Jointly published by the Fourth Freesom Forum and the Joan B. Kroc Institute of International Peace Studies, University of Notre Dame
Summary of General Findings
By Richard Garfield
Sustained increases in young child mortality are extremely rare. In Iraq, there have been many reports suggesting a rise in rates of death and disease since the Gulf war of January/February 1991 and the economic sanctions that followed it and continue to this day. There is no agreement, however, on the magnitude of the mortality increase, its causes, who is responsible for these deaths, or how to stop them from happening. Because the best data and the greatest changes in mortality occur among young children, this report focuses exclusively on deaths among children under five years of age. Information from twenty-two field studies, including data from thirty-six nutritional assessments were reviewed, along with demographic estimates from nine sources, three Iraqi government reports, ten UN-related reports, and eighteen press and research reports.
Data on the health and well being of children were drawn from four large, well designed and managed studies examining death rates among children from 1988 through 1998; Iraqi Ministry of Health data (26, 28) serve as a prewar baseline. Before the establishment of sanctions prior to the Gulf war in August 1990, for each 1000 children born, 40 died before reaching five years of age. Careful reexamination of a previous study showed a slight increase in mortality during sanctions prior to the Gulf war. A large rise in mortality in the period during and eight months after the Gulf war was reported in the well publicized international study done by an international study team from Harvard University (29, 30). Data are not available from any reliable studies on mortality since 1991. Very good data are available for the years 1996 through 1998, however, on child nutrition, water quality, adult literacy, and other social and health indicators which influence child mortality.
A variety of methods were used to estimate the mortality rate that is predicted by these indicators. The most reliable estimates were derived from a logistic regression model using a multiple imputation procedure. The model successfully predicted both the mortality rate in 1990, under stable conditions, and in 1991, following the Gulf war. For 1996, after five years of sanctions and prior to receipt of humanitarian foods via the oil for food program, this model shows mortality among children under five to have reached a minimum of 80 per one thousand, a rate last experienced more than thirty years ago. This rise in the mortality rate accounted for between a minimum of 100,000 and a more likely estimate of 227,000 excess deaths among young children from August 1991 through March 1998. About one-quarter of these deaths were mainly associated with the Gulf war; most were primarily associated with sanctions. Mortality was highest in the southern governorates of the country and lowest in Baghdad. Mortality was higher in rural areas, among the poor, and among those families with lower educational achievement. The increase in mortality was caused mainly by diarrhea and respiratory illnesses. The underlying causes of these excess deaths include contaminated water, lack of high quality foods, inadequate breast feeding, poor weaning practices, and inadequate supplies in the curative health care system. This was the product of both a lack of some essential goods, and inadequate or inefficient use of existing essential goods.
Given the most likely estimate of 227,000, there were an average of about 60 excess deaths each day. These child deaths far outnumber all deaths on all sides, among combatants and civilians, during the Gulf war. It exceeds the number of deaths known to result from any of the bombing raids in Iraq even on the days of the bombings. It exceeds each week the number of deaths that occurred in the tragic bombing of the Al Furdos bomb shelter during the Gulf war. That incident caused an international uproar, an apology from the Joint Military Command, and a revision in the procedures for selecting targets. Reaction to the much greater number of child deaths associated with sanctions has been far more muted. Confusion over the number of deaths and rhetorical argument over which side is responsible for those deaths has prevented the international community from focusing more effectively on how to prevent their continued occurrence.
Studies from 1996 onward suggest that there was little decline in mortality rates at that time. Since March 1998 the oil for food program has greatly increased access to essential supplies and the mortality rate has surely declined, but data are not yet available to estimate the magnitude of that decline. Indeed, the failure to institute stepped-up monitoring when sanctions were initiated in 1990 continues to limit the capacity to carry out timely and reliable assessments of humanitarian conditions in Iraq. Despite a steep rise in mortality rates, most Iraqi children survive under the social, economic, and political crises of the 1990s in Iraq but experience profound limitations on their health and well being. Far more attention needs to be devoted to identifying and minimizing the humanitarian damage to the Iraqis alive today, in preparation for an eventual shift from relief to reconstruction and development in the years ahead.
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