Article

Sanctions against Iraq "double" child mortality

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Child health specialists have called for an urgent review of the sanctions against Iraq and warned that the blockade has resulted in a doubling of the death rates among children aged under 5 years.Mortality is now more than 20 times that of the United Kingdom and about the same as Haiti, one of the poorest countries in the world, said the International Child Health Group. Maternal mortality has also more than doubled.The group, a UK based international alliance of paediatricians and other child health specialists, said that before sanctions were imposed, Iraq was relatively affluent and health care had been improving over the previous 20 years.A report prepared on behalf of the international group by three paediatricians based in the United Kingdom (Drs Barbara Golden, Mazin Alfaham, and Derek Robinson) said the latest data for 1994-9 show that mortality for children aged under 5 years was 131 per 1000 live births, compared with 56 for 1984-9—before sanctions.Infant mortality (that is, among children aged under 1 year) in 1994-9 was 109 per 1000 births, compared with 47 in 1984-9; maternal mortality is now 117 deaths per 1000 live births, compared with 50 in 1989.“The mortality rate for children is about the same as Haiti, but Iraq compared to Haiti was a rich country before the Gulf War. Health care and education were improving. The under-fives mortality rate had fallen steadily to 56 deaths per 1,000 births. The infant mortality rate had also fallen,” said the report.They said that since sanctions were imposed almost a decade ago, the increase in the death rate among children has been associated with diarrhoea, pneumonia, and malnutrition. Most of these deaths, they said, are avoidable.“Before sanctions malnutrition was a not a public health problem; now it is. Malnutrition increases greatly the risk of deaths from infections such as diarrhoea and pneumonia,” said the report.“The reasons for the excess deaths are clear—economic collapse with plummeting wages, soaring food prices, poor sanitation, lack of safe water, and inadequate provision of healthcare.”As further evidence for the effects of sanctions, the report points out that in the three autonomous areas of northern Iraq that are not subject to sanctions, the latest available data show that child death rates are falling.The report states: “Those who profess to be concerned with human rights and in particular, with children's rights must speak up for the children of Iraq and demand action. Sanctions must be reviewed. This is now a humanitarian imperative, quite distinct from the politics of imposing sanctions nearly 10 years ago. Those who have the power to effect change must put children first and accordingly.”Dr Golden, senior lecturer in paediatric and child health at Aberdeen University, said: “The whole structure is the problem. It is not just about shortages of food, or of medicines. It is about immunisation, help with pregnancy, help in the first year of life, help with childhood illnesses, the sanitation, the hygiene … all these things have broken down.“We have to do something because the children themselves can do nothing about their plight. They are powerless, and so too are their parents.”The report will be available on the website: www.abdn.ac.uk/.

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... Empirical data show Journal of Sociology and Social Welfare, June, 2004, Volume XXXI, Number 2 179 that sanctions contributed significantly to the decline of Iraq's health care system, once among the most advanced in the Middle East (von Sponeck, 2002;Popal, 2000;Pilger, 2000;UNICEF, 1998). Child malnutrition, disease, and child/infant mortality increased sharply in Iraq in the 1990s under the sanctions regime, while food self-sufficiency declined (Pellett, 2000;Abergavenny, 2000;Ascherio, et al., 1992;Garfield & Leu, 2000;Wareham, 2000;Garfield, 1999a;Pape, 1997). ...
... Using data from 1994-1999, British child health specialists found an abrupt rise in maternal mortality and a doubling of death rates for children under five. The group implicated economic sanctions as the cause of malnutrition, which combined with pneumonia and diarrhea to create thousands of preventable child deaths (Abergavenny, 2000). In 1998 the UN cited malnutrition as "a potent factor for increased mortality in young children" since the imposition of sanctions (UNICEF, 1998, p. 25). ...
... All hospitals experienced serious problems with lighting, cleaning, water supply and sewage; drug supplies and operations; and half of all diagnostic and therapeutic equipment was not working due to lack of spare parts [7] despite the fact that medical supplies were not part of the sanctions [8]. Dobson [9] estimates that the mortality rate for under-five children increased from 56 per 1000 live births in the period 1984-89 before the sanctions to 131 per 1000 live births in the period 1994-99. He attributed this increase to economic collapse, poor sanitation, lack of safe water, and inadequate provision of health care. ...
... The Gulf War of 1991 put most pumping and sewage treatment plants out of action thereby discharging raw sewer into rivers, contaminating domestic water supply, and leading to high diarrhoea prevalence [7,9,14,15]. Furthermore, there are reports of women receiving from government free but limited supplies of formula milk in the absence of breastfeeding [16]. ...
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Diarrhoea and acute respiratory conditions are common medical conditions among under-five children in resource-limited and conflict situations. The present study was conducted to estimate the prevalence and associated factors for acute respiratory conditions and diarrhoea among children under the age of five years in Iraq in 2000. Data for the Iraqi Multiple Indicator Cluster Survey were obtained from UNICEF. We estimated the prevalence of acute respiratory conditions and diarrhoea. Assessment of the associations between these two medical conditions on one hand and socio-demographic and environmental variables on the other was done using logistic regression analysis. Weighted analysis was conducted to account for complex survey design. A total of 14,676 children under the age of 5 years were reported by their mothers in the study. Of these 50.4% were males. About half (53.9%) of the children had complete vaccination status. Overall, 21.3% of the children had diarrhoea, and 6.9% had acute respiratory infection (ARI) in the last two weeks. In multivariate analysis, diarrhoea was associated with age of child, area of residence, maternal education, source of water, toilet facility, disposal of children' stool and disposal of dirty water. Compared to children aged 48-59 months, children in the age groups 6-11 months and 12-23 months were 2.22 (95%CI [2.02, 2.44]) and 1.84 (95%CI [1.71, 2.00]) times more likely, respectively, to have diarrhoea. Children whose mothers had no formal education were 11% (AOR = 1.11, 95%CI [1.04, 1.18]) more likely to have diarrhoea compared to children with mothers who had attained secondary level of education. Compared to children who belonged to households with unprotected well or river as the main source of water, children who belonged to households with piped water were 32% (AOR = 1.32, 95%CI [1.17, 1.48]) more likely to have diarrhoea while those who belonged to households with protected well were 26% (AOR = 0.74, 95%CI [0.62, 0.89]) less likely to have diarrhoea. Age of child, toilet facility, wealth, and sex of child were significantly associated with ARI. In a study of under-five children in Iraq in 2000, we found that history of diarrhoea and ARI were negatively associated with lower socio-economic status, adequate disposal of children's stool and dirty water, but the results were inconsistent in terms of access to potable water and sanitation facilities possibly due to non-functioning of water and sewage plants after the war. Improvement in water quality and sanitation are vital in the reduction of diarrhoeal diseases.
... Sanctions, enforced from 1990 to 2003, degraded Iraq's health-care system, formerly among the most developed in the region (Popal, 2000; von Sponeck, 2002 ). As Iraq's oil-dependent economy withered, child malnutrition , disease, and infant and child mortality increased sharply in the 1990s, and food self-sufficiency declined (Dobson, 2000; Garfield, 1999; UNICEF, 1998). Al-Nouri (1997) found that the UN trade embargo created profound effects on Iraqi family life by distorting social mobility, weakening social norms, altering longstanding social networks, and producing emotional strain and psychological distress. ...
Article
English The idea of disaster is usually associated with human suffering from natural events. However, human-made disasters caused by deliberate actions represent an equally important dimension of disaster. This paper analyzes Iraq as a human-created disaster, and suggests that social work play a role in responding to policies that produce disaster. French On associe habituellement la notion de 'catastrophe' aux souffrances de l'homme dé coulant d'é vé nements naturels. Toutefois, les catastrophes d'origine humaine causé es par des actions intentionnelles repré sentent une dimension tout aussi importante de ce phé nomè ne. Cette é tude envisage le cas de l'Iraq sous l'angle d'une catastrophe causé e par l'homme. Elle suggè re aussi que le travail social y joue un rôle en appuyant des politiques qui causent la catastrophe. Spanish La idea de desastre estáusualmente asociada con el sufrimiento humano en eventos naturales. Sin embargo, los desastres causados por humanos a travé s de acciones deliberadas representan una dimensió n igualmente importante del desastre. Este artículo analiza a Iraq, en tanto que desastre creado por humanos, y sugiere que el trabajo social desempeñe un papel en respuesta a las políticas que producen desastres.
Article
Having recently published a meta-analysis on the same clinical question,1 it was with great interest that we read Michael et al ’s systematic review of short versus standard duration antibiotics for urinary tract infections (UTIs) in children.2 Given the publication (in close succession) of two meta-analyses on the same question with (on the surface) strikingly different results, we thought a comment was in order. First, we applaud the authors on their methodologically sound review. The literature search was explicitly described and exhaustive. In fact, the authors identified a few studies that we had missed.3–6 The study outcomes for meta-analysis (frequency of positive urine cultures at 0–7 days after treatment and at 10 days to 15 months after treatment, and development of resistant organisms and recurrent UTI) were relevant and clearly defined. The authors provided appropriate and important meta-analysis measures including summary relative risks (RRs) and a quasi-NNT calculation with varying risk of treatment failure in the standard treatment group and confidence intervals corresponding to “best” and “worst” case scenarios. For their primary outcome, frequency of positive urine cultures 0–7 days after treatment, the authors found no significant difference between short (2–4 days) and standard (7–14 days) treatment (RR 1.06; 95% CI 0.64 to 1.76). This is in contrast to our finding of a 94 % increased pooled risk of treatment failure with short course treatment (≤3 days) compared to standard treatment (7–14 days) (RR 1.94, 95% CI 1.19 to 3.15; NNT=13, 95% CI 100 to 7). Why the discrepancy? We postulate a few possible explanations and conclude that the two meta-analyses, on closer inspection, actually have very similar results. Our omission of certain studies identified by Michael and colleagues may have biased our results. However, of the three …
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