No modern humanitarian emergency has been as intensely examined as the humanitarian crisis in Iraq in this decade. Since 1990, more than thirty major studies have been conducted on the impact of the war and the continuing economic sanctions. Major reports have been issued by the United Nations Children's Fund (UNICEF), the World Food Programme (WFP), the Food and Agricultural Organization (FAO), the Harvard Study Team, and the Center for Economic and Social Rights in New York. In 1997 alone extensive health and nutritional surveys were conducted by UNICEF and a joint FAO/WFP team. The findings of these most recent investigations were summarized in a November 1997 report to the Security Council by Secretary General Kofi Annan:

United Nations observers regularly report an exceptionally serious deterioration in the health infrastructure: a high infant mortality rate and high rates of morbidity and mortality in general, poor and inadequate storage conditions for supplies, an unreliable supply of electricity and back-up generators, faulty or non-functioning air-conditioning, defective cold-storage, interrupted water supplies, broken/leaking sewage systems and non-functioning hospital waste disposal systems.1

One of the most alarming reports on the consequences of the sanctions appeared in a December 1995 letter to The Lancet, the journal of the British Medical Association. Sarah Zaidi and Mary Smith-Fawzi, members of the 1995 FAO study team that had examined health and nutritional conditions in Iraq, asserted on the basis of the FAO report that since the end of the Gulf War sanctions were responsible for the deaths of 567,000 Iraqi children.2 A New York Times article picked up the story and flatly declared "Iraq Sanctions Kill Children."3 In May 1996 a feature segment of the widely viewed CBS television program 60 Minutes depicted sanctions as a murderous assault on children.4 UNICEF added fuel to the fire with an October 1996 report that 4500 children under the age of five were dying every month in Iraq from hunger and disease.5 Critics have called the UN sanctions "a massive violation of human rights" and have described the situation in catastrophic terms: "More Iraqi children have died as a result of sanctions than the combined total of two atomic bombs on Japan and the recent scourge of ethnic cleansing in former Yugoslavia."6 Former Attorney General Ramsey Clark, Bishop Thomas Gumbleton, and others regularly claim that sanctions have killed more than a million Iraqis, most of them children.

Doubts about the numbers were raised immediately. In January 1996, researchers at the London School of Hygiene and Tropical Medicine published a letter in Lancet about inconsistencies they found in the infant and under-five child mortality rates used by the FAO analysts.

In late 1996, Canadian scholars noted that the claim of 567,000 deaths was an extrapolation based on a sample of 36 infant deaths and 245 child deaths reported between 1991 and 1995. Others pointed out that the baseline figures used for comparison "infant mortality rates before the Gulf War" were themselves based on estimates, because Baghdad did not report these statistics in the five years preceding 1990.

In October 1997 Lancet published another letter from Zaidi that cast grave doubt on the most important findings of the 1995 report. Zaidi and her colleagues at the Center for Economic and Social Rights participated in a 1996 study mission that used the same survey methods and questionnaires as the 1995 FAO investigation. They found that "the mortality rates estimated in 1996 were much lower than those reported in 1995, for unknown reasons." Interestingly, this major disavowal of the catastrophic numbers went unnoticed by the press.

One problem with many of the most frequently cited studies is that they rely primarily on official Iraqi information sources. The 1995 FAO study contains a table reporting more than 500,000 deaths among children due to sanctions, but the source for these figures is the government of Iraq.

The study also contains an estimate by the Iraqi Ministry of Health that 109,000 people died annually because of sanctions, but it observes that the study's investigators "had no way of confirming this figure."

Similarly, a 1996 World Health Organization report on health conditions in Iraq was based largely on data supplied by Baghdad. The report simply accepts unsubstantiated Iraqi figures and uses them to estimate infant mortality and disease rates.7

These studies and assertions raise profound questions, especially regarding the most pressing: Are the sanctions killing babies? Beyond this, many wonder about the scale of the humanitarian crisis. Who is responsible? The answers to these questions are crucial not only for the fate of the Iraqi people and the course of UN policy there, but for the future of Security Council sanctions in general, as that body is now experiencing fatigue and division about the future of sanctions in light of the Iraq experience. At stake are the legitimacy and viability of economic sanctions as instruments of nonmilitary international policy.

We have contributed to the debate on Iraqi sanctions several times, especially criticizing the strategic misuse of these sanctions and their politicization.8 After 1995 we were increasingly calling attention to the severe humanitarian consequences of the sanctions. While we count ourselves among the critics of sanctions in Iraq, we have been skeptical of the claims that have been made about the scale of the humanitarian crisis. As a result we have drawn serious criticism from various commentators and especially from activists concerned with the immorality of sanctions against Iraq.9 For several years we have had concerns about the accuracy of the most widely quoted figures about Iraqi mortality. Part of our concern and doubt was fueled by knowing the facts about the data discrepancies we noted above. But when the New York Times and 60 Minutes are going to use a particular number of child deaths, however inaccurate, such figures take on life and meaning of their own. We had hoped to be able to verify these assertions about the enormous figures and to see if we could acquire any reasonably objective assessment. However, the more we studied the problem of sanctions-related mortality in Iraq, the more confusing the picture became. Inconsistencies and methodological problems seemed to plague nearly all of the more than two dozen major studies conducted in Iraq by UN and independent agencies. The inquiry was clearly beyond our own expertise.

To gain a more accurate picture of sanctions-related mortality in Iraq, we commissioned public health specialist Richard Garfield of Columbia University to conduct an independent study. Garfield was a member of the initial Harvard Study Group that investigated the impact of sanctions in Iraq in 1991, and he had published studies on the health impact of sanctions against Cuba and Nicaragua. We asked Garfield to evaluate the studies that have been conducted on Iraq to date and to take a fresh look at possible new methodologies for determining sanctions-related mortality, especially for children under five years of age. The present study is the result of Garfield's effort.

We believe it breaks new ground in examining the humanitarian impact of sanctions and provides as reliable a scientific basis for estimating the mortality impacts of the sanctions in Iraq as can possibly be obtained at this time and under these circumstances. We are grateful to Garfield for the enormous amount of energy and research he brought to this study, and we also owe a debt to the numerous colleagues in the public health field who provided critical commentary to Richard on earlier drafts of the work. We hope that his report will make a significant contribution to a more informed assessment of the Iraq sanctions. We believe that Garfield's study and innovative methodology may have wider significance in offering new approaches to the necessary task of assessing the humanitarian impact of United Nations sanctions.

The estimates offered by Garfield of 106,000 to 227,000 deaths of Iraqi children under five since the imposition of sanctions are significantly lower than the claims presented by the most vocal critics of sanctions in Iraq. But even the more conservative estimates in Garfield's study are horrifying. In particular we ourselves, who have been publicly skeptical of larger estimates, especially those used by the activist community,10 find no solace or academic satisfaction in these gruesome numbers. Garfield confirms that hundreds of thousands of innocent children in Iraq have died prematurely and unnecessarily during this sanctions crisis. This is an appalling humanitarian tragedy. The humanitarian crisis in Iraq demands urgent attention "from government and citizens alike" to put an end to the suffering of innocent children. We know that Richard Garfield's work will make a major contribution toward this important goal.

George A. Lopez
David Cortright


Goshen, Indiana
March 1999




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Notes
1.
United Nations, Report of the Secretary General Pursuant to Paragraph Three of Resolution 1111 (1997), S/1997/935, 28 November 1997, 14. Return to Text

2.
Sarah Zaidi and Mary C. Smith-Fawzi, "Health of Baghdad's Children," The Lancet 346, no. 8988 (2 December 1995): p. 1485; see also the editorial in the same issue, "Health Effects of Sanctions on Iraq," 1439. Return to Text

3.
Barbara Crossette, "Iraq Sanctions Kill Children, UN Reports," New York Times, 1 December 1995, A6. Return to Text

4.
CBS Television, 60 Minutes, 12 May 1996. Return to Text

5.
Barbara Crossette, "UNICEF says Thousands of Young Iraqi Children are Dying Every Month," New York Times, 29 October 1996, A6. Return to Text

6.
Center for Economic and Social Rights, UN Sanctioned Suffering: A Human Rights Assessment of United Nations Sanctions on Iraq (New York: Center for Economic and Social Rights, May 1996): 1. Return to Text

7.
This material on source discrepancies was originally published in the sidebar "Counting the Dead" in George A. Lopez and David Cortright, "Pain and Promise," The Bulletin of the Atomic Scientists 54, no. 3 (May/June 1998): 41. Return to Text

8.
See George A. Lopez and David Cortright, "Trouble in the Gulf: Pain and Promise," The Bulletin of the Atomic Scientists 54, no. 3 (May/June 1998): 39-43; David Cortright and George Lopez, "Are Sanctions Just? The problematic Case of Iraq," Journal of International Affairs 52, no. 2 (Spring 1999): 33-53; and Thomas G. Weiss, David Cortright, George A. Lopez, and Larry Minear, eds., Political Gain and Civilian Pain: Humanitarian Impacts of Economic Sanctions, (Lanham, Md.: Rowman and Littlefield, 1997). Return to Text

9.
See the letters and discussion in Sojourners, May/June, 1998 as an example. Return to Text

10.
See George A. Lopez, "The Sanctions Dilemma: Hype Doesn't Help" Commonweal, September 10, 1998, 10-12. Return to Text