance amounting to 50 per cent of their salaries. The Committee requests the Government to transmit a copy of the abovementioned decision as well as additional information on any other incentives designed to compensate nursing personnel for the constraints and hazards inherent in the profession.

Part V of the report form. Application in practice. Recalling that the Government has last communicated general information on the practical application of the Convention in 1986, the Committee would be grateful if the Government would make an effort to collect and supply up to date information in this respect, including for instance, statistics on the number of registered and practising nurses, the nurse-to-population ratio, the number of nursing schools and the number of students attending and graduating every year, copies of official reports or studies addressing nursing-related issues, any practical difficulties encountered in applying the Convention, etc.

Direct Request (CEACR) - adopted 2000, published 89th ILC session (2001)

The Committee notes that the Government’s report contains no reply to previous comments. It hopes that the next report will include full information on the matters raised in its previous direct request, which reads as follows:

Article 1(3) of the Convention.  With reference to the previous request, the Committee notes that the Government has supplied a copy of Decision No. 944 of 13.8.1985. It notes that this Decision concerns miscellaneous conditions applicable to the persons (not only nurses) providing voluntary services to paralysed victims of the battle of Kadissiyat Saddam but does not stipulate education and training for nurses or specify the requirements for the practice of nursing. The Committee requests the Government (i) to indicate whether the nurses covered by this Decision are required to have received the same education and training as nurses in other sectors and whether they need to fulfil the same requirements as in other sectors for the practice of nursing; and (ii) to state whether voluntary nursing care is also provided in circumstances other than those covered by the above decision and, if so, to supply information on them.

Article 5.  In reply to the questions concerning this Article, the Government repeats its indication to the effect that nurses in the socialist sector are guaranteed the rights by the laws on the public service and on retirement, and states that the appeal to the judiciary concerning practices prejudicial to their interest takes place after amicable measures are exhausted. The Committee points out that Article 5(1) of the Convention requires measures to promote the participation of nursing personnel in the planning of nursing services and consultation with such personnel in decisions concerning them. It requests the Government to indicate any measures taken to this end. Regarding Article 5(3) which calls for the settlement of disputes arising in connection with the determination of employment conditions either through negotiations or by such procedures as mediation, conciliation or voluntary arbitration, the Committee requests the Government to indicate any procedures established in this respect.

Part V of the report form.  Noting the Government’s statement that the requested statistics concerning the number of nursing personnel are not available, the Committee asks the Government to supply with future reports such statistics when available.

Direct Request (CEACR) - adopted 1999, published 88th ILC session (2000)

The Committee notes that the Government's report has not been received. It hopes that a report will be supplied for examination by the Committee at its next session and that it will contain full information on the matters raised in its previous direct request, which read as follows:

Article 1(3) of the Convention. With reference to the previous request, the Committee notes that the Government has supplied a copy of Decision No. 944 of 13.8.1985. It notes that this Decision concerns miscellaneous conditions applicable to the persons (not only nurses) providing voluntary services to paralyzed victims of the battle of Kadissiyat Saddam but does not stipulate education and training for nurses or specify the requirements for the practice of nursing. The Committee requests the Government (i) to indicate whether the nurses covered by this Decision are required to have received the same education and training as nurses in other sectors and whether they need to fulfil the same requirements as in other sectors for the practice of nursing; and (ii) to state whether voluntary nursing care is also provided in circumstances other than those covered by the above decision and, if so, to supply information on them.

Article 5. In reply to the questions concerning this Article, the Government repeats its indication to the effect that nurses in the socialist sector are guaranteed the rights by the laws on the public service and on retirement, and states that the appeal to the judiciary concerning practices prejudicial to their interest takes place after amicable measures are exhausted. The Committee points out that Article 5(1) of the Convention requires measures to promote the participation of nursing personnel in the planning of nursing services and consultation with such personnel in decisions concerning them. It requests the Government to indicate any measures taken to this end. Regarding Article 5(3) which calls for the settlement of disputes arising in connection with the determination of employment conditions either through negotiations or by such procedures as mediation, conciliation or voluntary arbitration, the Committee requests the Government to indicate any procedures established in this respect.

Part V of the report form. Noting the Government's statement that the requested statistics concerning the number of nursing personnel are not available, the Committee asks the Government to supply with future reports such statistics when available.

Direct Request (CEACR) - adopted 1994, published 81st ILC session (1994)

Article 1(3) of the Convention. With reference to the previous request, the Committee notes that the Government has supplied a copy of Decision No. 944 of 13.8.1985. It notes that this Decision concerns miscellaneous conditions applicable to the persons (not only nurses) providing voluntary services to paralyzed victims of the battle of Kadissiyat Saddam but does not stipulate education and training for nurses or specify the requirements for the practice of nursing. The Committee requests the Government (i) to indicate whether the nurses covered by this Decision are required to have received the same education and training as nurses in other sectors and whether they need to fulfil the same requirements as in other sectors for the practice of nursing; and (ii) to state whether voluntary nursing care is also provided in circumstances other than those covered by the above decision and, if so, to supply information on them.

Article 5. In reply to the questions concerning this Article, the Government repeats its indication to the effect that nurses in the socialist sector are guaranteed the rights by the laws on the public service and on retirement, and states that the appeal to the judiciary concerning practices prejudicial to their interest takes place after amicable measures are exhausted. The Committee points out that Article 5(1) of the Convention requires measures to promote the participation of nursing personnel in the planning of nursing services and consultation with such personnel in decisions concerning them. It requests the Government to indicate any measures taken to this end. Regarding Article 5(3) which calls for the settlement of disputes arising in connection with the determination of employment conditions either through negotiations or by such procedures as mediation, conciliation or voluntary arbitration, the Committee requests the Government to indicate any procedures established in this respect.

Point V of the report form. Noting the Government's statement that the requested statistics concerning the number of nursing personnel are not available, the Committee asks the Government to supply with future reports such statistics when available.

Direct Request (CEACR) - adopted 1990, published 77th ILC session (1990)

1. With reference to its previous comments, the Committee notes the information provided by the Government in its report, and the text of the Decisions and Instructions appended to the report. The Committee requests the Government to continue to keep it informed of any new legislative or regulatory provisions that are adopted to improve the occupational health and safety of nursing personnel in accordance with the provisions of Article 7 of the Convention.

2. As regards the other matters raised in its previous comments, the Committee would like to point out the following:

Article 1, paragraph 3, of the Convention. The Committee requested the Government (a) to indicate whether the persons providing voluntary nursing services to the victims of the battle of Kadissiyat Saddan who sustained paralysis must fulfil the same conditions as other workers in this sector, particularly with regard to occupational and technical training and the authorisation to provide such services, and (b) whether voluntary nursing care is also provided in circumstances other than those mentioned above and, if so, which provisions cover the personnel involved. In reply, the Government refers the Committee to Decision No. 569 of 26.5.1988 amending Decision No. 944 of 13 August 1985, which does not contain the information requested. The Committee hopes that this information will be provided with the next report.

Article 5. The Committee requested the Government to provide information on the manner in which the representation of nursing personnel is ensured in the private and public sectors, the way in which the representative organisations of these workers participate in determining their conditions of employment and the procedures followed in the public sector for the settlement of disputes arising in connection with the determination of these conditions of employment. In reply, the Government indicates that, in the socialist sector, labour law and the legislation on retirement guarantee the rights of nursing personnel, and the latter may appeal to the courts of law if their interests are harmed. The Government adds that, as regards the private sector, the rights of nursing personnel are guaranteed by the competent union and the conditions of employment are also determined by the laws and regulations in force. The Committee notes this information and asks the Government to indicate (a) any measures that may have been taken, in accordance with paragraph 1 of Article 5 of the Convention, to promote the participation of nursing personnel, in both the public and private sectors, in the planning of nursing services and consultation with such personnel in decisions concerning them, and (b) whether the disputes arising in connection with the determination of the terms and conditions of employment of nursing personnel can be settled not only by the appeal procedure referred to by the Government in its report, but also by negotiation between the parties or by procedures such as mediation, conciliation or voluntary arbitration, in accordance with paragraph 3 of Article 5 of the Convention.

Point V of the report form. The Committee requested the Government to provide information on the practical application of the Convention, called for in the above report form, including statistics on the number of nursing personnel by sector of activity and by level of training and functions, and in relation to the population and the number of patients and of other health workers. The Committee also requested information, if available, on the number of persons leaving the profession. Since the Government has not supplied this information, the Committee can only raise the question again in the hope that it will be provided with the next report.