Global Policy Forum

By Richard Garfield

Introduction

Potential humanitarian consequences of war with Iraq have been widely discussed. Reports from UN agencies and research organizations claim that thousands or millions of people will starve, be killed, become victims of weapons of mass destruction, or become refugees. Most of these reports are highly speculative and based on little substantive information. Here, instead, information from Iraq's experience in the Gulf war is combined with more recent observations on living conditions and current vulnerabilities. Data are tempered by personal observations during visits to Iraq and as consultant to international organizations there, most recently in January 2003. Reasoned analysis of such information is key if unnecessary suffering is to be avoided.

The Magnitude of Excess Deaths

No reasonable basis to estimate the number of excess deaths in a future war exists. Military planners prepare for a very wide range of possible outcomes and their best estimates are often quite wrong. But like in a burning building, while the number of deaths cannot be estimated the major areas of risk are well known. In the 1991 Gulf war casualties from chemical exposures were mainly related to oil well fires and numbered in the hundreds. Since biological and chemical weapons are difficult to disseminate they too may cause a relatively small number of casualties. This is especially true if they are not used in urban areas, where more people would be exposed in an attack.

Heavy bombardment in 1991 resulted in an estimated 3500 civilian deaths. This is a relatively small number of deaths given the number of explosives used and the large exposed urban population. Improved targeting could further reduce the number of deaths from bombings. Refugees and displaced people experience mortality rates about ten times higher than the settled populations from which they come. In 1991, there were an estimated 14,000 deaths among IDPs, mainly among the half a million Kurds in the inhospitable northern border region. Far more deaths were caused from two other types of exposures after formal hostilities ended. Internal fighting and among insurgents and vengeance attacks claimed about 35,000 lives in the two months after the war. This number approaches the total of 56,000 soldiers killed in the Gulf war. Destruction of essential goods and loss of access to services among the civilian population led to the highest number of post-war deaths. A doubling of mortality rates during this period among Iraq's population of 18 million over eight months resulted in 111,000 excess deaths. This exceeds the total number of deaths from all other causes combined(1).

Food and Nutrition

In 1991 domestic grain production was high, the population's nutritional status was good, extensive central stockpiles were in place, and buying power among most Iraqi families was good. A food crisis occurred during 1992 – 1997. Improved rations via the Oil for Food program after 1997 gradually led to improved nutrition. This contributed to both a decline in malnutrition and an increase in obesity(2). In the North in 2000, about 5% of people subsist exclusively on the ration and another 11% were able to only slightly supplement it (3). It can be assumed that the conditions of people in the rest of the country are worse as incomes are lower and food production more limited in the Center and South. The poor are those at greatest nutritional risk today, along with those in hospitals, orphanages, and prisons.

Child malnutrition rates in the Center and South of the country have in the last two years declined to the levels similar to those in 1991. Malnutrition rates in the North are lower now than at any time in the past (4). Since late 2002 the Iraqi government has attempted to stockpile foodstuffs (6) but is limited by a decline in oil revenues since 2000 and limits to authorized food purchases in the Oil for Food (OFF) program. The distribution of double rations for several months has increased household stocks. In addition, most people have purchased additional food in anticipation of war. Household stocks in 2003 include an average of 5 week's worth of food stocks. In 2003 grain production rebounded from drought but is still below 1990 levels.

Food Delivery Systems

The interruption of rationed food distribution and markets during military action would severely disrupt food supply. The high degree of dependence on the centralized provision of foodstuffs would require new supplies within weeks to avoid nutritional problems(7). Airdrop of food parcels, like during last year's war in Afghanistan, would be capable of distributing only a fraction of the 350,000 metric tons of food per month provided by the current Government food ration. The duration of conflict is a key variable for humanitarian conditions. If stability is established quickly, transport is available, warehouse stocks are released, and the importation of essential goods continues, the market there will likely be no food crisis. Most important in this regard is a need for the UN Security Council to establish a new mechanism to pay food suppliers from existing funds in OFF accounts. Without such legislation, payment is not assured once war begins and ships are likely to divert cargoes to other countries.

Damage to essential infrastructure

Electricity

A war in Iraq would likely start with a bombing campaign. The impact of bombings on the civilian population will depend on the choice of targets and the types of explosives utilized. Area impact munitions such as cluster bombs and thermobaric weapons, used in Afghanistan, would cause massive disabilities if employed in urban areas. As in wars in Kosovo, Afghanistan, and Iraq in 1991, the number of post-bombing casualties due to loss of essential infrastructure would likely be much larger than the number of deaths directly attributable to bombings. This can be avoided only if bombers carefully avoid targets including water pumping and chlorination stations, water sanitation plants, clinics, hospitals, transportation, electric generators, and communications. Similarly, collateral damage to such installations should be repaired immediately to limit humanitarian impact. Forward placement of spare parts and engineers, and alternative sources of water, food, and health care should be set up immediately following the securing of an area. Iraq's electrical grid is likely to be one of the first targets of US military action. In 1991, electrical power was the most severely damaged component of civil infrastructure with Baghdad losing power 10 minutes after initiation of the air war. Power did not return to most areas until after the cease-fire, nearly three months later (8). Duplicate parts were available for most key items at that time; such spares are not available today.

Before OFF materials for Iraq's electric system arrived in 2001, generating capacity had deteriorated to 38% of previous capacity during peak summer load (9, 10). Iraq remains "dependent on electrical power for water purification and distribution, sewage treatment, and the functioning of hospitals and health care centers" (11). Importation of electric generation equipment in the last 18 months under OFF has greatly increased production capacity in the national grid. The shortfall in production is estimated to be 10-15% during winter 2003, when for the first time since 1991 rolling blackouts is no longer common in central Baghdad. More importantly, an estimated 70% of health institutions and water pumping stations have back-up generators that received frequent use during blackouts in recent years. If these generators are supplied with fuel and maintenance they will be capable of supporting some essential services in urban areas throughout the country even if the national power grid is down.

Water

Damage to water treatment plants removed 2.5 million people from water supply after 1991. Iraqis received one quarter of pre-war water levels and water quality declined rapidly. Water pumping capacity in Baghdad increased from 166 liters per person per day in 1997 to 197 liters in 2002. Moreover, loss to leakage is estimated to have declined from 40% to 30% in the last year with the use of new OFF-supplied pipe. Virtually all-urban water systems are chlorinated and a 6-month supply of chlorine is in place. Local government is now very busy sinking shallow wells in many neighborhoods to provide a source for emergency water supply.

Medical Care Services

Iraq's network of 129 hospitals and 900 clinics is now better supplied than at any time in the last 10 years. Six months' worth of medical supplies are in the country and the health system is increasing their distribution from central to regional warehouses and service centers. Most health institutions have back up generators able to function at least part time. However, specialized medicines for emergency care are not widely available and no staff has adequate training in triage. It is not known if Iraqi health professionals will be available to civilians during the war; much appears to depend on the local security situation and competence of local administration.

Discussion

The Gulf war and a decade of post-war crisis have had a major impact on nutrition, education, sanitation, and health. From a country that was approaching the level of developed country standards in health and nutrition, Iraq since 1990 experienced a precipitous decline towards levels characteristic of poor underdeveloped countries. Recovery gained momentum only slowly after the OFF program supplied large stocks of humanitarian goods starting in 1997. This momentum showed more impact during 2001 – 2003. Iraqis await war with better conditions than at any time since the 1991 Gulf war, but poorer conditions than before it. To date most of the attention for humanitarian protection has focused on refugees, bombings, and chemical and biological weapons. Historical experience suggests that civilians would likely suffer more from disruption in the supply of essential goods, especially if it lasted for more than a few weeks. Similarly, a risk of a rapid rise in mortality is great if security is not assured even where organized military engagements have ceased. It is these risks that require more of our attention now.

References

1. June 1993. "A Case Study in Estimating Casualties from War and Its Aftermath: The 1991 Persian Gulf War", Beth Osborne Daponte, PSR Quarterly, pp. 57 - 66.

2. FAO. Assessment of the Food and Nutrition Situation: Iraq (September 2000).

3. World Food Programme. Assessment of the Adequacy of SCR 986 Food Basket. Erbil, Iraq. 2000.

4. UNICEF. Overview of Nutritional Status of Under-Fives in South/Centre Iraq. Baghdad: September 2002.

5. Garfield R. Changes in malnutrition levels in Iraq, 1990 1999. Nutrition Reviews 2000; 58(9); 269-77.

6. 7 August 2002. "War is talk of the town in Baghdad", Reuters.

7. 20 February 2002. "Food Security in Iraq: Some Food for Thought", Carol de Rooy, Unicef Baghdad.

8. 1993. The Gulf Conflict 1990 – 1991: Diplomacy and War in the New World Order, Lawrence Freedman and Efraim Karsh, Princeton University Press, p. 322.

9. 26 September 1991. "The Effect of the Gulf Crisis on the Children of Iraq", Harvard Study Team, New England Journal of Medicine, pp. 977 – 980.

10. 20 November 2001. Report from the Electricity Working Group to the Iraq Sanctions Committee, Slide 6.

11. 17 July 1991. "Report to the Secretary-General dated 15 July 1991 on humanitarian needs in Iraq prepared by a mission led by the Executive Delegate of the Secretary -General for humanitarian assistance in Iraq", Sadruddin Aga Khan, S/22799, para. 16 – 17.

FAIR USE NOTICE: This page contains copyrighted material the use of which has not been specifically authorized by the copyright owner. Global Policy Forum distributes this material without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. We believe this constitutes a fair use of any such copyrighted material as provided for in 17 U.S.C § 107. If you wish to use copyrighted material from this site for purposes of your own that go beyond fair use, you must obtain permission from the copyright owner.