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Economic sanctions have often been thought of as a humane alternative
to war, a way of bringing undesirable governments into line without
the loss of innocent lives. The situation in Iraq, however,
demonstrates that comprehensive economic sanctions can, in effect,
be a weapon of mass destruction, with devastating consequences for
public health.
Sanctions were imposed against Iraq in August 1990 after Iraq invaded
Kuwait, and they were reimposed to force Iraq's disarmament after the
1991 Gulf War. All goods entering Iraq require authority from the
United Nations Security Council Sanctions Committee, and Iraq's
exports of oil are severely limited. (While the Security Council has
now removed the ceiling on Iraq's oil exports, the oil industry is
severely damaged and lacking essential supplies.) The effects of the
sanctions on the health of the people of Iraq, particularly the
children, have been documented repeatedly by the UN's humanitarian
agencies and other bodies, and ignored repeatedly by policymakers.
In July 1993, the Food and Agriculture Organization and the World Food
Programme reported that the sanctions had ". . . generated persistent
deprivation, chronic hunger, endemic undernutrition, massive
unemployment and widespread human suffering" and that ". . . a grave
humanitarian tragedy is unfolding".1 A World Health Organization
study released in March 1996 stated that health conditions were
deteriorating at an alarming rate, and that malnutrition among young
children was widespread.2
In 1999, UNICEF conducted a child and maternity mortality survey of
nearly 40 000 households throughout Iraq. The child mortality
results indicated a major increase in mortality rates in the
preceding decade, both in infants and in children under five
years.3 This should be seen in the
context of the steady reductions in child mortality before the
imposition of sanctions, from an under-five mortality rate of 127 per
1000 livebirths in 1970, to 83 in 1980 and to 50 in 1990. The rates then
rose to 117 per 1000 livebirths in 1995 and to 125 in 1998. On the basis of
these results, Executive Director Carol Bellamy reported UNICEF's
conclusion: if the substantial reduction in child mortality
throughout Iraq during the 1980s had continued through the 1990s,
there would have been half a million fewer deaths of children under
five.4
In April 1999, I took part in an international delegation to Iraq, with
representatives of the United States, Canada, the United Kingdom,
Palestine and Australia, sponsored by International
Physicians for the Prevention of Nuclear War. The purposes were to
observe conditions, to deliver medical and pharmaceutical
supplies, and to make contact with professional colleagues who have
been internationally isolated.
In the hospitals we visited, most of the basic drugs and medical and
surgical supplies, including antibiotics and intravenous fluids,
were in short supply or unavailable. At Saddam Paediatric Hospital,
in Baghdad, clinicians we spoke to said that cholera,
gastroenteritis, tuberculosis, measles, pertussis, rubella,
poliomyelitis and other infectious illnesses have become more
common since the imposition of sanctions. Vaccination programs have
suffered from a lack of refrigerated transport.
A nauseating stench from blocked and broken sewerage pipes pervaded
many hospital wards. With adequate plumbing supplies and chlorine
and other chemicals for water purification either blocked by the
sanctions5 or unaffordable, it is very
difficult to control faecal-oral spread of infections.
Colleagues we met at Baghdad University College of Medicine also
spoke of the major effect that the lack of textbooks, and even paper for
photocopying, had had on medical education.
For the medical profession in Iraq, such shortages and Third World
conditions are a new phenomenon. Before the sanctions, Iraq, with its
vast oil wealth, had an abundance of medical supplies and one of the
best healthcare systems in the region. Malnutrition was not a major
public health problem in Iraq before 1990.6 The Harvard Study Team that
visited Iraq in April and May 1991 reported that many of the young
physicians they spoke to had never seen a case of marasmus before the
1991 Gulf Crisis, and even the older physicians had not seen
many.7
We heard several reports from doctors that the incidence of childhood
leukaemia and of major congenital abnormalities has risen sharply,
especially in southern Iraq near the 1991 war zone. Some suspected
that depleted uranium weapons used in that war may be a contributing
factor. (Depleted uranium, a by-product of the uranium enrichment
process, was used in armour-piercing shells both in the 1991 Gulf War
and against Serbia in 1999.) UN cancer statistics for southern Iraq
between 1989 and 1994 have shown a sevenfold increase in cancer
rates.8 Professor Doug Rokke, a
health physicist at Jacksonville State University, Alabama, who was
responsible for the clean-up of US depleted uranium equipment in
Iraq, argues strongly that its use should be banned.9 Research on this
subject is urgently needed.
Most of the Iraqi children with leukaemia die. According to Professor
Karol Sikora, Professor of International Cancer Medicine, Imperial
College School of Medicine, London, radiotherapy equipment,
chemotherapy drugs and analgesics for Iraq are consistently blocked
by the United States and Britain.10 Morphine is generally
unavailable, and even aspirin is severely rationed.
Denis Halliday was the UN Humanitarian Coordinator in Iraq until his
resignation in 1998 in protest at the effects of the sanctions. (His
successor, Hans Von Sponeck, resigned in February this year for
precisely the same reason.) Halliday was in Australia in April this
year, at the invitation of the Medical Association for Prevention of
War, for discussions with the Australian government, which still
supports the sanctions policy. He says that the sanctions are a form of
genocide, that they have done nothing but target civilians, and that
they strengthen Saddam Hussein.
The elimination of Iraq's weapons of mass destruction is an essential
step towards peace in the Middle East. However, while such weapons
remain elsewhere in the region, and the ongoing suffering,
degradation, humiliation and resentment of the Iraqis is ignored,
peace prospects remain grim.
For our profession, the defence and promotion of public health is one
of the greatest contributions we can offer humanity. Policies which
deprive whole populations of food, clean water and basic healthcare
are anathema to public health principles and must be condemned
outright. For all those who suffer the effects of this deprivation --
those who die needlessly and their relatives and our professional
colleagues who must watch them die -- we have a duty to speak out.
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