As the Bush administration gears up for an assault on Iraq, let us keep in mind that the people of Iraq have sustained a continuous assault on their existence by means of economic sanctions since 1990. Imposed by the United Nations on Iraq soon after it had invaded Kuwait, the sanctions preceded the Gulf War of January-February 1991. We briefly review here what is known about the human suffering caused by the sanctions â€“ specifically, its effect on child mortality, and point out web sources available for activists to educate themselves and their audiences. For a fuller treatment, see the report by 13 religious and non-governmental organizations and Save the Children UK (http://www.globalpolicy.org/security/sanction/iraq1/2002/paper.htm), released on August 6, 2002, twelve years into the sanctions. An extensive bibliography is maintained by the Campaign Against Sanctions on Iraq (http://www.cam.ac.uk/societies/casi/index.html).
In contrast to outright killings, deaths by sanctions cannot be enumerated by means of counting bodies in mass graves. Such an accounting depends on an epidemiologic examination. We offer this account not to quibble about numbers. There is no question that the number of deaths is enormous. For activists to maintain our credibility, however, we must try to obtain and disseminate accurate information.
Its infrastructure and economy destroyed by the bombing campaign, Iraq has been able only to partially rebuild its water, sanitation, and power plants â€“ partly because of â€œholdsâ€ placed on imports by the US and the UK. The UN Security Council itself estimated that only 41% of the population has regular access to clean water in 1999. A UNICEF study showed that 21% of children under 5 are underweight, 20% stunted (chronic malnutrition), and 9% wasted (chronic malnutrition). Furthermore, health services suffer from a lack of basic supplies and medicines. The end result has been childhood deaths from malnutrition, diarrhea, and pneumonia. The sanctions have had a destructive influence on other aspects of Iraqi society. Women are disproportionately unemployed. A report by the UN Security Council itself noted rises in mental illness, juvenile delinquency, begging and prostitution, as well as cultural and scientific impoverishment. (1)
The most reliable data on child mortality were collected in 1999 by UNICEF and the Iraqi government. The findings regarding child mortality rates were published with extensive documentation in May 2000 in the Lancet by Mohamed Ali of the London School of Hygiene and Tropical Medicine and Iqbal Shah of the WHO. (2) In the south/center of Iraq, 23,105 women drawn from all districts were interviewed. In the Kurdish northern autonomous region, 14,035 women were interviewed.
In the south/center of Iraq, the infant mortality rate (the proportion of infants who die between birth and 12 months) rose from 47 deaths per 1000 live births during the 1984-89 period to 108 deaths per 1000 live births during the 1994-99 period. For comparison purposes, the infant mortality rate for the U.S. in 1995 was 8/1000. Iraq went from a rate comparable to the Middle East and North Africa (54/1000) to one comparable to Sub-Saharan Africa (110/1000). (3)
The Under-5 mortality rate (the proportion of children under 60 months of age who die â€“ the Under-5 rate includes infants counted by the infant mortality rate) rose from 56 deaths per 1000 live births during the 1984-89 period to 131 deaths per 1000 live births during the 1994-99 period. The Under-5 mortality rate for the U.S. in 1995 was 8/1000 (few children die between the ages of 1 and 5), for the Middle East and North Africa, 71/1000, for Sub-Saharan Africa 178/1000. (4) Corresponding rates for the Kurdish autonomous region showed an overall decline during this period.
The Lancet article does not attempt to translate this rate into an absolute number of deaths. But prior to the publication of the Ali and Shah study, the results were posted on UNICEFâ€™s website (5), together with an estimate of how many excess deaths this represents. UNICEF graphically represents (http://www.unicef.org/reseval/pdfs/irqu5est.pdf), the manner in which the observed mortality is in excess of an estimated trend in mortality from 1960 to 1990. They note that if this trend had continued for the period from 1991 to 1998, that there would have been half a million fewer deaths among children under the age of five.
UNICEF did not claim that all these deaths were caused by the sanctions. The period covered by the study includes the Gulf War itself, periods of repression by the Baathist government, and fluctuations in oil prices. Some of the assumptions underlying the UNICEF estimates can be called into question. Correcting for lower birth rates and emigration from Iraq, and assuming that mortality rates would have remained steady instead of continuing to drop, would lead to a lower figure of 300,000 (rather than half a million) excess deaths in children under five through 1998. (6) Columbia University public health expert Richard Garfield has used the Ali and Shah data to revise his own estimate of the number of excess deaths in children under 5 to approximately 450,000 through 2002 (with a margin of error of 78600). (7) Again, while most of these deaths are associated with the sanctions, some are secondary to the Gulf War, 4 years of drought, or other causes.
Further, these estimates of child mortality, by definition, exclude deaths among adults, particularly the elderly. In addition, these figures take no account of the death of adults during the Gulf War, during which Iraqi combatants had little chance to defend themselves.(8)
The US and the UK, who have used their veto power in the UN Security Council to maintain the sanctions, have continued to maintain that the responsibility for these deaths lies with Saddam Hussein. These consequences, however, were predicted by US intelligence at the conclusion of the Gulf Warâ€“ making them clear policy choices. (9) Let us also recall Leslie Stahlâ€™s telling 60 Minutes interview with Madeleine Albright, Clintonâ€™s Ambassador to the United Nations in 1996. In reply to Stahlâ€™s query, “We have heard that a half million children have died. I mean, that’s more children than died in Hiroshima. And — and you know, is the price worth it?” Albright stated, “I think this is a very hard choice, but the price — we think the price is worth it.”
In the end, it is women, children, and elderly, the sick and the poor, those least responsible for Iraqi government actions, who suffer the most from the sanctions. And if the U.S. launches another assault on Iraq, their suffering will be compounded.
(1) See Save the Children UK report
(2) Mohamed M Ali, Iqbal H Shah. Sanctions and childhood mortality in Iraq. The Lancet, Vol. 355, p. 1851-7, May 27, 2000.
(7) Personal communication, September 26, 2002.
(8) Seymour M. Hersh. Overwhelming force: What happened in the final days of the Gulf War? The New Yorker, May 22, 2000, pp. 49-82.
(9) Jeff Lindemayer. Iraqi sanctions: Myths and facts. Z Magazine. November 2001. http://zmag.org/Zmag/Articles/nov01lindemyer.htm