Global Policy Forum

By Sarah Graham-Brown

UNICEF's recent reports on child mortality in Iraq provided ready fuel for the ongoing propaganda war over the future of sanctions. Iraq's representative at the UN has spoken of a "genocide" caused by sanctions while US and United Kingdom spokespersons, completely ignoring the sanctions' impact since 1990, have blamed Saddam's regime for Iraq's socio-economic decline. These claims and counter-claims have less to do with any concern over the fate of Iraqi children than with the difficulties the US and UK are experiencing in convincing the UN Security Council to keep sanctions in place while the Iraqi government takes advantage of this policy impasse.

UNICEF's findings, based on a household survey of 24,000 households in government-controlled central and southern Iraq, indicate that mortality rates for children under the age of 5 have more than doubled in just a decade: from 56 per 1000 in 1984-1989, to 91.5 in 1989-1994 and 130.6 in 1994-1999. There are marked differences for the figures for rural areas (in 1994-99, 144.9 per 1000) and urban areas (120.9 per 1000). In the north, a survey of 16,000 households revealed a different pattern. The under-5 mortality rate for 1984-1989, at 80 per 1000, was much higher than in the rest of the country, but the rise in 1989-1994 to 90 deaths per 1000 was less dramatic. Finally, in contrast to the rest of the country, the death rate in the north fell to 72 per 1000 between 1994-1999.

UNICEF carried out the study in the center and south in cooperation with the Iraqi government and in cooperation with local authorities the Kurdish-controlled north. If the sweeping accusations from the Iraqi side conveniently ignore its own role in this predicament, the explanations given for the figures by US and UK spokespersons also warrant skepticism and critical examination.

The US State Department's press spokesman James Rubin has argued that the report on child mortality rates in Iraq "indicates that the rates are declining in the autonomous northern regions, which is under the same sanctions regime as the rest of Iraq but where oil-for-food delivery is managed by the United Nations. In contrast, the report shows that Iraqi failure to deliver humanitarian aid in south and central Iraq has led to a doubling of the child mortality rate." Under Resolution 986 and its successors, 13 per cent of the total revenue from oil sales is allocated to humanitarian goods for the north. The rest of the country receives 53 per cent of total revenues for humanitarian imports. The UN is in charge of administering the program in the north in cooperation with the local Kurdish authorities, although the bulk purchases of food and medicine for the whole country are made by the Iraqi government and transported to the north.

UNICEF, however, dismisses the idea that differences in the current child mortality rates can be attributed to the different implementation of the oil-for-food program in the two parts of Iraq. The program only began two and a half years ago, "therefore it is too soon to measure any significant impact of the Oil-for-Food Program on child mortality over the five year period of 1994 to 1999 as is reported in these surveys." These reports provide the first national picture of infant and child mortality since the International Study Team's (IST) survey in 1991, which showed an estimated three-fold increase in deaths of children under five in the first eight months of 1991. Those figures reflected the conditions created by the war and refugee flight as well as the initial impact of economic sanctions, first imposed in August 1990.

The differing mortality figures for the north undoubtedly stem from the region's distinctive history since the 1980s. Higher mortality figures for the north in the late 1980s probably reflect the severe disruption caused by the forced clearance of Kurdish rural areas by Iraqi forces in the Anfal campaigns. The refugee crisis of 1991, which witnessed almost 2 million people fleeing to the country's borders, certainly involved a significant number of child deaths, but in the years that followed the north received considerably more aid than other parts of the country. At the end of 1991, the Iraqi government withdrew its troops from the three northern governorates, ending central control but also cutting government funding and imposing a trade embargo that lasted until 1997. This led the international community to provide substantial humanitarian aid for the north while maintaining international sanctions.

The situation since that time has hardly been good, with the "double embargo" complicated by protracted electricity cuts and further disruptions caused by low-level internal conflicts between various Kurdish factions. Yet in terms of health and nutrition, the volume of assistance to the north was, per capita, far in excess of that available to the rest of the country. Between 1991 and 1996, an estimated $1.2 billion worth of humanitarian relief assistance was channeled to Iraq through the UN system, bilateral donors and non-governmental organizations. Iraq's total population in 1997 was estimated at 22 million, but from 1991 until1996 about two thirds of all international aid to Iraq went to the north's approximately 3.5 million people, either to assist the return of refugees who fled in 1991 or for relief and rehabilitation during the following years. Direct humanitarian aid from official US sources, provided through the Department of Defense until 1995 and the Office of Foreign Disaster Assistance until 1996, went only to the north.

In the rest of Iraq, the decline in living conditions appeared sharper than in the north by 1993-4. Infrastructural problems affecting electricity, water and sanitation systems damaged in the war had become acute. In mid-1994 the already meager basic food ration was cut by one third. At that time the amount of external aid provided to government-controlled areas was very limited. The international community was reluctant to deliver aid, since it wanted Iraq to pay for its own needs under Resolutions 706 and 712, the first oil-for-food resolutions, the terms of which Iraq continued to reject. Meanwhile, many Western aid agencies have found the conditions of work too problematic to remain.

The continuing decline in economic and health conditions from 1994 to 1997 is clearly reflected in the rise in infant and child mortality levels shown by the UNICEF study. UN reports to the Security Council after two years of oil-for-food suggest that child mortality rates are leveling off, and nutritional levels are stabilizing in government-controlled areas. Since mid-1997, when the first goods purchased under the oil-for-food program arrived in Iraq, the external aid program has dwindled dramatically, even in the north, which previously received the lion's share of external assistance.

The underlying causes of Iraq's high levels of child mortality are open to question. How far have they been caused by food shortages? Have the collapse of the health services and the lack of clean water and sanitation played a role? The government food ration, although nutritionally poor, has probably prevented even more catastrophic malnutrition. Food and medicine have not been subject to sanctions, but materials and spare parts for water and electricity systems, badly damaged during the 1991 war, are under the UN Sanctions Committee's scrutiny and control. Both UN agencies and the International Committee of the Red Cross have repeatedly emphasized the severity of the problem in these sectors. These factors, as much as lack of food and medicine, have contributed to Iraq's health crisis. In the north these problems have been partly mitigated by external support. The collapse of purchasing power is the other factor in the equation. Although income fell in the north, it did not plummet to catastrophic levels as in the center and south, mainly because the rise in inflation and the decline in the value of the dinar were less steep in the north than in government-controlled areas.

In UNICEF's view, the oil-for-food program is "a short-term response to what is now a long-term crisis. It was not designed to address the many deep problems facing the children of Iraq, which are contributing to the current levels of child mortality, such as increasing poverty, declining access to services, deteriorating infrastructure and the quality of care and treatment." US officials have focused on the Iraqi government's reluctance to target special assistance to vulnerable groups, especially mothers and children, which UN agencies have been advocating for several years. The slow distribution of goods in several sectors, particularly medical supplies, as well as the government's refusal to order special nutritional items, has raised many legitimate questions. But the blockages are not all on the Iraqi side.

The Sanctions Committee's scrutiny of orders results in rejections or long delays on many items. On August 19, UN Secretary General Kofi Annan noted in his latest report to the Security Council on the oil-for-food program that "there has been a significant increase in the number of holds being placed on applications, with serious implications for the implementation of the humanitarian program." The monetary value of applications on hold was estimated at $500 million, with the highest concentrations in the telecommunications, electricity, water and sanitation sectors.

The lack of transparency in Sanctions Committee decision-making renders it difficult to discover the reasons for these delays. It is certainly possible to blame the Iraqi government for both incompetence and malfeasance in its use of scarce resources. Nonetheless, the overall scarcity of resources compared with the previous decade is the result of prolonged economic sanctions which, even by 1993, had led to an estimated drop in GDP to less than one-fifth of its value in 1979. UNICEF quoted the UN Security Council's Panel on Humanitarian Issues, which concluded in March 1999 that: "Even if not all suffering in Iraq can be imputed to external factors, especially sanctions, the Iraqi people would not be undergoing such deprivations in the absence of the prolonged measures imposed by the Security Council and the effects of war."

Throughout the 1990s, Iraq has been the target not only of military attack but also of the most draconian and protracted economic embargo ever imposed by the international community. After the 1991 Gulf war, the embargo was accompanied by an effort to provide aid to the Iraqi people and to protect them against human rights abuses by Saddam Hussein. This initiative seemed to break new ground in providing protection for civilians in a situation of conflict.

Yet the outcome of the international community's efforts has fallen short of the promise. Why has there been such a large gap between the rhetoric and the reality? How exactly has the combination of economic sanctions, international humanitarian aid and limited protection of civilians affected Iraq? And what lessons can be drawn from the experience? Sanctioning Saddam discusses the dilemmas of humanitarian aid and efforts to tackle human rights issues in Iraq. Both United Nations humanitarian agencies and non-governmental organizations working in Iraq have found the political questions hard to avoid. International decision making provides the context for the UN aid program and has influenced the effectiveness of NGOs working in different parts of the country. This is the most carefully documented and comprehensive account to be published on the consequences of intervention in Iraq during the 1990s.

Sarah Graham-Brown has written extensively on the Middle East. Since 1995, she has specialized in researching the post-war situation in Iraq. Graham-Brown is the author of the recently published Sanctioning Saddam: The Politics of Intervention in Iraq (New York: St. Martins Press).