Report from Iraq re public health

By Charlie Clements, portside list, 12 February 2003

I am a public health physician and a human rights advocate. I have just returned from a 10-day emergency mission to Iraq with other public health experts to assess the vulnerability of the civilian population to another war. I'm also a distinguished graduate of the USAF Academy and a Vietnam veteran, so I have some sense of the potential consequences of the air war we are about to unleash on Iraq as a prelude to the introduction of American troops.

The population of Iraq has been reduced to the status of refugees. Nearly 60 percent of Iraqis, or almost 14 million people, depend entirely on a government-provided food ration that, by international standards, represents the minimum for human sustenance. Unemployment is greater than 50 percent, and the majority of those who are employed make between $4 and $8 a month. (The latter figure is the salary of a physician that works in a primary health center.) Most families are without economic resources, having sold off their possessions over the last decade to get by.

Hospital wards are filled with severely malnourished children, and much of the population has a marginal nutritional status. While visiting a children's hospital, we were told about newly emerging diseases that had previously been controlled when pesticides were available. (Current sanctions prohibit their importation.) Later I saw a mother who had traveled 200 km with her young daughter, who suffered from leschmaniais, or kala azar as it is known there. She came to the hospital because she heard it had a supply of Pentostam, the medicine needed to treat the disease. The pediatrician told her there was none. Then he turned to me and, in English, said, It would be kinder to shoot her here rather than let her go home and die the lingering death that awaits her. Our interpreter, by instinct, translated the doctor's comments into Arabic for the mother, whose eyes instantly overflowed with tears.

The food distribution program funded by the U.N., Oil- for-Food, is the world's largest and is heavily dependent upon the transportation system, which will be one of the first targets of the war, as the U.S. will attempt to sever transport routes to prevent Iraqi troop movements and interrupt military supplies. Yet even before the transportation system is hit, U.S. aircraft will spread millions of graphite filaments in wind-dispersed munitions that will cause a complete paralysis of the nation's electrical grids. Already literally held together with bailing wire because the country has been unable to obtain spare parts due to sanctions, the poorly functioning electrical system is essential to the public health infrastructure.

The water treatment system, too, has been a victim of sanctions. Unable to import chlorine and aluminum sulfate (alum) to purify water, Iraq has already seen a 1000% increase in the incidence of some waterborne diseases. Typhoid cases, for instance, have increased from 2,200 in 1990 to more than 27,000 in 1999. In the aftermath of an air assault, Iraqis will not have potable water in their homes, and they will not have water to flush their toilets.

The sanitation system, which frequently backs up sewage ankle deep in Baghdad neighborhoods when the ailing pumps fail, will stop working entirely in the aftermath of the air attack. There will be epidemics as water treatment and water pumping will come to a halt. Even though it is against the Geneva Conventions to target infrastructure elements that primarily serve civilians, this prohibition did not give us pause in Gulf War I -- and, based upon current Bush administration threats, will not this time. Pregnant women, malnourished children, and the elderly will be the first to succumb. UNICEF estimates that 500,000 more children died in Iraq in the decade following the Gulf War than died in the previous decade. These children are part of the collateral damage from the last war.

How many civilians will die in the next war? That is hard to say. One estimate for the last Gulf War was that 10,000 perished, mostly during the bombing campaign that led up to the invasion. That figure will surely climb because our government has promised that a cruise missile will strike Iraq every five minutes for the first 48 hours the war. These missiles will seek out military, intelligence, and security-force targets around highly populated areas like Baghdad, Basra, and Mosul, Iraq's largest cities, where collateral damage is unavoidable. Unable to meet the acute medical needs of the country's population now, the health care system of Iraq will be overwhelmed by such an assault.

This scenario is conservative. I have not taken into account any use of weapons of mass destruction, or the possibility that the war will set loose massive civil disorder and bloodshed, as various groups within the country battle for power or revenge. I have also ignored what would happen if we became bogged down in house-to-house fighting in Baghdad, which could easily become another Mogidishu or Jenin.

There was a lot that made me angry on that trip. I have worked in war zones before and I have been with civilians as they were bombed by U.S.-supplied aircraft, but I don't think I've experienced anything on the magnitude of the catastrophe that awaits our attack in Iraq. Still, as deeply troubling as this looming human disaster is, another issue troubles me far more. If the U.S. pursues this war without the backing of the U.N. Security Council, it will undermine a half-century of efforts by the world community to establish a foundation of humanitarian and human rights law. Such an act on our part would also violate the U.N. Charter and make a mockery of the very institution we have helped to fashion in the hopes it would help prevent crimes against humanity. Many might define the consequences of such an attack on the population of Iraq as just that.

Saddam is a monster, there is no doubt about that. He needs to be contained. Yet many former U.N. weapons inspectors feel he has been defanged. His neighbors do not fear him any longer. There are many Iraqis who want him removed, but not by a war. Against the short- term gain of removing Saddam, we must take into account that idea that we may well unleash forces of hatred and resentment that will haunt us for decades to come in every corner of the world. I can just hear Osama Bin Laden saying now, Please President Bush, attack Iraq. There's nothing better you could do to help the cause of Al Qaeda!

Letter from Charlie Clements <clclements@aol.com>,

Charlie Clements, a public health physician, has spent much of his professional experience dealing with issues of war, human rights, and the humanitarian needs of refugees. He is the co-founder of the International Medical Relief Fund (IMRF) and was president during the 16 years it functioned (1982-1998). From 1984-1986 he served as the Director of Human Rights Education of the Unitarian Universalist Service Committee (UUSC). He has served on the board of Physicians for Human Rights (PHR) from 1987 to the present and is currently its past president. PHR was one of the founders and leaders of the International Campaign to Ban Landmines. Clements represented PHR at both the signing of the Treaty to Ban Landmines in Ottawa, Canada and the next week at the 1997 Nobel Peace Prize ceremony in Oslo, Norway. He is also the founder of the International Commission on Medical Neutrality, which has focused attention on the need to extend the protections afforded military physicians and patients by the Geneva Conventions in times of war, to include both civilian health professionals and patients. Clements is the author of Witness to War published by Bantam in 1984 and subject of a 1985 Academy Award-winning documentary of the same title produced by the American Friends Service Committee. He is a distinguished graduate of the U.S. Air Force Academy and a distinguished alumnus of the University of Washington School of Community Medicine and Public Health. He is the director of the Bartos Institute for the Constructive Engagement of Conflict at the United World College in Montezuma, New Mexico.