Iraq International Medical Aid Committee (IMAC)
Proposal to Donate Medical Assistance
Medical Donations must be reviewed and approved by the International Medical Aid
Committee before being brought into Iraq. Donations must meet recognized needs and
should improve the capacity of the Iraqi health system to provide for its people. Donations
must follow accepted international standards
Date of application:
Organization / country:
Name and contact information of your representative:
Name:
Phone:
E – mail:
□ Type of donation (Select all that apply):
□ Adopt a Hospital Assessment visit
□ Adopt a Hospital Program
□ Financial
□ Infrastructure rehabilitation
□ Medical Supplies
□ Medical equipment
□ Vehicles
□ Communications and Information Technology
□ Pharmaceuticals
□ Nutritional Aid
□ Education and Training
□ Medical Personnel
□ Other (Specify)
Please attach a detailed description of the proposed activities including:
• Past activities and experience in Iraq.
• How the donation will improve the Iraqi health system, sustainable.
• Proposed activities and locations (GPS or Arabic names)
• Date of availability and planned duration
• Mode / route of transportation, storage and distribution plans, and security arrangements
• Co-ordination with MOH, UN, and NGOs
Aid Committee Determination:

□ Approve □ Decline □ Approve with Modifications
Official / Date:
A hard copy will be forwarded.
Ministry of Health ICRC WHO Unicef CPA