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/.