December 2002/
January 2003

Views expressed are those of the authors, not necessarily of the AFSC.

"Collateral Damage": Health and Environmental Costs of War on Iraq

John Loretz is Program Director, International Physicians for the Prevention of Nuclear War

As the drumbeat for a war on Iraq pounded out of Washington, DC this fall, the airwaves were dominated by a very narrow set of concerns: the most effective way to eliminate Saddam Hussein's alleged weapons of mass destruction; the most effective way to eliminate Saddam Hussein; the Bush administration's heavy-handed efforts to get UN Security Council approval for a war that it desired to wage with or without such approval.

Lost in the white noise about regime change, terrorism, and "moral clarity" was any attention to the predictable effects of a US-led war on the Iraqi people, who were the primary casualties of the 1991 Gulf war and are certain to suffer death and injury on a large scale in a new war.

While estimates vary, there is general agreement that the 1991 war directly took the lives of more than 200,000 Iraqis, more than 100,000 of them civilians who died from the health effects of the war. In the decade that followed, between 300,000 and 500,00 additional deaths--mostly infants and children--could be attributed to the combined effects of a war-devastated economic and social infrastructure, a poisoned environment, and sanctions.

Despite some localized improvements since the implementation of the Oil for Food program, the health of the Iraqi people remains poor and would be subjected to further assault in a new conflict.

Might credible estimates of civilian casualties in a new war move the international community to demand non-violent measures to ensure Iraq's compliance with UN disarmament resolutions? With that goal in mind, the British affiliate of International Physicians for the Prevention of Nuclear War, Medact, decided to compile the best available evidence for the humanitarian costs of what military strategists considered the most likely course of armed conflict.

Basing their assumptions on US war plans leaked to and reported by the Washington Post in November, the authors of "Collateral Damage: The Health and Environmental Costs of War on Iraq" came to some stark and unambiguous conclusions, among them the likelihood that a US-led attack on Iraq could result in 48,000-260,000 deaths during the first three months of combat. Post-war health effects could take an additional 200,000 lives. At the most terrifying extreme--were a desperate Iraqi leadership to launch a chemical or biological weapons attack against Israel, provoking an already threatened Israeli nuclear response--the death toll in the region could reach as high as 3,900,000.

"Collateral Damage" was published on November 12, 2002 and was presented by Medact and IPPNW at press conferences in London and Washington, DC. IPPNW affiliates in more than a dozen other countries released the report to their own governments and media on the same day. Copies of the study were sent to members of Congress and to every permanent mission at the United Nations in New York.

Dr. Amy Sisley, a Professor of Surgery at the University of Maryland Medical System, and a member of IPPNW's US affiliate, Physicians for Social Responsibility, put the raw numbers into context for reporters at the National Press Club. "In an era where images of combat are beamed from aircraft," Dr. Sisley said, "it is too easy to forget about the direct, physical consequences of war. Bombs deafen, blind, and blow apart people, riddling them with shrapnel, glass, and debris. They collapse buildings on victims, including hospitals and clinics vital to treating the wounded. Unexploded ordinance left behind kills and maims, and battlefield toxins can contaminate the environment for decades."

Noting that "war is a major hazard to health and its impact may be felt months, years, or decades later" and that "modern warfare usually leads to more casualties among civilians than combatants," the authors of "Collateral Damage" cautioned readers that their research was hampered by an inadequate information base of sometimes dubious quality. Nevertheless, they expressed confidence that they had been able to arrive at a range of credible estimates.

Taking the Bush administration at its word that the aim of a war against Iraq is the overthrow and replacement of Saddam Hussein, the authors of the Medact report conclude that a new armed conflict will be "much more intense and destructive than in 1991, as well as using new, more deadly weapons developed in the interim."

In addition to immediate deaths and injuries among both combatants and civilians, the potential impacts of a prolonged and fiercely contested war on Iraq are described in the report as follows:

• Release of chemical, biological and possibly radioactive pollutants from bombing Iraqi weapons facilities, if US/UK allegations of stockpiling prove true;
• A public health crisis arising from huge infrastructure damage, including severe and possibly deliberate damage to an already weak medical infrastructure, shortage of water, food, and energy resources, lack of access to medical supplies and treatment, and consequent epidemic diseases;
• Possible sabotage of oil wells polluting the environment and damaging health not only in Iraq but throughout the region;
• Use of chemical and biological weapons (CBW) within and beyond Iraq;
• Possible nuclear retaliation by Israel, the US, and/or the UK in response to CBW strikes on Kuwait and Israel: a Hiroshima-size nuclear explosion over Baghdad could kill 66,000-360,000 people, while a modern-day thermonuclear bomb could kill 306,000-3,608,000, excluding long-term deaths and other effects;
• Possible civil war in Iraq, instigating famine, epidemics, and the flight of millions of refugees and displaced people;
• Global economic crisis through trade reduction and soaring oil prices with particularly devastating social and political consequences in developing countries.

The authors of "Collateral Damage" stress that they are not making an argument for doing nothing, acknowledging that "The brutal dictatorship of Saddam Hussein undoubtedly damages health in many ways, from direct action such as torture and execution to worse physical health and the mental and physical decline associated with living in fear."

Doing nothing, however, is not the only alternative to war. "In assessing how best to tackle this dangerous regime and work towards democracy and social justice for all," they assert, "the true cost of war must be calculated and widely debated. If the war is likely to cause worse problems than those it sets out to solve, then it is ill-advised under any circumstances, and other options must be explored."

Those options include designing sanctions that are narrowly focused on the Iraqi elite that keeps the regime in power; allowing time for weapons inspections to work and ensuring they are conducted objectively as well as thoroughly; encouraging the growth of a democratic and inclusive civil state in Iraq; supporting steps to reduce the global arms trade and to promote disarmament; and working through the UN to tackle the roots of Middle Eastern problems, including a just and fully enforced Israeli-Palestinian settlement.

The full text of "Collateral Damage," including technical data, figures, and sources, is on the Medact (www.medact.org) and IPPNW (www.ippnw.org) websites. For information, Gillian Reeve at Medact (gillreeve@medact.org) or Lynn Martin at IPPNW (617/868-5050, ext. 209; ldmartin@ ippnw.org). Contributions to support IPPNW's work may be sent to 727 Mass. Ave., Cambridge, MA 02139.

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