How Many Must Die?

It was a winter’s day, and I stood in an unheated room in a hospital in the ancient city of Mosul, Iraq. I was surrounded by children afflicted with a blood disease known as septicemia. I turned to our guide, a member of the Iraqi Red Crescent Society, and asked him about the prognosis for the children. Normally a calm, restrained man, he turned toward me with a look I had not seen on his face before. He appeared exasperated by my asking the prognosis for each child.

“Mr. George,” he said, “sometimes you know because of the shortage of medicines, they are all of them going to be dead.”

Then he turned away. At that moment, one of the doctors, a young woman, began to cry. Her colleague confided in English to me, “We have the skills, the training and all we can do is provide supportive care. Please understand, sometimes it is more than we can bear.”

I offered a teddy bear to a little boy nearby. His mother was standing between him and his brother. Both were dying from septicemia. Two other children from the same family had already died from this disease. The woman took the toy from her son’s hands and returned it to me.

“We don’t want toys,” she said in anger. “We want medicine.”

As a delegate with various humanitarian organizations, I have made four trips to Iraq in the past 18 months. I have spent much time on the pediatric and oncology wards of many public hospitals in Iraq, including in the cities of Mosul and Arbil in the north, Baghdad in the central region, and Basra in the south. In the hospitals, one sees most clearly the destructive force of sanctions and their impact on the young.

Iraq’s 23 million people have been living under sanctions for more than eight years. The sanctions were first imposed by the United Nations, under the leadership of the United States, in August 1990 following Iraq’s invasion of Kuwait. After the Gulf War, the economic sanctions remained in effect. They will continue until Iraq concedes to a list of conditions, including the elimination of its weapons of mass destruction and ongoing UN monitoring of its weapons capacity.

While nominally targeted at the government of Saddam Hussein, the sanctions have imposed conditions of life calculated to maximize suffering for the majority of Iraq’s citizens. In this regard, sanctions have been stunningly successful. Eyewitness testimony, as well as reports by UN humanitarian agencies, provide incontrovertible evidence of the price being paid by the people of Iraq, in particular the children and their grandparents.

Unnecessary Death

According to figures cited by United Nations officials, more than 1 million people — including 750,000 children below the age of five — have died in Iraq as a result of scarcity of food and medicine. Furthermore, 32% of Iraqi children under five are chronically malnourished. Almost one-quarter are considered underweight, twice as high as the levels in neighboring Jordan or Turkey, according to a 1997 UNICEF report.

UNICEF investigators point out that “malnutrition was not a health problem in Iraq prior to the embargo. Its extent became apparent during 1991, and the prevalence has increased greatly since then.”

Every day, an estimated 250 people die as a result of health problems related to the sanctions. Children under age five, who account for almost half of such deaths, are dying mainly due to diarrhea, pneumonia, and malnutrition.

Prior to sanctions, health care in Iraq was free and first-rate. Not any more. Now all the public hospitals lack even adequate sanitation and are forced to charge patients for most services.

Furthermore, the sanctions include an “intellectual boycott,” which cuts Iraqis off from international medical and scientific advances. For almost a decade, Iraqi physicians have been without access to current medical literature or contact with health professionals in other countries.

The economy, meanwhile, is in a shambles, and the GDP per capita has plummeted from $3,500 to $600. Public workers now earn an average of $3-5 a month, and at least 80% of a family’s income is spent on food, according to UNICEF. Public rations have been instituted, but food is in short supply and the rations do not provide sufficient minerals, vitamins, or nutrients.

The devastation of the sanctions follows massive destruction as a result of the 1991 Gulf War, in which the U.S. and its allies carried out more than 100,000 sorties against Iraq in a six-week period. An estimated 88,000 tons of bombs were dropped — an explosive tonnage equivalent to seven Hiroshima-type atomic bombs, according to the American Friends Service Committee (AFSC). In addition to military targets, the aim of this massive aerial bombardment was the destruction of the country’s life support system, especially its ability to produce and distribute clean, potable water to its citizens. Because of sanctions, water and sewage treatment plants continue to operate at a critically reduced capacity. Water-borne diseases such as gastroenteritis, cholera, typhus, and typhoid fever are common.

Cancers Increase

On one of my visits to Iraq, I went to the Saddam Teaching Center in Baghdad where Dr. Muhammed Hillal, chief of pediatrics, took me to the children’s oncology unit. In Iraq, prior to 1990, the remission rate for leukemia and other forms of cancer was about 70%, comparable to what it is the United States. Now, Dr. Hillal said, it is between 6% and 7%. Dr. Hillal maintains that there has been a six-fold increase in childhood cancer since the imposition of sanctions. He attributes the increase to the toxins from the weapons of coalition forces during the Gulf War, along with all the other toxins released into the environment as a result of the war.

Dr. Hillal introduced me to a 14-year old girl named Shaima. She was too weak to even lift her head. “She has maybe one or two days,” he confided in me. “The family has sold everything for treatment, and the hospital pharmacy has no more drugs to administer.”

As I gently touched Shaima’s fevered cheek, hoping to convey the love and sorrow I felt in my heart, her parents and grandparents, presuming I was a doctor, reached out to me and begged for medicine. I had nothing to give them but compassion and I knew that would not be enough.

In October, during my most recent visit, I returned to the Saddam Teaching Hospital. This time I met with Dr. Khalid, the senior resident of pediatrics, and Dr. Raad, head of the children’s oncology unit. Dr. Khalid, a thin man with a buoyant disposition despite the conditions under which he works, remembered me from previous visits and greeted me with deep affection. He took time from his schedule to escort me to the Intensive Care Unit (ICU) for children. Most of the patients were suffering from severe diarrhea and vomiting.

“This is because of the pollution of our water,” Dr. Khalid explained. “You know that we don’t have spare parts for our purification plants. This is an extreme difficulty in this hospital. We have more than 2,000 patients per day. You can’t imagine. We use a lot of water but because of the impurity, we cannot manage our patients properly.”

One child in the ICU had been accidentally poisoned with organic insecticide. There was no hope for his recovery. When his mother understood the reason for my visit, she became quite disturbed. “Why is the American President killing the Iraqi people?” she asked. “He doesn’t hurt our government, only the little children.”

Later, on the oncology ward, Dr. Raad took me on his rounds. I looked around the room at all the children and their mothers. The air conditioning wasn’t working. The temperature must have been over 100 degrees. Through broken windows, flies swarmed. Volunteers rolled a cart into the room containing a tureen full of a pasty gruel, the only food the hospital could provide. As I was about to leave, I noticed a young girl staring at me.

“Hanna!” I shouted, remembering her from the first time I had come to this hospital.

“Mr. George, how are you?” she asked, as delighted to see me as I was to see her. Hanna, who is 11, has been out of school for two years. She works at the hospital with her mother, who is a cleaner. Her father has been unable to find work.

Hanna and I teased each other in the hallway as I followed Dr. Khalid and Dr. Raad back to the main entrance. After we said good-bye, Hanna ran after me. “This is for you,” she said, placing a wild rose in my hand. Then she blushed and raced back inside the hospital.

Too Tired to Beg

On foot, I found my way to Sahat Al Tahreer, near the center of old Baghdad. Along the sidewalk of Al Rashid Street, vendors had set up shop selling whatever they could: cigarettes, candy, shoes, sandals, kerosene, household utensils. One man stood behind a scale. He had nothing to sell but the service of weighing. A line of men, with sunken cheeks, polished and buffed the shoes of those a bit more fortunate.

Under a sycamore, a mother sat. Her child, a girl of six or so with match-stick limbs, lay semi-conscious on a towel in front of her. The mother brushed flies away from the girl’s face. She didn’t put out her hand or ask for money. She only sat there, too weak, too disconsolate even to beg.

A block later, three older women in black pleaded for help. Dozens of young boys crowded around me, pressing me to buy chewing gum or give them money. I walked faster. I knew from experience how volatile the streets of Iraq can be. Because so many are in so much in need, giving money or a simple gift can be as deadly as flicking a lit match on a pool of gas.

About one mile from Sahat Al Tahreer, I crossed over to Sadoon Street. I came upon hundreds of children and women begging. I felt overwhelmed with sorrow and helplessness. There was nothing I could do but avert my eyes, even as my heart was taking hold of their need, even as my hand clutched the rose Hanna had given me, even as I bore the weight of all the tears that had fallen on me that day.