Death and Disease in Iraq

by Jim Lobe
by Jim Lobe

Between 21,000 and 55,000 people have died as a result of the U.S.-led invasion of Iraq and its aftermath, according to a new report that also warned of rapidly deteriorating health conditions for those who survived.

London-based Medact, the British affiliate of International Physicians for the Prevention of Nuclear War (IPPNW), concluded that the war's continuing impact – particularly the failure of occupation authorities to ensure security – has resulted in a further deterioration of the Iraqi population's health status. IPPNW's U.S. affiliate, Physicians for Social Responsibility, joined in the report's release Tuesday. The report's funding was provided by Oxfam and the Polden-Puckham Charitable Foundation.

"The health of the Iraqi people is generally worse than before the war," according to an executive summary of the 12-page report, which noted that the state of health in Iraq was already poor by international standards. It said women and children were particularly at risk due to the breakdown in law and order and damage to infrastructure and that women were also being affected by the emergence of religious conservatism after the war.

The report, entitled "Continuing Collateral Damage: The Health and Environmental Costs of War on Iraq 2003," is the follow-up to a pre-war study released last November that predicted at the time that between 49,000 and 261,000 people could be killed in an invasion of Iraq over three months.

The much lower estimated death toll in the seven months that followed the March 20 invasion is due primarily to the quick collapse of Iraqi military resistance and the fact that no weapons of mass destruction were used.

The report says that 172 U.S. and British combatants were killed during the war period (March 20 to May 1) and another 222 died between May 2 and October 20. It estimates the number of civilians killed during the war at between 5,708 and 7,356. From May 2 to October 20, the report estimates civilian deaths resulting from hostilities at between 2,049 and 2,209.

The major unknown, according to the report, is the number of Iraqi military deaths during the war. As few as 13,500 – or as many as 45,000 – soldiers and paramilitary fighters are believed to have been killed, based on extrapolations from death rates of between three and ten percent found in the units around Baghdad, as well as U.S. military estimates that 2,320 Iraqi soldiers were killed in and around Baghdad alone.

In the absence of official body counts, "the final toll will probably never be known" the report concluded, noting that the Iraqi Red Crescent is currently exhuming mass graves to identify Iraqi war dead around Baghdad and elsewhere.

In addition, thousands of combatants on both sides, as well as civilians, suffered serious injuries, including amputations and mental trauma, according to the report. It noted that one source, Iraq Body Count, estimated at least 20,000 civilian injuries by July, of which 8,000 were in Baghdad alone. Deaths and injuries from unexploded ordnance have continued, and are likely to be under-reported, according to the independent Mines Advisory Group (MAG).

The report estimated the number of Iraqi military wounded at roughly three times the death toll.

The full health impact of the war, however, continues to be felt in a variety of ways that defy precise monitoring due to the lack of accurate data, the failure of occupation authorities to collect and record data, and the inability of the Iraqi health system to cope with the number of people who need treatment.

"Limited access to clean water and sanitation, poverty, malnutrition, and disruption of public services including health services continue to have a negative impact on the health of the Iraqi people," according to Dr. Sabya Farooq, the report's main author.

Environmental damage, including extensive pollution of land, sea, rivers, and the atmosphere – some of which may have spilled over to neighboring countries – is also a major concern covered by the report. Oil well fires created oil spills and toxic smoke, while military convoys disrupted the desert economy. Land mines and other ordinance have maimed people and animals and continue to pose a hazard in various parts of the country.

Particularly worrisome are the remains of some of the military debris, particularly depleted uranium used in weapons and armor, and material looted from nuclear power plant sites, much of which remains to be accounted for.

"The health and environmental consequences of the war will be felt for many years to come," said Medact president, Dr. June Crown.

The report expressed particular concern about the health of young children. While Iraq had built one of the most advanced health systems in the developing world before the first Gulf War in 1991, that war and the sanctions that followed had a disastrous impact on its performance. One in eight children under five died before their fifth birthday; one in four was chronically malnourished; a quarter of all newborns were underweight; while maternal mortality stood at 294 for every 100,000 births, roughly the same level as Peru and Bangladesh.

In the immediate aftermath of the most recent war, small-scale studies found a dramatic increase in waterborne diseases, including typhoid and cholera and a doubling of acute malnutrition or wasting – problems to which young children are particularly vulnerable.

The report makes a series of recommendations to the occupation authorities, noting that, with the influx of new resources and the end of sanctions, health services could be significantly upgraded once security is assured. But it expresses concerns about the heavy participation of for-profit companies, mostly from the U.S., that have been awarded contracts to provide services and technical aid in the health sector.

The successful post-World War II reconstruction of Europe and Japan, it notes, included substantial investment in public health systems. "On the basis of international evidence," it urges, "commercialization of health care should be avoided."

Reconstruction of the Iraqi health sector, the report recommends, should be based "on the principle that health and health care are fundamental social rights... and an important aspect of nation-building..."

November 19, 2003

Jim Lobe is Inter Press Service's correspondent in Washington, DC.

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