SEVERAL RECENT studies have called attention to the serious consequences for the civilian population in Iraq of a war conducted against that country. The Iraqi people have experienced two grueling wars in the recent past -- one against Iran and the 1991 Gulf War -- which have resulted in hundreds of thousands of dead, most of them civilians or youngsters forcibly conscripted for military service. A new war against that country would seriously undermine its health infrastructure and lead to the suffering and death of huge numbers of civilians. As a result of the skewed priorities of the current Iraqi regime and of the economic sanctions imposed against it, a country that was once rich and prosperous has suffered a dramatic decline in the health and quality of life of the general population. It is estimated that only 47 percent of the population has access to clean water in rural areas, while safe water coverage has decreased from 94 to 92 percent in urban areas. This situation is further complicated by 500,000 metric tons of raw sewage that are discharged into the fresh water bodies in Iraq every day.
In Baghdad City, the garbage collection rate has decreased from 1.5 to 0.5 kilograms per capita per day for a population of 5.6 million, which is a serious health hazard and an important source of water contamination. According to a study conducted by UNICEF, children have to drink water which, in up to 40 percent of sample cases, contains up to 10 times the acceptable level of contamination. Until the treatment and disposal of sewage is properly done, children will continue to suffer high rates of diarrheal infections.
Currently, one in every five children is chronically malnourished, and one in three girls does not attend primary school due to deepening poverty and lack of schools. Malnutrition is an important and comprehensive indicator of children's well-being because it is a reflection of the functioning of several sectors in society. A significant contributing factor for the very high rates of children's malnutrition is the breakdown of power grids and water distribution networks following the last two major wars and more than a decade of international sanctions against the Iraqi regime. Before these events, the Iraqi people had the best health care services in the region.
Almost two-thirds of the Iraqi population -- between 14 million and 16 million people -- depend solely on a monthly food entitlement of approximately 2,200 calories per day. Although the food distribution system now works efficiently, the whole program risks becoming paralyzed shortly after the war starts again. In case war erupts, local food supplies will be insufficient for the needs of the population since even now they are used to supplement imported staples.
In addition to food supplies, the health of the Iraqi population depends in part on medicines and equipment provided under the Oil-for-Food Program, whose interruption will have serious effects, particularly on the most vulnerable sectors of the population. Hospitals and water and sanitation facilities depend on electrical supplies that are probably going to be damaged in case of an attack.
Save the Children UK warns that military intervention in Iraq could significantly increase the suffering of the majority of Iraqis, almost half of whom are children below 14. Aside from a public health crisis, the possible sabotage of oil wells could produce environmental damages -- with serious health effects -- not only in Iraq but in the whole region. The possible use by Iraq of chemical and biological weapons within and beyond Iraq could provoke a nuclear retaliation by the United States and/or the United Kingdom. A nuclear explosion like the one in Hiroshima over Baghdad could kill between 60,000 to 360,000 people. One with a modern-day thermonuclear bomb could kill 10 times as many people, excluding long-term deaths.
Even without the use of nuclear weapons, Medact, the UK affiliate of International Physicians for the Prevention of Nuclear War, winner of the 1985 Nobel Peace Prize, estimates that possible deaths during the conflict could range from 48,000 to 260,000, most of them civilians. Civil war within Iraq could result in 20,000 additional deaths.
Although there is every reason to want Saddam Hussein out of power in Iraq, any action against him should be contemplated taking into account the serious humanitarian consequences of such action.
Dr. Cesar Chelala is an international public health consultant.
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