Our common responsibility: The impact of a new war on Iraqi children

Executive Summary
Iraqi children are more vulnerable to the adverse effects of a new war than they were before the Gulf War of 1991.

Our Common Responsibility: The Impact of a New War on Iraqi Children, a report by the International Study Team assesses the vulnerability of Iraqi children today as compared to 1991. The report comes as the United Nations Security Council meets to consider the report of the United Nations weapons inspectors. As such, this report is directed to the Security Council, to the government of Iraq, and to the international community as a public document encouraging these entities to take into account the plight of Iraqi children when considering the alternatives of war and continued weapons inspections.

This report examines the physical and mental well being of the 12 million Iraqi children based on data collected in Iraq between 20 and 26 January 2003. The team conducted interviews, collected data, and reviewed existing data pertaining to the state of children in Baghdad, Basra, and Karbala in Iraq. In addition, the Team independently visited more than 100 Iraqi families (children and their parents) in their homes.

The main findings of the report are presented in sections divided into Physical Well-Being, Mental Well-Being and Emergency Preparedness. The first section, Physical Well-Being concludes that despite some recent improvements in the health and nutritional status of children from their post-1991 Gulf War state, Iraqi children are still in a significantly worse state than they were before the 1991 Gulf War. Similarly, because most of the 12 million Iraqi children are dependent on food distributed by the Government of Iraq, the disruption of this system by war would have a devastating impact on children who already have a high rate of malnutrition. The state of the physical well being of Iraqi children thus makes them much more vulnerable to war today than they were in 1991.

Perhaps the most startling findings are based on field data collected by two of the world's foremost child psychologists, who are leading experts on the psychological impact of war on children. They found that Iraqi children are suffering significant psychological harm due to the threat of war that is hanging over their head. This finding, based on the first ever pre-war psychological field research with children, is powerful evidence that the concern for children's wellbeing needs to be considered in the decision making process about to take place in the United Nations Security Council.

Finally, a review of the available data on emergency preparedness indicates that the international community has at present little capacity to respond to the harm that children will suffer by a new war in Iraq.

The study was initiated and organized by the International Study Team, an independent group of expert academics, researchers and practitioners examining the humanitarian effects of military conflict on the civilian population.

In 1991, the International Study Team produced a comprehensive report on the humanitarian effects of the Gulf War. Based on more than 9,000 independently conducted household interviews in 300 locations across all parts of Iraq, the 1991 International Study Team report has been acknowledged as the most comprehensive study of the impact of war on civilians.

The team members are:

Team Leader:

Dr. Eric Hoskins, Public Health and the Impact of War on Children

Contributors:

Mr. Rupen Das, Emergency Preparedness and Infrastructure
Dr. Curtis Doebbler, International Humanitarian Law & Children's Rights
Dr. Atle Dyregrov, Child Psychology
Ms. Kali Galanis, Gender
Dr. Mustafa Koc, Food and Nutritional Security
Dr. Samantha Nutt, Public Health and Medical Care
Dr. Magne Raundalen, Child Psychology
Ms. Tara Sutton, Visual Documentation

The International Study Team received financial support for Our Common Responsibility from the following organizations: Canadian Action for Indonesia and East Timor, Canadian Auto Workers, Canadian Catholic Organization for Development and Peace, Canadian Friends Service Committee (Quakers), Canadian Labour Congress, Center for Crisis Psychology at the University of Bergen in Norway, Centre for Studies in Food Security, Ryerson University, Toronto, Inter Pares, International Physicians for the Prevention of Nuclear War (IPPNW), Mennonite Central Committee Canada, Near East Cultural and Educational Foundation, Norwegian Psychological Association, Oxfam Canada, Peacefund Canada, Physicians for Global Survival, Primate's World Relief and Development Fund, Project Ploughshares, Rights and Democracy, The Simons Foundation, United Church of Canada, United Steelworkers of America, War Child Canada, and World Vision Canada.

Copies of the report can be obtained from:

War Child Canada
401 Richmond Street West, Suite 420 Toronto, Ontario, Canada M5V 3A8
Tel: (416) 971-7474 Fax: (416) 971-7946
Email: info@warchild.ca

Key Findings of Our Common Responsibility: The Impact of a New War on Iraqi Children:

• Iraqi children are more vulnerable now than they were in 1990, before the 1991 Gulf War.

• 16 million Iraqi civilians - half of them children - are 100 percent dependent on government-distributed food rations. If war breaks out, this distribution system will be disrupted, leading to food shortages, malnutrition and possibly starvation.

• There is only an estimated one month's supply of food in Iraq. If war occurs, food imports will be disrupted.

• Approximately 500,000 Iraqi children are acutely malnourished or underweight. These children are particularly vulnerable to disease and death should war occur.

• The health care system is worn down and only a fraction of its pre-1991 state. The UN estimates that hospitals and clinics will run out of medicines within 3-4 weeks of a conflict.

• The death rate of children under 5 years of age is already 2.3 times greater than it was in 1990. Most children (70 percent) die of diarrheal and respiratory diseases. This greater vulnerability means greater illness and death rates among children under conflict circumstances.

• Iraq's water and sanitation systems are in bad need of repair following 12 years of sanctions. 500,000 metric tons of raw sewage is dumped into bodies of fresh water each day. As consequence only 60 percent of Iraqis have access to fresh (potable) water. Further disruption to these services, as occurred during the 1991 Gulf War, would be catastrophic for Iraqi children.

• The UN estimates that a war could lead to more than 1.4 million refugees and as many as 2 million internally displaced persons (IDPs). This figure could include nearly ¾ million refugee children and 1 million internally displaced children.

• Iraqi children are already badly traumatized by 12 years of economic sanctions. With war looming, Iraqi children are fearful, anxious and depressed. Many have nightmares. Forty percent surveyed do not think that life is worth living.

• The United Nations estimates that, in the event of war, as many as 500,000 persons could require emergency medical treatment. Almost half of these could be children.

• The level of emergency preparedness is currently very low. Adequate provision has been made for responding to the special needs of children.

In summary, a new war in Iraq would be catastrophic to Iraq's 12 million children, already highly vulnerable due to prolonged economic sanctions.

Iraqi children are at grave risk of starvation, disease, death and psychological trauma in the event of war.

According to the International Study Team, should war occur, Iraqi children will face a grave humanitarian disaster. While it is impossible to predict both the exact nature of any war and the number of expected deaths and injuries, casualties among children will be in the thousands, probably the tens of thousands, and possibly in the hundreds of thousands.

Introduction

Context
Legal Framework
The Security Council
The Laws of War

Physical Well-Being

Household Economy
Food Security
Agriculture
Limits to Food Production
Food Ration Program
Food Insecurity and the Possibility of War

Infrastructure and Environment
Electricity
Water and Sewage

Health and Nutrition
Child Morbidity and Mortality
Nutrition
Maternal Mortality and Life Expectancy
Vaccine Preventable Diseases, Immunization Coverage and the Cold Chain
Health Services and Essential Drugs

Gender
Methodology
Women's Main Roles and Responsibilities
The Effects of the Gulf War and Economic Sanctions on Women in Iraq
The Impact of Further Deterioration in Living Conditions on Women

Displacement

Mental Well-Being

Psychological Consequences of the 1991 Gulf War on Children
Mental Consequences of a Possible War on Children
Depletion of family resources
Malnutrition, cognition and parent-child interaction
Traumatic Loss
The 2003 Iraqi data
Study One - Visiting Families
Alone with the fear
Interviewing the Youngest Ones (4 to 7 years old)
The mental impact of the present situation
Interviewing the Teenagers
Messages from Iraqi Children
Questionnaire Results
Conclusion
Child Mental Health Questionnaire Results

Emergency Preparedness

Food
Emergency Shelter and Non-Medical Supplies
Medical Needs
Water and
Planning and Coordination

Military Force

Scales of Military Power
An Air Assault
A Ground Assault

Conclusions

Child Vulnerabilities Compared: 2003 and 1990

References

Tables and Charts

Three Basic Principles of International Humanitarian Law Protecting Children
Iraq's Food Dependency
Under-Five Mortality Rates in Iraq
Trends in the Malnutrition of Iraqi Children
Trends in Nutritional Status of Children Under-Five Years of Age in South and Central Iraq
Trends in Low Birth Weights in Institutional Deliveries
Iraqi Ministry of Health Budget
Child Mental Health Questionnaire Results
Child Vulnerabilities Compared: 2003 and 1990

* * *

Introduction

"It is not true to assume that the suffering of Iraqi children cannot get worse." (Sherlock, 2002)

This report comes at a time when the international community, as represented by the United Nations and the Security Council, is in the process of deciding whether to authorize the use of military force to disarm Iraq, or to continue to advocate peaceful means of disarmament, namely the existing regime of weapons inspections.

The strategic and political considerations of such a decision are complex and subject to debate, but they are not themselves the focus of this report. Instead, the aim of this report is to concentrate international attention on the approximately 12 million children who reside in Iraq, and to identify and highlight the likely negative humanitarian impacts of a military conflict on their health and well being.

The threat of war comes at a time when Iraqi children are perhaps least equipped to withstand further stresses on their physical and mental well-being. Compared to the period immediately preceding the 1991 Gulf War, Iraqi children are now much more vulnerable to any attack. The life-sustaining infrastructure around them - health care, water, sanitation, food supply and infrastructure - has broken down and is badly in need of repair.

This report examines the current humanitarian status of Iraqi children, their vulnerabilities, and the potential impact of a war in Iraq. It examines eight key sectors that, together, provide a snapshot of the humanitarian condition of children in Iraq. These sectors are (1) Household Economy, (2) Food Security, (3) Infrastructure and Environment, (4) Health and Nutrition, (5) Gender (6) Child Psychology, and (7) Emergency Preparedness.

Analysis of the above sectors is based on data collected in published and unpublished reports, interviews with United Nations, governmental and non-governmental officials, research, household interviews and field visits conducted in Iraq from January 19-26, 2003. Field visits were carried out in Baghdad, and the two southern cities of Basra and Karbala. Field data concerning the psychological impact of the risk

of conflict on Iraqi children and the ability of these children to withstand another war was collected from more than 100 households in Baghdad and Basra. In addition, more than 200 12-year-old Iraqi children completed a questionnaire to assess their mental health.

Data used in this report was only acquired from reliable sources and excluded all Iraqi government data. Rigorous scientific methodology was employed throughout the study. Conclusions reflect the considered analysis of the most reliable data available by acknowledged experts in the various sectors.

The International Study Team takes no position on the current political crisis with Iraq. Instead, it has as its sole objective the advancement of principles concerning the protection of civilians, and to highlight dangers faced by children caught in the crossfire of war.

In recent years, the Security Council has embraced the concept that protection of civilians, particularly children in armed conflict, is a fundamental part of its peace and security agenda. Yet despite this development, decisions are regularly taken without full regard, or sometimes despite it, for the well being of children. The authors of this report have a simple request: give serious consideration to the humanitarian implications of pursuing a military solution to the crisis with Iraq. On behalf of the smallest of the world's citizens, and also the most vulnerable, we ask this of you.

At the same time, we address this report to the government of Iraq. The past 12 years has witnessed tremendous human suffering of the Iraqi people. Iraqi sovereignty means not only independence, it means responsibility. The government of Iraq has a profound responsibility to protect and nurture its 12 million children. As the search continues for a diplomatic solution to the current political crisis, we implore the government of Iraq to act in the best interests of the Iraqi child and fully implement Security Council resolution 1441, calling for an end to its weapons programs.

Context

Iraq is inhabited by approximately 13 million adults and 12 million children. More than 4 million children are under five years of age.

Just prior to the 1991 Gulf War, Iraq was described by the United Nations as a high-middle-income country, with a modern social infrastructure. Although the Iran-Iraq war caused enormous economic damage, and more than 100,000 deaths, Iraq's health, education and other social programs continued to advance throughout the 1980s. Life expectancy, at 67 years, was at a level equivalent to Brazil. Nearly all urban dwellers and 72 percent of rural residents had access to clean water, while 93 percent of Iraqis had access to health services. Iraq's medical facilities and public health system were well developed (UNICEF, 1993).

With Iraq's August 1990 invasion of Kuwait, and the subsequent 1991 Gulf War, a country on the verge of joining the ranks of developed industrial states was temporarily plunged into a preindustrial era (Khan, 1991). Over a period of six weeks, coalition forces dropped more than 90,000 tons of explosives on Iraq. Between 50 and 70 percent of bombs dropped missed their intended targets (Haines, 1993). Civilian deaths during the Gulf War, the subsequent civil uprisings, and the Kurdish refugee crisis were estimated at between 40,000 and 80,000 deaths. As many as 100,000 Iraqi soldiers were also killed (Ahtisaari, 1991; Daponte, 1993).

The Gulf War resulted in a complete breakdown of the Iraqi civilian infrastructure. Bomb damage reduced postwar electricity to just 4 percent of prewar levels. Oil refineries, food storage facilities, industrial complexes, sewage pumping stations, telecommunications facilities, roads, railroads and dozens of bridges were destroyed during the war. Water supply in Baghdad was reduced to 5 percent of prewar levels (Joint WHO/UNICEF Team Report, 1991). Sewage systems were paralyzed, with raw sewage backing up into homes and hospitals. Raw sewage from most of Baghdad's then 4 million inhabitants was pumped untreated into the Tigris river, southern Iraq's main source of drinking water. A breakdown in food distribution resulted in country-wide food shortages, widespread malnutrition and, in some areas, pre-famine conditions (IST, 2001). The breakdown in electricity, water and sanitation led to outbreaks of infectious diseases, including cholera, typhoid, gastroenteritis, malaria, meningitis, measles and others. The combination of malnutrition and infectious diseases resulted in dramatically increased rates of infant and child deaths - a three-fold increase - resulting in more than 50,000 child deaths in 1991 alone (IST, 2001).

In Iraqi Kurdistan, more than 2 million Kurds were forcibly displaced from their homes and sought refuge in neighbouring Turkey and Iran. Many thousands died from exposure and disease. In the south of Iraq, a civil uprising was brutally suppressed resulting in more than ten thousand civilian deaths.

Since early 1991, despite substantial attempts to recover from the damage caused during the Gulf War, Iraq has remained subject to a sanctions regime that has crippled basic services and made it impossible to recover economically. By mid-decade, although modest improvements in social services had been made, the social infrastructure (electricity, water, sanitation, health care, education and the economy) were still functioning at a fraction of their prewar state. Malnutrition remained high, and mortality rates among children were triple prewar levels.

Meanwhile, until Iraq complied with UN Security Council Resolution 687, which mandates the elimination of Iraq's nuclear, biological and chemical weapons programs, sanctions remained in place, further jeopardizing civilian recovery. It remains a subject of considerable debate the degree to which Iraq has complied with the terms of UN Security Council Resolution 687.

In 1996, Iraq finally accepted the terms of UN Resolution 986, which permitted the controlled sale of limited quantities of Iraqi oil in order to purchase essential humanitarian supplies. To date, Iraqi oil valued at approximately $61 billion has been exported under the Oil-for-Food program. Of this amount, some $26 billion worth of humanitarian supplies have been delivered to Iraq - on average $4.3 billion per year since the program began. An additional $10 billion worth of supplies are currently in the production and delivery pipeline. It is worth noting that prewar food imports alone amounted to $3 billion per year, while the cost of returning the civilian sector of Iraq to its prewar state has been estimated at more than $200 billion (Arab Monetary Fund, 1993).

Since the inception of the Oil-for-Food program, there has been modest improvement in certain sectors, particularly child malnutrition and drug supply. Overall, however, the social infrastructure remains badly broken down and worn out, unable to meet even the basic needs of the civilian population. Illness and disease remain at high levels, and mortality rates of children remain more than double their 1990 levels.

Now, in early 2003, Iraqi civilians face the renewed threat of military conflict. This threat, and the accompanying uncertainty, has already led to increased anxiety and fear among Iraqi children. More physically and mentally vulnerable than they were in 1990, the 12 million Iraqi children now face a future potentially even more grave and more devastating than that which they suffered during the 1991 Gulf War.

War is always most deadly for the civilian population, particularly women and children. A war in Iraq will be no different. Indeed, it is because the international community witnessed the humanitarian disaster resulting from the 1991 Gulf War that it is known that this war will result in many thousands of child deaths. This is indeed a great price for the children of Iraq to pay, and must be weighed against the rational and serious requirement that Iraq must rid itself of all efforts to possess nuclear, chemical or biological weapons. As the international community weighs its options to deal with the political crisis involving Iraq's government, it is essential that it also give equal and serious consideration to the tragic consequences a military conflict would have for Iraqi children.

Legal Framework

The Security Council

The United Nations Security Council (UNSC) is the world's primary authority for making decisions concerning international peace and security. Its mandate is based on the Charter of the United Nations. This instrument has been accepted by almost every government, including the United States, its allies and Iraq, as a binding obligation of the highest order. According to Article 25 of the Charter member states agree to implement the decisions of the UNSC. The Charter also states that "the Security Council shall act in accordance with the Purposes and Principles of the United Nations" (art. 24).

In the implementation of its responsibilities the UNSC has acted to restore Kuwaiti sovereignty after Iraq's 1990 invasion, to impose sanctions on Iraq, to attempt to address humanitarian concerns, and to take steps towards destroying Iraq's weapons of mass destruction (WMD). Sanctions were imposed by UNSC Res. 661 (6 August 1990). UNSC Res. 687 (3 April 1991) created the regime of weapons inspections after the 1991 Gulf War. To mitigate the adverse humanitarian impact of sanctions, the Oil-for-Food Program (OFFP) was proposed by UNSC Res. 706 (15 August 1991) and finally adopted by UNSC Res. 986 (14 April 1995). It was accepted by Iraq in May 1996 and, under the terms of the Oil-for-Food program, the first oil flowed in December 1996. The program has since been revised several times. A revision in 1999 allows Iraq to sell as much oil as it can produce, although Iraq's production remains well below what it has actually contracted to sell (UNHPI, 2002). Although 72 percent of the monies are now earmarked for humanitarian assistance, delays in the delivery of drugs, medical supplies and other humanitarian goods have limited the system's effectiveness (Interviews, 2000a).

The circumstances of children in armed conflict has increasingly been a focus of the Security Council's agenda. Annual reports on the issue are presented by the Secretary General's office, and the UN Special Representative to the Secretary General for Children and Armed Conflict regularly meets with the Council. The issue of the protection of civilians during warfare, the topic of several UNSC resolutions, is now the subject of annual discussions. It is fair to say that the plight of war-affected children has not gone unnoticed by the UNSC. On the contrary, there have been substantial gains in recent years, and most Council members are genuinely and seriously concerned with the issue.

This report calls upon the UNSC to consider, in a serious, comprehensive and verifiable manner, the impact of an armed conflict on Iraqi children. For the UNSC to do so would be in accordance with its own statements of concern for the wellbeing of children in armed conflicts and further enhance the credibility of these important statements and resolutions.

The Laws of War

War leaves children exposed to the most ruthless and unforgiving environment on earth. To mitigate the harm to children during wartime, States have agreed to respect several principles of human rights and humanitarian law at all times. Thus the Convention on the Rights of the Child (CRC) is non-derogable - that is, it applies at all times without exception - as do the laws of international humanitarian law.

The most basic rules of international human rights and humanitarian law apply regardless of the legality of the use of force. These rules purposefully impose restraints on how states may fight wars against each other. In a conflict involving the United States and Iraq the most prominent of the legally binding instruments of international human rights law relevant to the protection of civilians are:

• The Convention on the Rights of the Child
• The International Covenant of Civil and Political Rights
• The American Declaration on the Rights and Duties of Man
• The Fourth Geneva Convention Relative to the Protection of Civilian Persons in Time of War

While each of these instruments provides explicit protections for children during armed conflicts, it is the Fourth Geneva Convention that provides the most explicit lex specialis (relevant law) during an armed conflict in Iraq. In part, this is true because although the Convention on the Rights of the Child is non-derogable - applies at all times without exception - the United States (Somalia being the only other country) is not a party to the CRC. In addition, rules derived from customary international law will apply to all parties in the conflict.

While some nations considering participating in an attack on Iraq have a wide variety of universal, specialized and regional conventions applying to them, several, including the United States, are governed by the rules of warfare as reflected in the four Geneva Conventions from 1949, and customary international law. Customary international law is distilled from the opinio juris (legal opinion) and practice of states, which may in turn be reflected in the Hague Regulations annexed to the Fourth Hague Convention and in United Nations Resolutions (UNGA Res. 2444 and 2675).

There are three commonly cited primary rules of laws of war related to the protection of civilians that are found in the above-mentioned sources of law. These are the most basic of the laws and govern the interpretation of other rules of law.

The rules are aimed at protecting both the direct physical integrity of protected human beings, as well as providing indirect protection of facilities necessary for human survival. Here they are stated with the emphasis on the child.

The first of these laws is that children are not to be the object of attack. Every child is considered not to be officially a part of the armed forces of his/her country when an attack takes place and is therefore protected by this rule. This includes the children of soldiers who are off duty, as well as those soldiers participating in an armed conflict. And all children in Iraq, without distinction as to nationality, are unambiguously protected by customary international law. The customary law protection is elaborated in United Nations Resolutions UNGA (Res. 2444 and 2625). An example of this is the statement in the resolution concerning Respect for Human Rights in Armed Conflict where it is stated "[t]hat it is prohibited to launch attacks against the civilian populations as such" (UNGA Res. 2444). The United States government has unambiguously accepted this resolution as customary international law (UN Doc. A/C.3/SR.1634).

A second law is that soldiers must always distinguish between children and combatants. This corollary to the first principle of law must be interpreted in the interest of the protection of children and provides a positive obligation for states. This distinction serves as the basis for the protections in the first principle and in the following principle of law. This law is customary international law and is reflected in words immediately following the statement of the first law in the same resolution which reads: "distinction must be made at all times between persons taking part in the hostilities and members of the civilian population to the effect that the latter be spared as much as possible." This provision requires states to make effective and identifiable efforts to ensure that children are protecte