Publications

The war on Iraq and its aftermath exacted a heavy toll on combatants and civilians, who paid and continue to pay the price in death, injury and mental and physical ill health. Between 21,700 and 55,000 people died between March 20 and October 20, 2003 (the date on which this report went to press), while the health and environmental consequences of the conflict will be felt for many years to come.

This toll is calculated in a comprehensive, independent survey written and researched by health professionals for the Iraqi Health Monitoring Project, managed by Medact and part-funded by Oxfam and the Polden-Puckham Charitable Foundation. Its conclusions are based on the best available information on a range of health indicators from sources in the public domain, and observations from expert individuals and organisations in and outside Iraq.

The impact of war on health is usually assessed primarily in terms of its most direct and visible effects death and injury through conflict. Between 7,800 and 9,600 Iraqi civilians are estimated to have died in this way, and 394 Coalition combatants. Estimates of the number of Iraqi military deaths range from 13,500 - 45,000. In the absence of official body counts, the final toll will probably never be known. In addition, thousands of combatants on both sides as well as civilians suffered severe injuries, including amputations and mental trauma that triggers psychiatric disorders.

The full effects of war are, however, felt through many other less direct but potentially equally deadly or more deadly pathways. Here the death toll and disease burden could be numbered in tens of thousands. Yet it may never be known for certain, owing to the lack of accurate data, lack of functioning health information systems, lack of commitment to collecting or disseminating the data, and the absence of agreed conceptual models for measuring the effects of conflict on health.

The report assesses the impact of the war on the determinants of health, including limited access to clean water and sanitation; poverty and household food security; environmental degradation; disruption of social systems and public services, including health services; and social breakdown. There has been deterioration in all these determinants. The health of the Iraqi people is generally worse than before the war. And as documented in our earlier report, Collateral Damage: the health and environmental costs of war on Iraq (issued 12 November 2002), that state of health was already poor by international standards; any fresh conflict was likely to lead to further decline, at least in the short to medium term.

The impact of the war on the Iraqi environment is also documented. This includes extensive pollution of land, sea, rivers and the atmosphere that may have spilled over to neighbouring countries. Oil well fires created oil spills and toxic smoke. Troop movements destroyed fragile desert ecology. Explosive remnants of war and land mines killed and maimed people and animals and polluted the landscape. Bombardment destroyed topsoil and arable/grazing land as well as the physical infrastructure of buildings, roads, railways, power stations, sewage plants and telecommunications.

The report analyses the postwar occupation and reconstruction of Iraq from a health perspective. While acknowledging efforts to provide emergency health relief and restore battered health services, it notes that long-term health and wellbeing will depend on restoration of security, revitalisation of the economy, and reconstruction of all services that impact on health as well as regeneration of health services.

The report also advocates the need to study the long-term effects of war on mental and physical health, an internationally neglected issue despite the continuing presence of conflicts around the globe whose massive health and human cost is seldom fully counted.

Finally, the reports recommendations include a proposal for the re-establishment of an Iraqi health sector based on the principle that health and health care are fundamental social rights. Health system reconstruction provides an opportunity to correct past mistakes in the organisation of health services. It can be an important aspect of nation-building, and promote healthy inter-community and international relationships through which, as the World Health Organisation points out, health can act as a bridge to peace.