Continuing collateral damage: the health and environmental costs of war on Iraq

Originally published


Health of Iraqi people is worse following war says new report

The war in Iraq was declared officially at an end six months ago, but the health and environmental costs of the conflict are still being felt. Drawing on sources within and outside Iraq, the international health charity Medact says that the health consequences of the 2003 war on Iraq will be felt by its people for years, maybe generations.

The report, Continuing Collateral Damage: The health and environmental costs of war on Iraq 2003, will be released on November 11 in London and 13 other countries. It follows Medact's initial report on Iraq, 'Collateral Damage', which was published in November 2002, prior to the war.

The findings have emerged from a comprehensive independent survey assessing the health and environmental impact of the war undertaken by Medact since March 2003. The research was carried out by an international team of authors and advisers, all experts on health and conflict.

The new report estimates that more than 20,000 Iraqis have died between the start of hostilities and when the report was finalised late last month. The number of people affected by the aftermath of the war is still rising as the Iraqi people continue to pay the price in death, injury and mental and physical ill health.

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

Because of the continuing insecurity and alarming deterioration in the health of Iraqi people since the war, Medact is calling on the occupying forces and UN agencies to:

Further investigate the current and long-term health impacts of the war.

Ensure that all reconstruction of public services including health is fully funded

Carry out their obligation under the Geneva Convention to maintain law and order and to protect hospitals, health professionals and those who provide humanitarian aid.

Note to editors

The report will be launched in London at a press conference on Tuesday 11 November from 0915 - 1000 at the British Medical Association, Tavistock Square, London WC1.

The press conference will be followed by a seminar from 1000 - 1300 in the same location with members of the Nobel Peace Prize-winning organisation International Physicians for the Prevention of Nuclear War (IPPNW) to discuss issues arising from the report.

The report will also be issued on November 11 or 12 by IPPNW affiliates in 13 countries: Australia, Belgium, Canada, Finland, France, Germany, India, Italy, Japan, the Netherlands, Norway, Switzerland, and by Physicians for Social Responsibility and IPPNW in New York.

The report, an Executive Summary and additional material will be available at and from 0900 on November 11.

The report will be available in English, Arabic, German and Italian. The Executive Summary will be available in English, Arabic, Sorani Kurdish and other languages.

The report is published in association with IPPNW and was part-funded by Oxfam and the Polden-Puckham Charitable Foundation.

Available for interview:

Sabya Farooq, author of the report.

Jane Salvage, editor of the report and author of Collateral Damage: the health and environmental costs of war on Iraq (Medact 2002)

Dr June Crown, President, Medact and former President, Faculty of Public Health Medicine of the Royal Colleges of Physicians, UK.

Mike Rowson, Director, Medact tel 07703 21 4469.

plus medical experts on specific topics such as mental health and war, and the health impact of the weapons used.

For more information and to arrange interviews contact Project Co-ordinator Gill Reeve on 020 7324 4740/4739; 020 7485 3067 (h) 07791 470486 (m);

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Continuing Collateral Damage: The health and environmental costs of war on Iraq 2003


The health consequences of the 2003 war on Iraq will be felt by the Iraqi people for years, even generations.

This report assesses the impact of the war on the environment and on the mental and physical health of civilians and combatants. Its conclusions may help to determine whether waging war on Iraq was more or less damaging than alternative courses of action; how best to conduct postwar affairs to minimise further loss of life and maximise health gain; and how to approach such issues in debates about other conflicts.

It builds on Medact's 2002 report, Collateral Damage: the health and environmental costs of war on Iraq, which concluded that the health of the Iraqi people had deteriorated alarmingly since the 1990-91 Gulf War and predicted that further conflict could have calamitous effects. We launched the Iraq Health Monitoring Project in spring 2003, aiming to research, document, analyse and disseminate information about the health consequences of the war. A second goal was to develop a model for measuring the core health impacts of war; none currently exists despite the continuing massive impact on health of conflicts worldwide.

The project has collated information on a range of health indicators from sources in the public domain and discussions with a variety of organisations and individual experts active in Iraq, both external and Iraqi.The already complex task was hampered by lack of valid and reliable data. Much of the information needed to paint a complete picture is not available, not collected and/or not published. There is also a danger of bias in different sources in the polarised situation produced by a conflict.

The report begins with a brief description of the war and the impact of the weapons used, particularly weapons of disputed legality.The impact of the war on health and the environment is then assessed, including its direct and indirect effects on mental and physical health in the short and longer term.War affects health at an individual and societal level through multiple direct and indirect pathways, and its impact on aspects of the physical and social infrastructure that predispose to ill health is examined, ending with an overview of the current state of Iraqi health.The impact of postwar reconstruction on health and the health system is explored. The report ends with a series of recommendations which ought to be addressed immediately to halt further health decline.

The best available evidence and expert opinion was utilised, but as the months go by it remains impossible to calculate the precise impact of the war on health in the past, present or future. What is certain is that the health of civilians and combatants has suffered greatly and continues to suffer. In addition to the fatalities there is a huge burden of mental and physical disability and disease, and long-term implications for the development of individuals, communities and Iraqi society as a whole.

Our 2002 report suggested that the total of possible deaths on all sides during a conventional conflict and the next three months could range from 49,000 to 261,000. Tentative estimates now suggest an actual range from 22,000-55,000. These figures are 'low' because the Iraqi military resistance collapsed faster than anyone foresaw and there were no exchanges of weapons of mass destruction. Meanwhile the current situation continues to damage health and the environment in Iraq.We cannot make an assessment of the health impact this disruption has caused but the evidence presented in this report suggests it may be considerable. The Geneva Convention enjoins occupying powers to protect people's health, yet the death toll continues to rise.We begin by examining the health impact of some of the weapons used during the war.

Iraq: the background

Population 25 million (50% under 18), including 5 million in the capital Baghdad

Other major cities Arbil, Basra, Diyala, Kirkuk, Mosul

Area 438,317 sq km, bordered by Iran, Saudi Arabia, Kuwait, Jordan, Syria, Turkey

Geography Desert, fertile plains in the centre between the Tigris and Euphrates rivers, and mountains in the north

Main languages Arabic (official and predominant) and Kurdish

Ethnic groups Predominantly Arab (75-80%),Kurdish (15-20%), other 5%

Religion Islam (97%). Most of the Shiite Muslims (60-65%) live in the south, and Sunni Muslims (32-37%) mostly in the centre and north. Christian and other 3%

Economy Owns 10% of the world's oil reserves. Population mainly urban but there is substantial agricultural production

Human development 126th out of 174 nations in the UN Human Development Index that compares countries' overall development level. In 1990 50th out of 130, and in 1995 106th out of 174
(Unicef 2002; The World Guide 2001/2002).

(pdf* format - 363 KB)

: Highlights and explains the contrast beween the widespread use of precision weapons and the high number of incidents involving civilian deaths and 'friendly fire'. (pdf* format - 146 KB)

: Looks at the questionable legality of inhumane weapons used during the conflict and explains their impact on health. (pdf* format - 121 KB)

: Mental well-being in Iraq - six months after the start of Operation Iraqi Freedom (pdf* format - 117 KB)