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The effect of sanctions on children of Iraq
  1. L Al-Nouri,
  2. Q Al-Rahim
  1. FRCPCH, Yarmouk, PO Box 15103, Baghdad, Iraq
  1. Correspondence to:
    Dr Al-Nouri;

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Sanctions were imposed on the people of Iraq in 1990. Iraqi people are still suffering, especially children. Infant mortality (IM) has increased more than five times. Previously it had decreased from 139 in 1960 to 20 in 1989, which was comparable to developed countries. In 1992 it went up to 111.1 In 1999, a decade later, IM was still high at 104.2 The Gulf War and trade sanctions caused a threefold increase in mortality amogn Iraqi children under 5 years of age. It has been estimated that more than 46 900 children died between January and August 1991.3

The study of the UN Food and Agricultural Organisation, published in a letter to the BMJ in 1995, concluded that deaths of more than 560 000 children could be attributed to UN sanctions. It also stated that the death rate among children under 5 years in Baghdad had increased fivefold since the war ended in 1991.4 Data for 1994–99 showed that mortality for children under 5 years was 131 per 1000 live births, compared with 56 for 1984–9, before sanctions. The reasons for excess deaths are clear—economic collapse with plummeting wages, soaring food prices, poor sanitation, lack of safe water, and inadequate provision of health care.5

The rate of low birth weight (<2500 grams) which was in the region of 9% in the period 1980–88, increased to 21% in 1994.1 The 1995 Baghdad nutrition survey of children under five years of age showed that the percentage of children below −2SD in urban Baghdad was 28% for stunting, 29% for underweight, and 12% for wasting. Severe malnutrition (−3SD) was noted among children, 10% for stunting, 7% for underweight, and 3% for wasting.6 The survey by FAO in the year 2000 indicated the prevalence of wasting in children under 5 years at the unacceptably high level of 10%, only a marginal difference from the 1995 survey.7

In school children aged 6–8 years the prevalence of wasting ranged from 1% in the upper class to 6.7% in rural areas. Similar differences were found for stunting and underweight.7 In a 1994 survey 1.6% of children under 5 years were reported to have night blindness, indicating vitamin A deficiency. A survey of school children in the north in 1994 showed a 30–50% prevalence of goitre, and evidence of iodine deficiency disease elsewhere throughout the country. Rickets are still being reported from hospitals at a rate of 3–5 cases per week.7

Diarrhoeal diseases and mortality due to dehydration were well under control prior to the Gulf War; there was a threefold increase from May 1990 to May 1991.8 Other water born infections increased from 1990 to 1999, for example typhoid by 60% and cholera almost fivefold.7 A measles epidemic occurred in 1998.7 There have been alarming rises in cases of malaria and leishmiais.1 Other infections like tetanus, poliomyelitis, diphtheria, and pertussis all showed an increase after the Gulf War.1

The National Immunization Programme which had begun in 1985 came to a complete halt between January and April 1991.8 The percentage of fully immunised one year old children fell from 94 for tuberculosis, 83 for diptheria, tetanus, and pertussis, 83 for polio, and 82 for measles to 79, 63, 64, and 68 respectively.1

A child psychology study (1991) revealed a level of psychological stress and pathological behaviour that was the highest the authors had seen in 10 years of conflict research. It revealed a highly disturbed population of children. Fear and anxiety were associated with memories of crisis. Seventy five per cent felt sad and unhappy, and four out of five expressed fear of losing their family by death or separation.8

There was a threefold increase in leukaemia in the southern provinces, sites of the Gulf War battlefield. A WHO investigation in 1995 suggested a possible link to products—now incorporated in the food chain—which were derived from depleted uranium used in piercing artillery shells. There were staggering deficiencies in cancer treatment facilities because of UN sanctions which were intended to exclude food and medicines.9

A report in 1996 showed that one third of hospital beds were closed. More than half of all diagnostic and therapeutic equipment was not working due to lack of spare parts and maintenance. All public hospitals experienced serious problems with lighting, cleaning, water supply, and sewage. The population had been burdened by a rapid rise in serious infections, nutritional deficiencies among children and pregnant women, and other treatable conditions for which neither drugs nor operations were available.10

Paediatricians have been isolated by the intellectual embargo from the international medical community. Physicians who wish to attend international conferences face travel restrictions, like denial of visas to European countries or the USA. In 1990, the delivery of European and American medical journals was abruptly stopped. This intellectual embargo served to undermine the care of patients, and denies Iraqi doctors the right to share scientific advancement and its benefits.11