The Gulf war started on January 16, 1991, and when it ended six weeks later,
              more bombs had rained on Iraq, which is only twice the size of Illinois, than
              was dropped in all of World War II; 142,000 tons of bombs, including 350
              tons of depleted uranium shells. The relentless air campaign destroyed much of
              the country’s infrastructure; food processing and pharmaceutical plants, power
              plants, sewage pumping stations (biological warfare), roads, and bridges.

              The cease-fire ushered in the most stringent sanctions ever imposed on a
              country; most items necessary for daily living, hygiene, and schoolwork were
              prohibited; for example, women’s sanitary tissues, pencils, and the medication
              nitroglycerine needed to treat angina pectoris. Scores of items were deemed
              by the victorious powers to have a dual use potential, so that the graphite in
              pencils could ostensibly be used in nuclear reactors, and nitroglycerine to
              make dynamite, not to treat life-threatening heart disease! Furthermore, Iraqi
              Americans and other concerned U.S. citizens could not use U.S. mail
              satisfactorily to send medicines, journals, or books because there was, and
              remains to this day, a 12-ounce limit on individual packages.

              As Iraq could no longer sell its oil, or trade with other countries, its currency,
              the Dinar, collapsed. Having traded at 3.3 U.S. dollars before the war, the
              Dinar was only worth 1/5000 of a dollar in 1995, and is 1/2000 of a dollar
              now. This obviously meant that the entire Iraqi middle class, as well as
              countless hitherto very wealthy families were financially, was ruined. The poor,
              of course, were the hardest hit, as their low income and meager, if any,
              savings could no longer buy them anything.

              The consequences of the military operations and the following sanctions have
              produced an immense human tragedy in Iraq. The United Nations
              International Children Emergency Fund (UNICEF), conducting household
              interviews in Iraq seven months after the war, reported 47,000 excess deaths
              among children less than five years old. The age-adjusted relative child
              mortality was 3.2 times the pre-war rate. The Food and Agriculture
              Organization of the United Nations (FAO) reported in 1995 over one million
              deaths in Iraq, of which 570,000 were among children. It described four
              million people, one-fourth of the population, as starving.

              A 1995 FAO mission to Baghdad sampled 25 clusters comprising 2120
              children in various city neighborhoods; the findings were published in the
              British journal, Lancet (1). Compared to the pre-sanctions period, infant
              mortality had risen by 200%, the death rate of children under five years old by
              500%, and the incidence of diarrheal diseases, a major cause of childhood
              morbidity and mortality, by 300%. Stunting of growth had increased from
              12% in 1991 to 28% (similar to the figure from the Congo) in 1995, the
              prevalence of low body weight from 7% to 29%, and of wasting from 3% to
              12%, similar to the figure from Madagascar (1). The Swiss Society for Social
              and Preventive Medicine (Lausanne) reported in June 1995 that between
              1989 (pre-war) and 1994 in Iraq, there had been a doubling or greater in the
              incidence of polio, neonatal tetanus, typhoid fever, cholera, leishmaniasis, and
              malaria.

              In 1995 the UNICEF reported that the sanctions on Iraq inhibited the imports
              of spare parts for crucial machinery, chemicals, and means of transportation.
              The World Health Organization of the United Nations (WHO) stated in
              March 1996 that there had been a sixfold increase in the mortality of Iraqi
              children less than five years old under the sanctions, and that the majority of
              the population was on a semi-starvation diet.

              Dr. Leon Eisenberg, a member of the Harvard mission to Iraq, asserted that
              the sanctions represented a war against public health, that they had resulted in
              epidemics of gastro-enteritis, typhoid, and cholera, that there was marasmas
              (a wasting condition), and that children were dying of preventable diseases
              and starvation (2). He correctly stated that economic sanctions had no basis in
              law, morality, or humanity, and appealed to the American Medical
              Association to oppose them (2).

              A delegation of British physicians visited major hospitals in Iraq and published
              its findings in the British Medical Journal in 1997 (3). One-third of hospital
              beds were closed; one half of the medical equipment was not functional for
              lack of spare parts; and the average patient stay had been more than halved
              (3). There were serious shortages of lighting, water, and sewage disposal
              facilities; and patients had to bring their own blankets and heaters (3). In Ibn
              al-Athir Hospital in Baghdad the cleaning staff had been reduced from twenty
              to two; bed sheets and blankets were used to clean the floors. The average
              monthly hospital cleaning budget had been reduced to 1500 Dinars ($1).
              Hospitals had no disinfectants; hand soap was reserved only for the operating
              rooms; many wards had leaking sewage pipes, no working toilets, and were
              infested with flies, insects, and vermin (3). In Mosul, Iraq’s second largest
              city, hospital administrators had reduced the number of weekly operations
              from fifteen to two; they preferred surgical procedures that took less than one
              hour and required less sutures, and the surgeons economized by using one
              instead of three sutures to close an appendix operation (3). In that same year
              a UNICEF report in November stated that 960,000 Iraqi children, one third
              of all children, had chronic malnutrition.

              As if all this misery were not enough, Iraqi citizens, the children above all, are
              suffering from the pernicious effects of the 350 tons of depleted uranium shells
              that were dropped on the country during the war (4). Depleted uranium has
              replaced titanium as a cheap coating for projectiles used to pierce armor. It
              burns on impact, atomizing into fine dust, which is inhaled and ingested by
              humans and livestock, and it also enters the food cycle via water and soil. Its
              radioactivity only begins to decrease after 4,500 million years (4,5,6)! There
              has been a phenomenal rise in the incidence of cancers, especially of the
              blood, brain, and soft tissues among Iraqis, particularly the children (4,6).
              Congenital birth deformities, some quite grotesque, have also multiplied among
              Iraqi families, and those of the Gulf War veterans from the U.S. and other
              "coalition countries" (4,6). Less dramatic, but quite disturbing, has been the
              Gulf War Syndrome, a condition of weakness, debility, death, and suicide
              among Desert Storm veterans from the U.S., Canada, Britain, Australia, and
              New Zealand (4-6). There is mounting suspicion by medical and radiation
              experts that the syndrome is related to "low level" radiation illness, but the
              U.S. and other Western governments have obfuscated the issues and
              attempted to push the matter under the rug. Doctors and scientists have been
              pressured or fired, and files, computer discs, and veterans’ medical records
              have disappeared (4,6).

              In Iraq itself the incidence of lymphoma has increased ten times, and that of
              brain cancer forty times among the soldiers who served in the heavily
              bombarded area around Basra (4). Even in Mosul in northern Iraq, studies by
              four universities revealed a fivefold rise in cancers after 1991 (4). Worse still,
              most of these miserable cancer victims cannot get radiation therapy because
              the necessary equipment is prohibited by the sanctions regime. Recently Dr.
              Karol Sikora, of the WHO Cancer Programme, and Professor of Cancer
              Medicine at the London Imperial College School of Medicine, protested
              vehemently against this restriction, and stated that doctors cannot and should
              not keep quiet about matters of this gravity (7).

              There has also been an alarming rise in the incidence of amenorrhea (cessation
              of the menstrual period), miscarriage, intra-unterine fetal death, and birth
              deformities (4,6). Dr. Jenan Ali, at Basra General Hospital, has a
              photographic record of all the babies born without eyes, brains, genitalia, or
              limbs, or with grotesquely deformed heads or bodies (4). In Mosul, too, in the
              north, a survey found twenty malformed babies in 160 families; most of the
              fathers of these households had served in the Gulf War (4). In August 1996,
              the UN sub-commission on Human Rights designated depleted uranium a
              weapon of mass destruction; nevertheless it continues to be used, and has
              been so far sold to seventeen countries (17).

              Biological warfare, too, continues against the Iraqi population. The screw
              worm fly, indigenous to the US, Mexico, and Central America, was unknown
              in Iraq until September 1996, when it suddenly appeared north of Baghdad
              and spread to twelve of the eighteen provinces of Iraq. The larvae of this
              insect can consume a whole cow in one week, and cattle have been
              devastated by this new development. The flies can be packed in boxes and
              dropped from the air; UN planes or U.S. and British military aircraft
              undertake the only flights in and out of Iraq. An expert on biological warfare at
              the German Bundestag stated, "Iraq is the latest victim of what appears to be
              a deliberate introduction of screw worm…" (8).

              It is abundantly clear that the silent war against the Iraqi civilians continues
              unabated, and that it has killed or crippled far more people than the Gulf War
              itself had done. More importantly, the sanctions, while destroying Iraq’s
              infrastructure for food production, public health, education, and the human
              resource itself, have nevertheless failed to achieve their stated objective of
              toppling the Iraqi regime.

              Even our Secretary of State, Madeleine Albright, who had earlier told Leslie
              Stahl on "60 Minutes" that the death of 570,000 Iraqi Children was a
              worthwhile price to pay to eliminate Saddam Hussein, now admits that "In
              many cases sanctions have been imposed for years, even decades, without
              achieving their objectives", and that "Good intentions, however, do not
              automatically translate into good results". (9)

              The U.S. and Britain have used United Nations Resolution 986 (Oil for Food)
              to lull public opinion into a sense of complacence about the human tragedy in
              Iraq. It is clear that UNR 986 has not so far produced a noticeable
              improvement in the condition of Iraqi civilians and children. It has been
              bogged down by bureaucratic and political obstacles, and by continued
              sanctions on crucial non-military items. So far it has translated into 25 cents
              only per day per Iraqi citizen, and has provided less than 25% of the minimal
              required caloric intake. According to the head of the U.N. World Food
              Programme in Iraq in 1997, Arthur Holdbrook, U.N. 986 had not solved the
              problem of unsafe drinking water, had no provisions for purchasing needed
              hospital equipment, and no moneys to be spent locally to rebuild infrastructure
              and provide work and income for Iraqis (10). The failure of UNR 986 to
              alleviate the suffering of the population has been recently dramatized by the
              resignation of the top UN aid official in Iraq, who explained that it was very
              difficult for him to work under the sanctions regime which had crippled the
              Iraqi economy, and that he did not wish to be party to that tragic process. He
              is the second person in that position to resign since the implementation of
              UNR 986.

              Countless persons and organizations of diverse affiliations have either criticized
              or condemned the sanctions on Iraq for having inflicted tremendous suffering
              on the people; the Pope, the World Council of Churches, the WHO,
              UNICEF, FAO, U.S., British and other physician groups, the Wall Street
              Journal, the Chicago Tribune, the International Action Center (established by
              former U.S. Attorney General Ramsey Clark), the Arab American
              Anti-Discrimination Committee, and very recently even the usually apathetic
              American College of Physicians (11). One must therefore wonder why the
              U.S. and British governments continue to espouse the cause of non-military
              sanctions. Could it be perhaps that their real motive is the destruction of Iraq
              as a people and a country?

              It is high time that all non-military sanctions against Iraq are removed, and that
              the developed countries, including the U.S., help with reconstruction of
              infrastructure, improvement of public health, and rejuvenation of agriculture.
              Furthermore, the UN should delegate a body of physicians and scientists to
              study the effects of depleted uranium on the people and environment of Iraq,
              to make recommendations to limit the ongoing damage, and to establish a fund
              to undertake a massive cleanup operation. Then and only then will the world
              community make amends for the massive inhumanity that has been inflicted on
              the Iraqi people. Never since the Mongol invasion of the thirteenth century has
              Iraq suffered such calamity.

              References:

                        1. Lancet 346: 1485, 1995.

                        2. New England Journal of Medicine 336:1248, 1997.

                        3. British Medical Journal 315:1474, 1997.

                        4. Poisoned legacy, in "The New Internationalist"; 316:12-14,
                        1999.

                        5. Health and Environmental Consequences of depleted uranium
                        in the US Army, June 1995.

                        6. Metal of Dishonor, International Action Center, 1997.

                        7. British Medical Journal 318:203, 1999.

                        8. Biological warfare, in "the New Internationalist": 316,
                        21,1999.

                        9. Annals of Internal Medicine 132:155-157, 2000.

                        10. Voices in the wilderness: January 3, 1997.

                        11. Annals of Internal Medicine 132:159-161, 2000.

              Dr. Bakir is Professor Medicine at the University of Illinois College of
              Medicine, and Senior Physician at Cook County Hospital in Chicago.