Where are the statistics on the Iraqi health disaster?
One of the important lessons from the Second World War was that science should not be an accomplice nor indifferent when war crimes are committed against innocent civilians (Acheson, 1996; Leaning, 1996). What is happening currently in Iraq as a consequence of the Gulf War and the sanctions that followed is 'genocide' against innocent Iraqi civilians (Simons, 1998). Today there are 6000-7000 deaths of children every month as a consequence of the sanctions. Science, and particularly health sciences, are playing an unsatisfactory role in highlighting or investigating the serious health catastrophe that a whole country is suffering: out of 368 articles that addressed the health effects of the Gulf War, only four articles were related to the health of the Iraqi population.
The mayhem of the war
Whatever the political causes behind the Gulf War, the humane cost to Iraqi civilians remains unacceptable in terms of the goals that the war tried to achieve. Many observers commented that the Gulf conflict was not a 'war' in the conventional sense (Simons, 1998). For example, very advanced weapon systems were used against a small developing nation 'Iraq' (Middle East Watch, 1991). In no area of weaponry was Iraq a match for the US high-tech death machine assembled in the Arabian desert and on ships in the Arabian Gulf and the Indian Ocean. Iraq faced an alliance led by the greatest military power on earth: the 'United States'. As one American citizen stated during the Gulf War: 'this ain't a war. It's just us dropping bombs and killing people' (quoted in Simons, 1998).
The first phase of the war involved five weeks of intensive air attacks. The US-led alliance flew 110,000 bombing sorties using 1,800 planes and dropping 88,000 tons of bombs (equivalent to seven Hiroshima-size atomic bombs) against not only military targets but the entire Iraqi economic infrastructure, destroying irrigation facilities, food processing, fertilizer and powdered milk plants, electrical generating, water purification and pharmaceutical plants, and hospitals (Middle East Watch, 1991). It used some aircraft for the first time in combat, such as the British Tornado and US F-117A Stealth Fighters. Other technologically advanced weapon systems were also used, such as the unmanned Tomahawk Cruise Missile, and advanced infra-red targeting that illuminated Iraqi tanks buried in the sand (Ibid., 1991).
The Americans, in particular, used many untried weapons on Iraq. These weapons and their effects on Iraqi civilians and the military went mostly unreported by the media (Simons, 1998). Some of these weapons had long-term environmental and sanitary devastating effects, whilst others constituted illegal weapons of mass destruction (Simons, 1998).
As in the Korean and Vietnam wars, Napalm was also used in the Gulf conflict. But in the Gulf conflict a much more advanced version of these illegal weapons was used; the substances used in burning humans were more flammable, spread over larger areas and were almost impossible to extinguish. Cluster bombs were used too in a new advanced form. Rockeye cluster bombs were reported to have been used in carpet bombing against civilian and military targets. Each of these bombs contain 247 clusters, that explode into 2000 high-velocity razor-like pieces of shrapnel that practically shred people.
The Iraqi population has also suffered from many unreported environmental effects from the war (Simons, 1998). For example, when the US air force bombed oil refineries, in addition to the casualties amongst workers in these plants, people living in the vicinity of these refineries suffered death by suffocation from the cloud of smoke generated by the massive fire. People in that area who survived have had long-term health problems due to the pollution produced by the burning refineries and other burning facilities.
Another problem is the environmental effects of radioactive dust from the depleted uranium (DU) shells. It has been reported that DU is known to cause kidney failure, cancers and other diseases (Doucet, 1994). During the 43-day war, the US and Britain fired and dropped 5000-6000 shells containing between 700 to 800 tons of DU on Iraq (Simons, 1998). It has been suggested that the DU in these shells has caused the deaths of around 50,000 children during the first 8 months of 1991 (Doucet, 1994). A recently held International Symposium on DU Impact concluded in Baghdad on the 3rd of December 1998 (Ciment, 1998). One research study indicated that large landscapes in southern Iraq have been polluted by DU radiation, whilst Iraqi health officials have reported that cancer cases in southern Iraq have increased by almost 200 % since the outbreak of the war.
The psychological effects of the war on the Iraqi people, particularly children, are another area that needs investigation. A descriptive study of Iraqi children by a team of psychologists - experienced in war psychology - revealed part of the story (Harvard Study Team, 1991). Three quarters of the children interviewed by the team showed signs of despair; four out of five expressed fear of losing their families; two-thirds could neither sleep nor concentrate properly and doubted whether they would survive to adulthood. The team suggested that the prevalence of these problems were disproportionately high in comparison with other conflicts, and also claimed that the majority of Iraqi children will suffer from severe psychological disorders throughout their lives. It recommended the need for international action to assess and manage this problem in fulfilment of the promise that the international community made at the United Nations Children's Fund (UNICEF) summit that 'children have the right to be looked after and brought back from despair and trauma'. To my knowledge nothing has yet been done to investigate this problem further.
The genocide of the sanctions
Iraq's population stands at an estimated total of over 22 million, half of which is under 16 years of age. The population is predominantly urban (70%) with an annual growth rate of 2.7%. In the beginning of this decade, the country enjoyed a high adult literacy rate of up to 95% and the Government provided efficient and free health services through a network of hospitals in large cities and towns and primary health care (PHC) centers in semi-urban and rural areas. Consequently, Iraq succeeded in reducing its infant mortality rate (IMR) to about 42 per 1000 live births prior to the Gulf War.
At the end of the Gulf War and in spite of the fact that the war's aim in expelling Iraq from Kuwait had been achieved, coalition partners agreed to a range of sanctions, predominantly consisting of a sweeping economic embargo of Iraq that effectively paralysed the economy and affected Iraqi civilians, particularly children - those who had nothing to do with the politics of that war (Simons, 1998). The IMR more than doubled to 92 per 1000 live births in the five years of sustained economic and trade sanctions since the Gulf War (UNICEF, 1995). Simons (1998) in his book The Scourging of Iraq asked the question: to what extent, if at all, is it justifiable to subject a helpless civilian population to disease and starvation in the furthering of political objectives? He tried to explore the question from the point of view of international law and argued that sanctions constitute a war crime committed against Iraqi people by the US and its allies.
In spite of the American claim that the sanctions are only intended to prevent Iraqi rearmament, the list of items vetoed by the sanctions committee show the falsehood of this claim (Simons, 1998). The punitive sanctions have denied Iraq the opportunity for post-war reconstruction. There has been very little improvement in the post-war polluted and hazardous environment. In 1994 an assessment mission to Iraq organised by the International Federation of Red Cross and Red Crescent Societies discovered that repairs to the Iraqi infrastructure were being hindered by the lack of spare parts and replacement systems. The mission reported the many problems that were maintained by sanctions:
An account of the effects of the sanctions on Iraq's health was documented in the report of the United Nations Children's Fund (UNICEF, 1995). The report showed how the mortality of children under five years of age had been on the rise since the imposition of sanctions. The monthly average of mortality cases among children of this age group, due to acute respiratory infections, water-borne diseases and malnutrition reached 4,409 for 1994, compared with only 742 cases in 1990, while the average of monthly mortality cases by the end of July 1995 stood at 4,475. The more recent estimate of mortality in 1999 is 6,300 for children under 5 years of age (Society for International Communication, 1999).
The report also highlighted a significant increase of low birth-weight babies (i.e. under 2.5 kgs) compared to the total number of registered births over the five-year period of sanctions. The monthly average of low birth weight babies in 1994 was 21.1% compared to 4.5% in 1990, while the monthly average by the end of July 1995 had reached 21.5%. The current figure for 1999 is 23.5% (Society for International Communication, 1999).
Infectious diseases, particularly water-borne infections, have increased significantly. The war's destruction of the infrastructure of Iraq, including sanitation and water purification, is of particular relevance to this situation (Middle East Watch, 1991). Furthermore, the sanctions have made it difficult to purchase the spare parts needed to repair these facilities. Cases of cholera have risen from zero in 1990 to 1,345 in 1994 and to 2,560 in 1998. Similarly, typhoid has increased dramatically from 2,240 cases in 1990 to 24,436 cases in 1994 and to 19,825 in 1998. Pneumonia among children under five has also increased from 11,713 in 1990 to 23,257 in 1994 (UNICEF, 1995; Society for International Communication, 1999).
This is a 'man-made' public health disaster, whose victims are mainly people who were not even born until after the Gulf War. It is unacceptable that the Iraqi civilian population should bear the consequences of an international political conflict.
Research on the health effects of the Gulf War
A survey of Medline (a database of medical and health-related research articles) for articles on the Gulf War revealed 368 articles that covered the health-related issues. Only 4 out of these 368 articles were on how the Gulf War affected the health of Iraqi people. The majority of the rest were on the health effects of the conflict on the American troops who have suffered from a range of symptoms, which together form the Gulf War Syndrome.
Two articles were recently published in The Lancet by the Gulf War Illness Research Unit - a London-based unit funded by the US Department of Defence (Ismail et al., 1999; Unwin et al., 1999). In these articles, the authors claim to be trying to investigate the aetiology of the symptoms of the Gulf War servicemen and to reach a phenomenological formulation of these symptoms and whether they constitute a syndrome. However, the studies suffer from serious methodological omissions as the authors have failed to address the following issues:
These articles and many others illustrate the complete political bias of the research bodies on the subject. There is very little interest in what is happening to the population which was the target of the war mayhem and its environmental hazards. The main body of research continues to focus on the health of the people who dropped the bombs rather than the people who received them. If there is a Gulf War Syndrome it would be apparent in Iraqi women and children and not only amongst American or British soldiers.
Acheson, D. (1996), 'Preventing genocide', BMJ, 313, pp. 1415-1417.
Ciment, J. (1998), 'Iraq blames Gulf war bombing for increase in childhood cancers', BMJ, 317, p. 1612.
Doucet, I. (1994), 'Desert Storm syndrome: sick soldiers and dead children?', Medicine & War, 10, pp. 183-94.
Harvard Study Team, (1991), Public Health in Iraq after the Gulf War, May.
Ismail, K., Everitt, B., Blatchley, N., Hull, L., Unwin, C., David, A., Wessely, S. (1999), 'Is there a Gulf War syndrome?', The Lancet, 353, pp. 179-182.
Leaning, J. 'War Crimes and medical science', BMJ, 313, pp. 1413-1415.
Middle East Watch (1991), Needless deaths in the Gulf War, civilian casualties during the air campaign and violations of the law of war. New York: Human Rights Watch.
Simons, G. (1998), The scourging of Iraq; sanction, law and natural justice, Macmillan Press: London.
Society for International Communication (1999), Impact of sanctions on health, nutrition and environment in Iraq.
United Nations Children's Fund (UNICEF) (1995), The Status of Children and Women in Iraq, A Situation Report, September.
Unwin, C., Blatchley, N., Coker, W., Ferry, S., Hotopf, M., Hull, L., Ismail, K., Palmer, I., David, A., Wessely, S. (1999), 'Health of UK servicemen who served in Persian Gulf War', The Lancet, 35, pp. 169-178.