This week’s New England Journal of Medicine has a—shall we say—rather frank exchange of views on the methods for assessing casualty rates in Iraq following the 2003 invasion. Readers may well wonder how it is that two studies of deaths in Iraq could come up with a ten-fold difference in reported deaths. The short answer is that the studies used different methodologies, for instance one measured only deaths directly due to violence while the other measured “excess deaths” of all causes relative to pre-invasion mortality rates.

But there is another report in the same NEJM that deserves our attention. A team of researchers collected data on 651 children treated for a type of leukaemia before the invasion, and showed that the economic sanctions had a devastating effect on chances of survival.

It would seem that the economic sanctions against Iraq, by interrupting the availability of chemotherapy, were directly responsible for the deaths of many children with acute lymphocytic leukaemia. And these deaths came from one disease in one Baghdad hospital. During the UN sanction period, drug shortages were a frequent occurrence in Iraq and often included antibiotics and other critical medications. Apart from medical supplies, the sanctions also interrupted the supply of clean drinking water and other public necessities. In short, the sanctions became a humanitarian disaster that is today almost impossible to quantify.

What I find particularly sad is that nobody comes out well from these findings. While the US and the UK were the most forceful proponents of the sanctions, they exempted medical supplies from the embargo. So Saddam Hussein has his own part to play in deliberately distorting the sanctions in order to make his own people suffer. If Hussein had complied with the rules of the sanctions, most of this misery would have been avoided. Does this get the pro-sanction nations off the hook? Of course not. The rationale behind the sanctions was that Hussein was an egotistical dictator who would stop at nothing to increase his wealth and power. To apply sanctions in such a way as to allow Hussein to manipulate them for his own political goals is like giving a loaded gun to a desperate man holding hostages. You don’t get to absolve yourself if things go wrong in such circumstances.

And the blame doesn’t stop there. It should be recalled that the UN Security Council, which refused to approve the 2003 invasion, had approved the sanctions — and kept them in place for 13 years. Apart from Germany, which I believe had a genuine moral opposition to the Iraq invasion, there is little doubt in my mind that most other opposing nations were quite happy to impose sanctions to so long as they got their cheap Iraqi oil and kept their Iraqi investments intact; for these nations, I believe their real opposition to the Iraq invasion was not humanitarian but because they feared a loss of influence in a post-Baathist Iraq.

I wish I could take something good from all this, but it is hard for me to escape the conclusion that tens or even hundreds of thousands of Iraqi children died in the interbellum period because political leaders around the world decided their lives were not all that important.

Tags: chemotherapy, deaths, iraq, leukaemia, mortality, nejm, new england journal of medicine, sanctions