Survey information by the World Food Programme/Food and Agriculture Organisa-tion in 2000 indicated 800,000 Iraqi children �chronically malnourished.� (116) The UNICEF 1999 study, also based on extensive field surveys, had shown 21% of children under five underweight, 20% stunted (chronic malnutrition) and 9% wasted (acute malnutrition). Several recent reports have noted that the UN has created initiatives to help the most vulnerable in the Center and South through targeted nutrition programs. These have had some positive results, but it is clear that the government of Iraq has not adequately implemented them.
The FAO 2000 report pointed out that at 2,000 kilocalories, the universal ration provided under the UN program was insufficient in total yield, absent substantial local food additions. The same report insisted also that the composition of the food basket remained nutritionally inadequate: Of great concern is the lack of a number of important vitamins and minerals such as vitamin A, C, riboflavin, folate and iron in the diet. Although the planned ration is reasonably adequate in energy and total protein, it is lacking in vegetables, fruit, and animal products and is therefore deficient in micronutrients." (117) Despite the Oil-for-Food program and the $11 billion worth of food that has entered the country, infant mortality remains very high. Today, most child deaths are not directly due to malnutrition, though. Rather, they are water-related, from such conditions as diarrhoea. Poor water quality and lack of sanitation, combined with existing malnourishment, have taken over from poor nutrition as the prime killer of children in Iraq. UNICEF reported in July 2001 that �Diarrhoea leading to death from dehydration and acute respiratory infections (ARI), together account for 70 per cent of child deaths.� (118)
Deliberate bombing of water treatment facilities during the Gulf War originally degraded the water quality. Since that time, sanctions-based �holds� have blocked the rebuilding of much of Iraq�s water treatment infrastructure. Additionally, sanctions have blocked the rebuilding of the electricity sector which powers pumps and other vital water treatment equipment.
Health problems in Iraq arise from multiple factors, many of which can be attributed to the sanctions. Electricity shortages, in addition to shutting down water-treatment, seriously disrupt hospital care and disrupt the storage of certain types of medicines. Sanctions also result in shortages of medical equipment and spare parts, blockages of certain important medicines, shortage of skilled medical staff, and more.
There can be no doubt, based on health and mortality surveys, that Iraqis are suffering from a major public health crisis. The sanctions both deepen that crisis as a cause and also block measures that could mitigate it through public health measures and curative medical procedures. The health status of the Iraqi people has been a key indicator of the humanitarian consequences of the Iraq sanctions regime.
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UNICEF, in a widely-publicised study carried out jointly with the Iraq Ministry of Health, determined that 500,000 children under five years old had died in �excess� numbers in Iraq between 1991 and 1998, though UNICEF insisted that this number could not all be ascribed directly to sanctions. (119) UNICEF used surveys of its own as part of the basic research and involved respected outside experts in designing the study and evaluating the data. UNICEF remains confident in the accuracy of its numbers and points out that they have never been subject to a scientific challenge.
Prof. Richard Garfield of Columbia University carried out a separate and well-regarded study of excess mortality in Iraq. Garfield considered the same age group and the same time period as the UNICEF study. (120) He minimized reliance on official Iraqi statistics by using many different statistical sources, including independent surveys in Iraq and inferences from comparative public health data from other countries. Garfield concluded that there had been a minimum of 100,000 excess deaths and that the more likely number was 227,000. He compared this estimate to a maximum estimate of 66,663 civilian and military deaths during the Gulf War. Garfield now thinks the most probable number of deaths of under-five children from August 1991 to June 2002 would be about 400,000. (121)
There are no reliable estimates of the total number of excess deaths in Iraq beyond the under-five population. Even with conservative assumptions, though, the total of all excess deaths must be far above 400,000.
All of these excess deaths should not be ascribed to sanctions. Some may be due to a variety of other causes. But all major studies make it clear that sanctions have been the primary cause, because of the sanctions� impact on food, medical care, water, and other health-related factors. Though oil-for-food has changed the situation studied by UNICEF and Garfield, resulting in less malnutrition, recent field reports suggest that infant mortality remains high, due to water-borne disease. (122) The mortality rate for under-five children has probably not continued to rise since the 1999 studies, but the rate apparently remains very much higher than that reported in Iraq before 1990.
In the face of such powerful evidence, the US and UK governments have sometimes practiced bold denial. Brian Wilson, Minister of State at the UK Foreign Office told a BBC interviewer on February 26, 2001 �There is no evidence that sanctions are hurting the Iraqi people.� When denial has proved impossible, officials have occasionally fallen back on astonishingly callous affirmations. In a famous interview with Madeleine Albright, then US representative at the United Nations, Leslie Stahl of the television show 60 Minutes said: �We have heard that half a million children have died . . . is the price worth it? Albright replied, �I think this is a very hard choice, but the price � we think the price is worth it.� (123)
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