The Politics of Dead Iraqi Babies

By MATT WELCH

So how many Iraqi children are dying due to United Nations sanctions? Osama bin Laden claims "a million innocent children," and says that's a leading reason why Americans need to be blown up. Anti- sanctions advocate John Pilger maintains that, according to the United Nations Children's Emergency Fund, "at least 200 children are dying every day … as a direct result of sanctions." Letter writers to virtually every U.S. newspaper, citing the United Nations, have put the number at a cool 5,000 a month.

All of these widely quoted statements are false.

As we brace ourselves for a possible war against Saddam Hussein over his noncompliance with the weapons inspections mandated by the 11-year-old sanctions regime, it's worth trying to figure out whether U.S.-led policy is destroying innocent lives, and undermining America's moral high ground.

Unfortunately, pro- and anti-sanctions partisans have obscured the issue with misinformation that needs clearing away before any honest analysis can take place.

Estimates of "excess" child deaths -- the number above the "normal" mortality rate -- vary widely due to politics and inadequate data, especially concerning children older than 5. The Iraqi regime, which has blamed nearly every civilian funeral since 1991 on sanctions, claims there have been more than 600,000 under-5 deaths these past 11 years (4,500 per month), and 1.5 million overall.

Arriving at a reliable raw number of dead people is hard enough; assigning responsibility for the ongoing tragedy borders on the speculative. Competing factors include: sanctions, drought, hospital policy, breast-feeding education, Saddam Hussein's government, depressed oil prices, the Iraqi economy's overdependence on oil exports and food imports, leftover destruction from the Iran-Iraq and Persian Gulf wars, differences in conditions between the autonomous north and the Saddam-controlled south, and a dozen other variables difficult to measure without direct independent access to the country, which Hussein forbids.

Yet this murkiness has not deterred advocates on all sides from claiming absolute certainty on the issue. The warmongering New Republic, for example, announced in October that the notion that "sanctions have caused widespread suffering" was simply "false." Meanwhile, the leaders of the anti-sanctions movement in the United States continue to describe U.N. policy as "sanctioned mass murder that is nearing holocaust proportions."

The idea that sanctions have killed a half-million children (or 1 million, or 1.5 million, depending on the imagination of the source) took root in the mid-1990s, based on a comedy of error-filled data.

In August 1995, the U.N. Food and Agriculture Organization gave officials from the Iraqi Ministry of Health a questionnaire on child mortality and asked them to conduct a survey in the capital city of Baghdad. On the basis of this five-day, 693-household, Iraq- controlled study, the FAO announced in November that "child mortality had increased nearly fivefold" since before sanctions. As embargo critic Richard Garfield, a public health specialist at Columbia University, noted in his own 1999 survey of under-5 deaths, "The 1995 study's conclusions were subsequently withdrawn by the authors. … [Yet] their estimate of more than 500,000 excess child deaths due to the embargo is still often repeated by sanctions critics."

In March 1996, the World Health Organization published its own report on the humanitarian crisis. It reprinted figures -- provided solely by the Iraqi Ministry of Health -- showing that a total of 186,000 children under the age of 5 died between 1990 and 1994 in the 15 Saddam-governed provinces. According to these government figures, the number of deaths jumped from 8,903 in 1990 to 52,905 in 1994.

Then, a New York-based advocacy outfit called the Center for Economic and Social Rights (CESR) took a look at the Iraqi government's highest numbers, and promptly tripled them. In May 1996, CESR concluded that "these mortality rates translate into a figure of over half a million excess child deaths as a result of sanctions."

That report might well have ended up in the dustbin of bad mathematics had a CESR fact-finding tour of Iraq not been filmed by Lesley Stahl of "60 Minutes." In a May 12, 1996, Emmy-winning report, Stahl threw CESR's fanciful conclusions at Madeleine Albright, then the U.S. ambassador to the United Nations. "We have heard that a half million children have died," Stahl said. "I mean, that's more children than died in Hiroshima. And -- and you know, is the price worth it?" Albright replied, "I think this is a very hard choice, but the price -- we think the price is worth it."

It was the nondenial heard 'round the world. In the hands of sanctions opponents and foreign policy critics, it was portrayed as a confession of fact, even though neither Albright nor the U.S. government has ever admitted to such a ghastly number (nor had anybody aside from CESR and Lesley Stahl ever suggested such a thing as of May 1996). The "60 Minutes" exchange is well-known to readers of Arab newspapers, college dailies, and liberal journals of opinion.

The other, far more credible source of the 500,000 number comes from a pair of 1999 UNICEF studies that estimated the under-5 mortality rates of Saddam-controlled Iraq and the autonomous north, based on interviews with a total of 40,000 households. "If the substantial reduction in the under-five mortality rate during the 1980s had continued through the 1990s," the report concluded, "there would have been half a million fewer deaths of children under 5 in the country as a whole during the eight year period 1991 to 1998." Or around 420,000, had the mortality rate stayed at 1989 levels.

Yet mortality actually decreased in the north (from 80 per 100,000 in 1984-89 to 71 in 1994-98) while more than doubling in the south (from 56 per 100,000 to 131). When the report was released, UNICEF Executive Director Carol Bellamy attributed the discrepancy to "the large amount of international aid pumped into northern Iraq at the end of the [Persian Gulf] war."

Increased mortality in the south, UNICEF concluded, was due to several factors, including a dramatic increase in the bottle-only feeding of infants in favor of more nutritious breast milk. "It's very important not to just say that everything rests on sanctions," Bellamy said in a subsequent interview. "It is also the result of wars and the reduction in investment in resources for primary health care."

But in the hands of sanctions opponents and some news organizations, these findings were translated into a U.N. admission that sanctions were "directly responsible" for killing half a million children (or even "infants"). In the first three weeks after Sept. 11 alone, the UNICEF report was mischaracterized in more than a dozen prominent U.S. newspapers

By November, UNICEF was annoyed enough with the misrepresentations to send out a corrective press release insisting that the surveys were never intended to produce an "absolute figure" of deaths, and that the half-million number assumed conditions that just didn't exist: "In other words if there hadn't been two wars, if sanctions hadn't been introduced and if investment in social services had been maintained -- there would have been 500,000 fewer deaths of children under five."

Sanctions critics almost always leave out one other salient fact: The vast majority of the horror stats they quote apply to the period before March 1997, when an oil-for-food program that had long been rejected by Saddam Hussein finally delivered its first boatload of supplies, nearly six years after the U.N. first proposed the idea. In the past four years, Iraq has sold enough oil to bring in $18 billion worth of humanitarian products and oil-equipment supplies, with another $16 billion on the way.

As the U.N. Office for the Iraqi Program stated in a Sept. 28 report, "With the improved funding level for the program, the government of Iraq is indeed in a position to address the nutritional and health concerns of the Iraqi people, particularly the nutritional status of the children."

What of the other side's obfuscations? They're usually based on the improving mortality rates of the three northern provinces.

The New Republic claims the region "is subject to exactly the same sanctions as the rest of the country." This is false: Under the oil- for-food regime, the north, which contains 13 percent of the Iraqi population, receives 13 percent of all oil proceeds, some of it in cash. Saddam's regions, with 87 percent of population, receive 59 percent of the money (recently increased from 53 percent), none of it in cash.

So whom can you trust?

I was impressed with the way Richard Garfield of Columbia University compared Iraq to other countries under sanctions, picked apart the methodologies of studies that came before, and freely admitted which of his data points were weakest. (You can see for yourself at www.cam.ac.uk/societies/casi/info/garfield/dr-garfield.html.)

His conclusion: Between August 1991 and March 1998, there were between 106,000 and 227,000 excess deaths of children under 5 (he recently updated the "more likely" latter number to 350,000 by the end of last year).

The chief causes, in Garfield's view, were "contaminated water, lack of high quality foods, inadequate breast feeding, poor weaning practices and inadequate supplies in the curative health care system. This was the product of both a lack of some essential goods, and inadequate or inefficient use of existing essential goods." And, of course, sanctions.

"Even a small number of documentable excess deaths is an expression of a humanitarian disaster, and this number is not small," he concluded.

"Excess deaths should … be seen as the tip of the iceberg among damages to occur among under 5-year-olds in Iraq in the 1990s. … The humanitarian disaster which has occurred in Iraq far exceeds what may be any reasonable level of acceptable damages according to the principles of discrimination and proportionality used in warfare. … To the degree that economic sanctions complicate access to and utilization of essential goods, sanctions regulations should be modified immediately."

Ultimately, the question of sanctions is inextricably tied to the threat of Saddam Hussein developing weapons of mass destruction.

But knowing, or at least estimating honestly, that sanctions have contributed to the deaths of more than 100,000 children is the first step in confronting what seems clearly to be a failed policy.

If the anti-sanctions cause is just, it will survive the truth.