The war of 1991 had already caused a large number of victims among the civilian population. The country's infrastructure, particularly its health-related facilities (drinking water treatment and wastewater disposal) had been seriously damaged, causing an enormous humanitarian catastrophe in addition to the harm resulting from the bombings and from the massive displacement of the population.

There is no doubt that the sanctions have inflicted much greater harm than the immediate destruction caused by the 1991 war. Sanctions have, in effect, prevented Iraq from rebuilding itself after being destroyed by the war. This situation, lasting ten years, has produced disastrous consequences because of the cumulative effects of both inadequate health and sanitation services and food shortages.

However, it is economic deprivation that has had the most profound effect on Iraqi society, and this has even started to affect people's sense of identity. These are the specific processes we have tried to identify and analyze. Even though the short duration of our mission prevented us from claiming to have carried out a very detailed or rigorous analysis of Iraqi society, we can at least give an overall picture that we feel is relatively close to reality.

Our first impression of Baghdad was not quite what we expected. The streets were full of people – students were walking around with exercise books in their arms, normal city traffic was moving, stores were open and some fruit and vegetable stands were displaying their wares, as is customary in many Arab countries. However, we soon noticed that there were not many people in the stores, and most people did not have access. As we gradually extended the range of our observations and met more people, we came to appreciate the scope of the economic disaster that underlies the humanitarian catastrophe in Iraq.

According to the Security Council's humanitarian panel quoting the UNDP, Iraq's economic situation has changed from one of relative prosperity to one of mass poverty. In contrast with a figure of $3,500 (US) in 1988, average 'per capita' income dropped to $1,500 in 1991 and $1,036 in 1998 (UN, 1999 a).

The loss of oil revenue and the large number of factory closures, caused by the embargo, have led to shortages of a wide range of products and massive layoffs. Before the embargo, oil represented 61% of GDP (FAO, 1999), services 22%, industry 12% and agriculture 5%. A major portion of oil income was used to fund social services, such as health, water and sanitation facilities and education. The 75% drop in GDP that occurred in 1991 had an immediate, direct effect on Iraq's "social" budget, which has continued ever since. Whereas agriculture only represented 5% of GDP before sanctions, it now represents almost 50% on account of the drop in other sources of wealth. In 1995, the United Nations Office of Humanitarian Affairs estimated that four million Iraqis, or 20% of the population, were living in extreme poverty (FAO, 1999).

The embargo has created shortages of various types of goods with resultant higher prices. Because of the prohibition on exports, price increases have been followed by a lightning swift devaluation of the local currency. The Iraqi dinar that was worth more than $3 (US) in 1990 is now worth only 1/20^th of cent, i.e., 1/6,000^th of its value ten years ago.

Until 1990, Iraq was a welfare state employing a large share of its workforce. It is thus the fixed-salary employees who have suffered the most from devaluation.

For example, teachers currently earn 5,000 — 7,000 dinars per month, i.e. a maximum of $3.50 per month. We met special education teachers taking care of disabled children, who also earned $3.50 per month. Nevertheless, the price of food staples, comparatively speaking, is still very high. A small shopping expedition that we went on in order to prepare a very simple meal for three people cost several thousand dinars or the monthly salary of many government employees. A kilo of tomatoes cost 750 dinars and a kilo of cucumbers 2,000 dinars.

In a revealing exercise, we cooperated with some employees in the services sector to calculate a typical family budget. They estimated that, in order to live modestly, as they were doing in 1990, they would currently need close to 70,000 dinars per month for a family of four (see box below). Since they could not get such an income, they were forced to progressively sell their household furniture and other personal possessions. A market specializing in this type of commerce has developed. There you can find items such as family souvenirs, rugs, silverware bearing the initials of its former owners, antique silver or gold jewelry, and electronic equipment (televisions, tape recorders etc.).

Academics and even writers come there to sell their dearest possessions – their books. During a walk on Al Mutanabbi Street, in an area traditionally devoted to bookshops, stationers and printers, we saw great classics of Arab or foreign literature, occasionally containing personalized authographs, spread out on the dusty sidewalk in the hope that a foreign visitor might buy them cheap.

The direct, rapid impoverishment of a large portion of the population has brought in its wake a host of material, social and psychological consequences, such as: malnutrition and health problems, an inability to provide basic health and clothing requirements, chronic psychological stress leading to breakdown and depression, permanent states of mental tension, and feelings of powerlessness, sometimes leading to family violence. Several of the people we spoke to said that the problem of "street children" is getting worse and is becoming a growing social problem. Poverty also seems to be the reason for a significant rise in prostitution.

This impoverishment has also had an impact on the country's social structure. It has led to the virtual disappearance of the middle class, as financial difficulties go hand in hand with a loss of social status. More traditional rural groups, sometimes deriving their income from dealing in smuggled goods, have climbed up the social ladder, but it is difficult to get a clear picture of all these social changes. However, there is a noticeable return to traditional social values and a decline in the secular and republican values of the former economic elite. These new social trends have been reinforced by the departure of a relatively high number of the former Baghdad elite, which only serves to make those that remain more aware of their loss of status.

Infrastructure and services

The various infrastructures are extremely deteriorated, since the lack of spare parts, caused by the embargo, and the lack of financial liquidity, caused by the paralyzed economy, have resulted in virtually no equipment maintenance. All this has affected a wide range of social functions or facilities, such as electricity production, water treatment, transportation, housing, schools and hospitals. Consequently, these conditions greatly affected people's health .

Several electrical power stations that were seriously damaged by the bombing have not been repaired because of the embargo. Apart from the frequent power cuts this situation causes on a regular basis, it has paralyzed the sewage system; as a result, drinking water quality has been seriously affected. UNDP calculates that $7 billion would be required to restore the electrical power production to its 1990 levels (UN, 1999 a).

Wastewater is either not being treated satisfactorily or is not being treated at all in certain regions, and we have observed whole neighbourhoods housing internal refugees in Basrah where household drains are flushed directly in front of the houses. Before the 1991 war, 90% of the urban population and 75% of the rural population had access to drinking water. By 1999, these proportions had dropped to 61% and 41% respectively.

In all Third World Countries, the drinking of contaminated water is the leading cause of infectious disease, particularly in children. Because of a sanitation system that it can no longer maintain, Iraq has become again an underdeveloped country. A country's level of development can be measured by the Human Development Index, a formula used by the United Nations to calculate the standard of living of people in the world's countries. This index takes into consideration both material wealth and the quality of services and various other social indicators. In 1990, Iraq ranked 55^th on the HDI scale, but fell to 106^th in 1995 and 125^th in 1999.

In addition, the recurring bombings since 1991 have become more intense since 1998. In 1999 alone, there were 138 days of bombing with thousands of bombs dropped on almost 450 targets in Iraqi territory. These are not only military targets. Apart from "collateral damage", i.e., civilians killed by the bombing, the Americans consider that electrical power stations are legitimate targets, because they can help the Iraqi government produce weapons. Without spare parts and financial liquidity, the country's infrastructure cannot be rebuilt or repaired. It has thus become increasingly deteriorated, thereby depriving the Iraqi population of essential services.

This situation is likely to have, in the long term, a very profound impact on Iraq's national institutions as tools of social integration. Without the financial means to operate, these institutions break down and lose their credibility in the people's eyes. The population is loosing its trust in the national collectivity’s ability to solve its problems, and is increasingly relying on various ethnic-religious affiliations to find the security the State can no longer provide. These trends have now existed for ten years and could have serious long-term consequences that are difficult to assess and that will certainly be difficult to reverse.

Smuggling

Nonetheless, it is not everybody who suffers from the embargo. As can be expected in shortage situations, a smuggling-based economy has emerged. A new class of entrepreneurs has developed special skills to get around the system and import consumer goods from neighbouring countries – from Turkey via the Kurdish zones, from Jordan, along the only road linking Baghdad to Amman, from the Gulf states and, lastly from Iran, as the religious tourist industry from Iran to Iraq seems to be flourishing. We have not yet come across a coherent analysis of the changing balance of power between the various social classes and groups over the last ten years. However, we have noticed that some luxury homes are being built (an architect told us that houses that would have been worth $150,000 (US) in 1990 are now built for $50,000), that a number of very upscale stores continue to operate (albeit with reduced numbers of customers) and that several restaurants that are relatively high-priced (4,000 dinars for a meal) for those on fixed-incomes are still very busy. As stressed by Hans von Sponeck, the UN Humanitarian Coordinator for Iraq, the kind of entrepreneurial behaviour encouraged by sanctions operates outside the law, to the detriment of more traditional types of businesses.

Until 1990, Iraq was a relatively wealthy society, with a developed system of social services. Although the political rights of its citizens were not respected, their economic and social rights were better taken care of than in many other Arab societies. The restructuring of the market in the framework of the embargo appears to have established parameters that will impact on Iraqi society in a very negative way for many years to come, even after the lifting of the embargo. Thus, the embargo has violated the basic human rights of the country's civilian population, and it has destructured and destroyed its social institutions in a fundamental way.

IV. EDUCATION

The economic and social crisis that has affected Iraq since the mid-1980s onwards (the period of the war against Iran) had already begun to have negative effects on the country's educational situation. The 1991 bombing campaign and the ongoing sanctions program have now reduced the educational system to a totally pathetic state. According to UNICEF, 3,000 school buildings were destroyed in 1991. In addition, the impoverishment of the population and the dramatic drop in the government's education budget have brought about a considerable decline in the quality and quantity of educational services.

In order to provide a somewhat more specific picture, we will begin by quoting paragraphs 14 and 22 of the "humanitarian panel"'s Report to the UN Security Council (UN, 1999 a):

"14. As described by UNICEF, the Government of Iraq made sizable investments in the education sector from the mid-1970s until 1990. According to UNESCO , educational policy included provision for scholarships, research facilities and medical support for students .  By 1989 the combined primary and secondary enrollment ratio stood at 75% (slightly above the average for all developing countries at 70%, according to the Human Development Report for 1991) Illiteracy had been reduced to 20% by 1987 . While Iraq's indicators were inferior to that of other Arab countries such as Egypt, education accounted for over 5% of the state budget in 1989, above the developing country average of 3.8% (cf. UNDP Human Development Reports)."

"22. School enrollment for all ages (6-23) has declined to 53%. According to a field survey conducted in 1993, as quoted by UNESCO, in Central and Southern governorates 83% of school buildings needed rehabilitation, with 8.613 out of 10.334 schools having suffered serious damages. The same source indicated that some schools with a planned capacity of 700 pupils actually have 4500 enrolled in them. Substantive progress in reducing adult and female illiteracy has ceased and regressed to mid-1980 levels, according to UNICEF. The rising number of street children and children who work can be explained, in part, as a result of increasing rates of school drop-outs and repetition, as more families are forced to rely on children to secure household incomes. Figures provided by UNESCO indicate that drop-outs in elementary schools increased from 95.692 in 1990 to 131.658 in 1999."

In addition, according to Iraqi government statistics, 20% of all primary and secondary school-age children, that is a million of them, did not register in school in 1998 and another 200,000 dropped out during the school year.

More recently, UNICEF summary reports, dated January 2000, show that, from 1999 to 2000, the primary school dropout rate increased from 3% to 6.6%. The current educational situation in Iraq is characterized by a series of sobering characteristics: school buildings that are partially or completely closed due to a lack of maintenance and repair; a chronic shortage of basic school supplies, desks, books and other educational material which are also high-priced; and a growing number of teachers who leave the profession in search of other better-paid occupations . Some of the effects of these factors include: overcrowded classrooms, shortened school days, and a bare minimum educational program. In several instances, students only receive three hours of classes per day and several schools receive three consecutive shifts of students per day!

Our visits to several schools where the Italian NGO, Un Ponte per Bagdad, had carried out major renovations totally confirmed this disastrous situation. At Ibn Al Mo'tazz school, we learned that 45 male teachers and 15 female teachers, for a total teaching staff of 60, handled two shifts of students, 650 in the morning and 650 in the afternoon. The classrooms were in a pathetic state, containing some 15 small old tables, designed for two students each, but which had to accommodate three, or even four, children each. Nothing that could legitimately be called teaching equipment was available; there were only a few old geographical maps, stained and torn through use.

Anuparma Rao Singh, the UNICEF representative, told us during our visit to the United Nations complex in Baghdad that 55% of Iraq's schools are currently unfit for teaching and learning. She told us that UNICEF was very concerned – and, frankly, pessimistic – about what is going to become of children between 11 and 18 in Iraq because of a number of factors: the intellectual underdevelopment observed in many of them, a high drop-out rate, the increasing use of child labour, and the rise of the phenomenon of "street children". It seems that more girls than boys are dropping out of school. We were told that, if a choice had to be made, parents usually prefered to send their sons, rather than their daughters, to school.

The situation at the university level is hardly better. In former times, Iraq had many, well-respected universities that attracted students from all over the Arab world. Several young Iraqi students were also able to study abroad with State financial support. All that is now over. Iraq is essentially cut off from the rest of the world, so far as the development of knowledge and access to information is concerned. Generally speaking, the most recent books in university libraries are ten years old. There are obviously few computers and no Internet access. After all these years of sanctions, it is also out of the question that Iraqi graduate and post-graduate students take part in international conferences.

Despite these unfavourable conditions and the fact that job prospects in their fields of study are extremely limited , a large number of Iraqi students continue to attend university. This perseverance shows how highly education is valued in Iraqi society and also represents a form of resistance – a refusal to give up in the face of the problems caused by the embargo.

We should not, however, downplay the effects of sanctions on the Iraqi education system. Well aware that he was risking further American criticism, Hans von Sponeck told us that an Iraqi intellectual he knew had even used the expression, "intellectual genocide." For Mr. von Sponeck, the sacrifice of a complete generation of education-deprived young people would be the most harmful consequence of maintaining the embargo.

V. HEALTH

The feeling of abandon and despair that we sometimes saw was nowhere more acute than when we visited hospitals in Baghdad and Basrah. The sight of destroyed infrastructure was all the more heartbreaking when we realized that we were dealing with recently-built hospitals, containing advanced, high-quality equipment and well-trained medical personnel that used to compare well with what we have to offer in Canadian hospitals.

At the Al-Mansour Hospital in Baghdad, images of death and desolation washed over us at the sight of rows of children suffering from cancer and leukemia, just left to themselves without chemotherapy, antibiotics and even intravenous solutions. However, this one example is not sufficient to explain the deaths of more than 500,000 children between 1991 and 1998 that have been attributed to the cumulative effects of the nine years of sanctions imposed on Iraq. Based on the increased mortality among Iraqi children observed by a recent UNICEF field survey (UNICEF, 1999), this estimate is still a good indicator of the Iraqi population's present state of health and totally justifies all our concerns.

In this section, we will begin by presenting a detailed overview of the situation, based on reports from the main international humanitarian organizations (UNICEF, ICRC and UNOHCI). This review will be rounded out by comments from senior officials in these organizations that were noted during our meetings with them. After analyzing the reasons for the high mortality rate in the most vulnerable sections of the population, we will present our in-field observations, then the input from Iraqi hospital staff, and finally other relevant information from various sources.

Health indicators before sanctions

Certain types of epidemiological data are normally used to measure the state of health of a given population. In order to give an indication of how Iraq fared in this respect before sanctions, table 1 shows the most reliable and most commonly used indicators.

According to a WHO analysis, published in 1999 (WHO, 1999), indicators for pre-1990 Iraq "reflect the health status of a modern developing society, in which the wealth it obtained from exporting its main commodity, oil, contributed into improving the quality of life of the Iraqi people, which then (1988/1989), was already at a relatively ‘satisfactory’ level, with indications of a trend for further improvement if compared with the indicators that prevailed in Iraq in the 1970s".

Higher mortality rates during the sanctions period

The UNICEF Director in Iraq, Anuparma Rao Singh, manages a staff of ten observer teams, responsible for overseeing the fair, adequate and efficient distribution of resources and commodities that the Iraqi government procures in the education, health and water sectors . This supervision is exercised at all levels from warehouse to final users.

Ms. Singh's organization is responsible for promoting the UN Convention on the Rights of the Child, and, for many years, has spoken out against the continual deterioration in Iraqi health indicators, particularly those reflecting children's health.

Immediately after the Gulf War, an international team of researchers (Ascherio, 1992), conducted a nationwide survey on the Iraqi people's nutritional situation and on mortality. The survey showed that, for the first half of 1991, mortality among children less then five years old had tripled, compared with the equivalent period before the war. As there had been no data for the whole country since this survey, UNICEF collaborated with the Iraqi Health Ministry in conducting an extensive epidemiological survey in 1999, aimed at measuring infant mortality over the last 20 years and establishing a body of comparative data.

Backed by the WHO, which provided technical expertise, UNICEF conducted a methodologically sound survey: in the Central and Southern regions of Iraq (20.9 million inhabitants), a sample of 24,000 women was selected by a three-level stratification method. The women chosen were interviewed between February and March 1999 using a questionnaire. The same year, a similar epidemiological survey was carried out in the three governorates of Kurdistan (3.4 million inhabitants).

The survey findings for the central and southern regions of Iraq showed that the infant mortality rate (IM, mortality rate before one year of age per 1,000 live births) and the mortality rate for children under 5 (M<5) both showed a steady increase over the 10 years preceding the survey, i.e., the period during which Iraq was subject to sanctions. The IM increased from 47 deaths per 1,000 live births between 1984 and 1989 to 108 deaths between 1994 and 1999. During the same period, M<5 climbed from 56 to 131 deaths per 1,000 live births.

In order to provide a fair reflection of the scope of this public health disaster, Ms. Singh showed us a comparative analysis (Jones, 1999), charting the under-five infant mortality between 1960 and 1999 (see graph 1). If the rapid, steady drop in this rate during the three decades prior to sanctions had continued during the 1990s the M<5 rate would have been approximately 30 deaths per 1,000 live births in 1999.

However, according to UNICEF's latest survey, the rate climbed to 131 deaths per thousand live births between 1994 and 1999. Taking into account the annual number of births recorded during the sanctions period (1991—98), it is estimated that the number of under-five children who died during this period is half a million more than the projected number if pre-sanctions trends had continued.

Maternal mortality, just like the other public health indicators, has showed the same negative trend. For the period from the beginning of sanctions to date, the maternal mortality rate per 100,000 live births has increased from 160 to 294, making this the leading cause of death among Iraqi women of child-bearing age over the last ten years (UNICEF, 1999).

Causes of death under sanctions

We have strong feelings of indignation in front of wars in which the casualties can be counted directly. On the other hand, seemingly non-violent sanctions do not provoke the same condemnation despite the serious damage they do to the health of people living in the countries targeted (Morin & Steven, 2000). If more proof is needed of this, the embargo against Irak shows that economic sanctions cause considerable suffering, undermine the well-being of an entire nation, and result in mortality rates far higher than those observed in the most bloody of wars. So, how does this come about?

The state of health of a given population depends on the complex interaction of a series of factors, including access to food, potable water and a good level of public hygiene. These factors have a far more decisive effect on people's health than access to hospital care or medicine. We have explained above that the embargo has caused serious economic difficulties affecting all aspects of life in Iraq. The decline in access to potable water and the definite drop in standards of public hygiene are some of the most serious consequences of this situation.

It is important, however, to also speak about the food situation in Iraq that several researchers have described as a "famine." (Zurbrigg, 1999). Since 1990, the average Iraqi has been dependent on a rationed food distribution system. Dr. S. Zurbrigg, a historian of famine, states that, like a number of similar situations in both historical and modern times, Iraq suffers from famine, not because of an absolute lack of food, but because the majority of its people cannot access the meagre quantity of food available on the market. This food has been put out of the financial reach of most of the population because of the ways in which the embargo has profoundly upset the Iraqi economy. Specifically, the embargo has upset the traditional food distribution system, creating a situation that combines both soaring inflation and a horrendous drop in family purchasing power. The World Food Program (WFP) reported in 1995 that the family purchasing power index in Iraq dropped from 3.62 in 1990 to 0.06 in 1995. This last figure is about 1/20^th of the index of 1.25 that is the WFP standard for the onset of family nutritional deficiency (UN, 1999 b).

Although the 1999 data showed an initial levelling of the rising chronic malnutrition curve (UNICEF 2000), probably due to the starting of the oil-for-food program, this only reflects a stabilization of high levels of malnutrition that still remain very alarming (see Table 2). As even the UN Secretary-General admitted in November 1999, "the caloric value of the food basket, as was the case during the previous periods, has fallen short of the Programme targets throughout the past six months. At the end of October 1999, of the 31 distribution cycles since the start of the Programme, the targeted food basket requirements were met in only 6, none of which were during the current reporting period. These shortfalls were largely the result of under-procurement of some commodities, notably pulses, milk and cheese. On average, the food basket as distributed during the reported period provided 1,993 kilocalories per person per day, thereby meeting almost 93 per cent of the caloric requirement of the food basket and 85 per cent of the protein requirements" (SG-UN, 1999).

*Variation = (1998 or 1999 value - 1990 value) ÷ 1990 value

Infectious diseases

Table 2 compares pre- and post-sanctions statistics for the main health problems in Iraq. Acute malnutrition in children has more than tripled. The problem of malnutrition in pregnant women, which manifests itself in low baby birth-weights has undergone a five-fold increase. Although the incidence of common diseases, such as respiratory infections and diarrhea, has not changed very much, these diseases nevertheless account for 10—18 times more deaths. These relatively innocuous diseases have become fatal in post-embargo Iraq, since they occur in populations where both individual and collective defence systems have been weakened. Individuals are more susceptible because of the interaction of malnutrition, poor hygienic conditions and psychological stress, and the population as a whole is vulnerable because of the low level of health care available. This latter factor is important because it helps to understand how the most vulnerable individuals in the Iraqi population, namely very young children, pregnant women, or the chronically ill, weakened by embargo-caused malnutrition, are dying. And they are dying, not directly of hunger, but rather because of widespread diseases, such as diarrhea and pneumonia, which are not normally fatal.

The incidence of diseases, like tuberculosis, that are related to an individual's standards of living is steadily increasing and are a direct reflection of deteriorating economic conditions (WHO, 1999). The incidence of lice infections, which is usually related to breakdowns in the public hygiene system, has increased from a mere 198 cases in 1990 to more than 43,600 cases in 1998. In addition, the general despair, the extremely difficult material circumstances of life, and the constant threat of bombing and war have all had a profound psychological impact. As a result, there were 510,000 psychiatric consultations in 1998, an increase of 250% compared with the number recorded in 1990, whereas the overall population increase was barely 20% over the same period.

Cancers and congenital malformations

The international organizations we met did not have reliable or complete data on the pattern of cancer and leukemia in the Iraqi population since the embargo started. However, according to several reports and the testimony of Iraqi doctors and medical officials, collected by a very large number of observers including our own delegation, there has been an alarming increase in cancer during this time. This is particularly true of various forms of leukemia and lymphoma, which, based on various estimates, have increased between 400% and 1,000% (Arbuthnot, 1999). The same goes for the abnormally high incidence of congenital malformations (see below) that have been observed in the southern areas of Iraq that were the main theatre of fighting during the Gulf War.

Several carcinogenic factors and substances can be cited to explain this (Bertell, 1997), including:

i) smoke and chemical pollutants from the oil wells that burned during the war;

ii) the large quantities of insecticides and pesticides that were used during the war as protection against possible infestation;

iii) the allies' destruction of Iraq's chemical and biological weaponry during the fighting and their release into the environment; and

iv) the intense electromagnetic radiation emitted by the highly sophisticated arms and equipment used by each side.

At the same time, specialists are increasingly looking at depleted uranium as being the main suspect in the increased incidence of cancers, congenital malformations, and miscarriages. Depleted uranium (DU) is a nuclear waste product which has replaced tungsten as the coating for projectiles and missiles and given them tremendous penetrating power. DU burns on impact, producing a fine powder that can be inhaled or ingested when it disperses in the environment. It also enters the food chain through water or the soil. According to the American Army's Institute of Environmental Policy, "DU-associated risks are both chemical and radiological in nature;" "when it is inhaled in oxidant form, DU is deposited in the lungs and can cause cancer." In 1990, before the Gulf War, Great Britain's Atomic Energy Commission estimated, in a report submitted to the British government, that the use of 50 tons of DU on the battlefields of a war with Iraq could result in an increase of approximately 50,000 cases of cancer over the next decade. This did not prevent the allies from dropping some 300 tons (Birchard, 1998), or possibly even 900 tons (Arbuthnot, 1999), of DU on Iraq during the six weeks of bombing in 1991.

In 1996, the Sub-Commission on Prevention of Discrimination and Protection of Minorities condemned the use of weapons containing depleted uranium, classifying them as weapons of mass or blind destruction, in the same category as nuclear weapons, chemical weapons, aerosol bombs, napalm bombs, cluster bombs and biological weapons. Studies on this question have been conducted by many individuals and pacifist organizations, as well as by American, British and Canadian war veterans, who think they may have been exposed to DU. However, field research is still in its early stages and, according to Dr. Popal, the WHO representative in Iraq, international organizations, including Dr. Popal's own, consider the topic very sensitive and almost taboo. Under these circumstances, it has not yet been possible to conduct a thorough field study in order to establish a convincing cause-and-effect relation between DU and all its suspected ill effects. However, as Rosalie Bertell, the eminent radiobiologist and well-known pacifist, states (Bertell, 1997), "Desert Storm veterans along with the people of Iraq and Kuwait were victims of one of the latest military experiments on human beings. I believe that the ignorance was culpable and criminal".

The health system

Before going to Iraq, mission members had often heard or read about American criticism of the perverted or negligent way in which medical aid to Iraq was being distributed, and the American Secretary of State held the Iraqi government responsible for this. When we met Dr. Popal in the UN compound in Baghdad, we immediately questioned him on how this aid was being distributed. Dr. Popal explained that the WHO, as the organization responsible for distributing medicine and other medical supplies in the regions controlled by the central government had noticed no major problem or deliberate obstruction in the process. Seventy-seven per cent of all the medical material that had arrived in Iraq in 1999 had been distributed. The Iraqi authorities store 14% of the medicine and supplies as a buffer reserve (less than the standard 20%). The remaining 9% is slow to leave storage because of reasons we cover in the section on the oil-for-food program.

Overall, the Iraqi health system's infrastructure and organization have suffered considerable damage as a result of the Gulf War. However, it has continued to operate in spite of defective equipment, ridiculously low staff salaries and a general lack of medicine (WHO, 1999).

People are unhappy with the public health services (WHO, 1999), but outpatient clinic and dispensary consultations indicate an increased call on medical services. The number of nurses has decreased significantly, but Table 3 does not provide any information on the deplorable conditions our mission witnessed on the spot.

For example, a major university centre in Baghdad, the Al-Mansour Hospital, had only two nurses on average for each forty-bed unit of relatively serious cases (cancers and post-operational care). Despite the dedicated efforts of its nursing staff and highly qualified doctors, healthcare standards have fallen to deplorable levels (ICRC, 1999). Because the embargo also affects the availability of scientific publications, doctors are no longer able to update their medical knowledge through reading specialized medical journals. Many doctors have left the country and nursing staff have quit because of salaries that are nothing more than a meagre pittance.

Since sanctions were first imposed, Iraq's 130 hospitals, many of whom were built by foreign companies in the 1960s and 1970s, have not benefited from required repairs or maintenance to their equipment. Hospital buildings are starting to show signs of wear and tear, as are their wiring, ventilation systems and elevators. In sum, regardless of whether it is a question of costly, imported equipment or the simplest of supplies, the Iraqis are not in a position to replace them.

* Variation = (1998 value + 1990 value) ÷ 1990 value

The more than one thousand dispensaries that serve the needs of the majority of the population, do not need sophisticated infrastructure; all the same, the lack of basic supplies and equipment – stethoscopes, sterilizers, swabs and even writing paper – is a genuine impediment to the proper functioning of these dispensaries. "As a result, there have been enormous repercussions on the quality of the care patients receive, and therefore on their health" (ICRC, 1999).

VI. THE SITUATION OF IRAQI WOMEN

The situation of women in Iraqi society shares many common features with all the other countries in the world. Iraqi women are responsible for looking after children, and, in a more general way, for the whole family. It is therefore not surprising that, in a country that has been subject to a devastating embargo for ten years, women's living conditions have been affected.

Children suffer from health problems linked to malnutrition and a lack of care and medicine. The mothers feed, dress, educate and generally take care of the children. They also do household tasks in dwellings that are usually too small and poorly heated.

Many fathers leave to find work in neighbouring countries, since work is painfully hard to find in Iraq. In such cases, mothers are left with being solely responsible for the children.

Many families have three or four children. Contraception is virtually a taboo word in Iraq. Polygamy is tolerated and many marriages are arranged. Still, the young hope to be freer.

We were told that one third of all women work outside the home, mainly in areas like primary and secondary education, social work, nursing and pharmacy services. Women also work in the hotel industry. Nonetheless, it is still striking to observe, as we saw in Baghdad, how absent women are from public markets.

In fact, this reality made us wonder what exactly women's rights are in Iraqi society where patriarchal ideas predominate. For even though Iraqi girls go to school and university, we also noticed a return to traditional religious practice that could very well involve further restrictions on women.

This is undoubtedly explained by people's need for comfort in a situation where it is difficult to see light at the end of the tunnel. However, women should not have to bear more than their share of the burden of that situation, as is now the case.

Observers are already seeing a resurgence of early marriages in rural areas. Teenage girls are married off because that makes one less mouth to feed. In some circles, young girls are withdrawn from school in order to help their mothers and because parents have to choose which of their children to send to school. Usually, the boys are chosen. Many women now wear the traditional black cloak (better known by its Iranian name, "chador"), and this reflects the continued strong influence of tradition and a certain revival of conservatism.

There are many grounds for blaming the embargo against Iraq. The current and expected setbacks in Iraqi women's progression towards equality are just one more reason to do so.

VII. THE CULTURAL DIMENSION

By virtue of its geographic location at the crossroads of various cultural influences, Iraq became the cradle of human writing. Conditions were suitable in Mesopotamia for the development of one of the world's oldest civilizations, known for having left countless traces in western civilization. Babylon is a source of inspiration for Iraqis, and they are very conscious of the historical depth of the culture they have inherited. In this fertile region, fiercely coveted because of its location at the junction of the two mythic rivers, the Tigris and the Euphrates, successive dynasties developed a refined lifestyle. In the Arab-Islamic golden age, culture florished with a particular devotion to poetry and maqam, the setting of text to music according to strict rules. We should not forget that Baghdad was for a longtime the capital of the Islamic world.

The artists that we met were most eloquent in the way they articulated this sense of the historical depth of their cultural heritage. Their opinions and perceptions provided a good idea of the state of mind of a good part of the population, and we tried to be receptive to their sensitivities, while being aware that those of them who live abroad can afford to express more criticism of the current regime.

Education was established as a major governmental priority in the early 1970s and the country's education system acquired an excellent reputation throughout the Arab world. Iraq's highly effective literacy programs earned it an award from UNESCO in 1982 in recognition of the progress made. The government continued to develop these programs until the early 1980s. Nowadays, in spite of the drop-out rate, the school attendance remains relatively high, while universities have not experienced a major decline in attendance. According to the Iraqi Minister of Education, Fahad Al Shaqra, it would seem that education is one of the Iraqis' preferred means of resistance: "Do you want the Americans to get what they want from you?" he says to them. "No? Get on with your studies, then!"

Before the embargo, Iraqi cultural life benefited from consistent government support that helped spread Iraqi culture not only within the country, but throughout the whole Arab world. Many Iraqi artists are leaders in their fields: Nakik Al Malaïka, El Sayib, Al Jayawahiry, Mohamed Ghani, Ismael Fatah Al Turk, Kathum Al Saher, Abdul Rahman Munif, Faiq Hassan, Nadum Al Ghazali, Munir Bashir and Abdul-Razaq Abdul-Wahed. However, some of these artists had to go into exile to get away from the repressive regime. Some others were imprisoned, and yet others were killed. This totalitarian regime has always encouraged culture, but does not allow the free expression of ideas. The reaction of Iraqi artists has been to take refuge in an extreme symbolism, and avoid getting involved in the country's social and political life. This approach has allowed some facility in getting round the various prohibitions. For example, since he became the government's official poet, Abdul-Razaq Abdul-Wahed writes only romantic poems.

Since 1991, the arts in general have received virtually no funding at all. Artists who were used to travelling without any problems find themselves unable to obtain visas. When Culture Minister, Farouk Salouf was questioned on this point, he claimed that the embargo prevented Iraqi artists from being able to export their art because of their inability to obtain entry visas in western countries. The artists maintain in half-spoken words that it is the Iraqi government that no longer grants exit visas for fear that its artists will settle elsewhere. According to artist Qasim Sabty, the owner of the Hewar art gallery, this restriction is possibly the reason why there are currently six private art galleries in Baghdad, whereas there was only one in 1991.

During the American bombing campaign, some historic sites representing a significant part of Iraq's long cultural history, were hit. Some of the artists we met are convinced that the United States did not bomb Iraq at random, but deliberately chose sites that were strategic, not only militarily, but also from a cultural standpoint. The purported aim was to wound the Iraqi people in its sense of belonging to one of the world's oldest civilizations.

According to Mr. Sabty, Iraq's artists have, nonetheless, not deserted their country. However, for them, it has become virtually impossible to work because of the difficulties they encounter in looking for both materials and buyers for their works. Painters and sculptors alike find themselves victims of speculators and have to sell their creations for seldom more than one-fifth of the prices they used to receive before sanctions. As prisoners in their own country, Iraqi artists are trapped between a government that muzzles them and sanctions that suffocate them – like almost every other Iraqi, they do their best and struggle for their daily bread. It might be thought that their works would be marked by violence, anger and bitterness. Far from it. The paintings that are produced are mostly abstract. European sources of inspiration are felt at a distance – Iraqi painters have been particularly successful in combining art with both "western" and "eastern" symbolism. Virtually all the artists use escapist themes and non-representative forms. The lone exception is the Director of the Saddam Art Center, Amir Al Aubaidy, whose canvases are covered with disemboweled Iraqi children, burning American flags and the faces of American and European personalities with blood dripping from their vampire teeth.

For French literature students, Ali B. and Faleh H., who are also writers and translators, one of the main difficulties is accessing recent knowledge and information. They are afraid that the result will be a generation of ignorants – an outcome that would simply be unacceptable for this society that is rich in every sense of the word.

Poet Abdul-Razaq Abdul-Wahed expressed his consternation in these terms: "Where is the Americans' dignity? They mobilize 30 other countries and they control the world's international institutions just to kill a little country of some 20 million inhabitants ! I feel sorry for the West."

On the night of January 17, 1991, Mr. Abdul-Wahed wrote and then recited the following poem in public at a concert that was held only six hours after the start of the bombing. It is a poem that succeeds in encapsulating the feeling that we have often found among Iraqi people: pride, dignity and an awareness of belonging to a people of cultural pioneers.