Dr Susan Wareham is President, Medical Association for Prevention of War (Australia) and Regional Vice-President, International Physicians for Prevention of Nuclear War.
Walid spends most of his time on the streets of Baghdad. He is fourteen years old and shines shoes each day to earn a meagre existence for his mother and brothers. If he had been born ten years earlier Walid would have attended school until at least age fifteen, but times have changed. Since 1990 the people of Iraq have lived, and died, under economic sanctions. And Walid and the rest of his generation are the major victims.
I recently took part in a humanitarian mission, sponsored by Washington Physicians for Social Responsibility and the International Physicians for Prevention of Nuclear War, which travelled to Iraq to deliver pharmaceutical and medical supplies and to make contact with a people whose suffering has been largely forgotten by the world community. We met with UN, Red Cross and Red Crescent officials, church and government officials, doctors, teachers, taxi drivers and street children, and we witnessed a human tragedy which continues to unfold daily.
We did not go primarily to collect data on the effects of the sanctions, for the plight of the people of Iraq has been repeatedly documented. As early as 1992 an article appeared in the New England Journal of Medicine, stating that more than 46,900 children had died between January and August 1991 from the combined effects of the 1991 war and the sanctions (1). In 1995 The Food and Agriculture Organisation reported "The situation throughout the country is increasingly disastrous with economic decline spreading across almost all sectors of Iraqi society. Malnutrition is widespread affecting nearly all social groups throughout the country" (2). In October 1996 UNICEF stated that more than 4,500 children under the age of five were dying each month from hunger and disease (3) . The situation is not improving.
To fully understand what has happened, one must see this in context. Iraq, with its vast reserves of oil, is a very wealthy country. Until August 1990 the health care system was one of the best in the region, with all services and supplies readily available4. Education was free and compulsory, and literacy rates were very high.
Health care in Iraq now is equal to the worst of Third World standards and, as in other such situations, it is particularly young children who are affected. The major killers are treatable or preventable infectious diseases such as pneumonia and gastrointestinal infections.
At Al Mansour Paediatric Teaching Hospital and Saddam Paediatric Hospital, basic supplies such as antibiotics and intravenous fluids are severely deficient. Even bed sheets are rare. The smell of sewerage is frequent. At Ibn Al Baladi Hospital, paediatrician Dr Alhan al Rashid says that many of the babies born there are of low birth weight (less than 2.5 kilograms). In addition, the rates of major congenital anomalies, such as anencephaly and hydrocephaly, and of childhood leukaemia have risen sharply. This is thought to be due to depleted uranium weapons which were used against Iraq in 1991 (and are almost certainly being used now against Serbia).
The poor state of sewerage and water treatment works, partly a result of the 1991 bombing, is a major public health concern. Spare parts, plumbing equipment and chemicals needed for purification are all classified as "dual-use" under the sanctions (able to be used by the civilian or military sectors) and are delayed or prohibited by the Security Council Sanctions Committee. The refusal to allow chlorine to disinfect water supplies is, at best, contrary to basic principles of preventive medicine, and at worst, negligent to the point of being criminal.
Distribution of food and medicines is also obstructed by the Sanctions Committee. Forklifts, trucks, truck tyres and mechanical spare parts are "dual-use" and subject to lengthy delays. In addition, the money to buy these things and to pay the workers is lacking.
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