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Re: March 24

Subj:   Articles Sanctions/Cuba and Iraq
Date:   03/31/2000 12:36:34 AM Central Standard Time
From:   Hammondc

There were some articles published in the January 18, 2000 Annals of Internal 
medicine concerning sanctions.  Perhaps a letter to the editor commending the 
American College of Physicians-Society of Internal Medicine and answering the 
Madeleine Albright editorial would be in order.  I have lifted the high 
points and summarized below.  If you would like me to fax the entire text of 
the articles, please let me know.  

Karine Morin and Steven H Miles for the Ethics and Human Rights Committee of 
the American College of Physicians-American Society of Internal Medicine 
reviewed the impact of sanctions on civilians.  They state, "In contrast to 
war's easily observable casualties, the apparently nonviolent consequences of 
economic intervention seem like an acceptable alternative.  However, recent 
reports suggest that economic can seriously harm the health of persons who 
live in targeted nations."    In a paragraph that clearly alludes to Iraq 
(the references are articles about Iraq), they state that in countries where 
broad economic sanctions are applied, malnutrition caused by the high cost 
and shortage of food is often a leading cause of morbidity and death among 

Even in instances where humanitarian good, such as food and medicine, are 
exempt from sanctions, there is often little practical effect if foreign 
currency is not available to import such goods, foreign bank accounts are 
frozen, or borders are closed.  Other types of trade restrictions, such as 
strict requirements for export licenses and/or restrictions on 
transportation,  may make the terms of trade "virtually unattainable."

The American Public Health Association has already developed a policy 
addressing economic sanctions.  The recommendations of the Ethics and Human 
Rights Committee (supported by the AMA) include:
1.  Excluding from sanctions humanitarian goods, such as food- and 
health-related materials or medical supplies, that are deemed likely to 
reduce the morbidity or mortality of civilians. 
2.  Empowering qualified and neutral agencies to publicly and expeditiously 
address humanitarian appeals for exemptions, to conduct and disseminate 
analyses of the health effects of economic sanctions, and to monitor and 
report the effects of the sanctions on an ongoing basis. 
3.  Providing medical and health-related supplies and services to offset any 
increased morbidity caused by sanction. 
4.  Monitoring and reporting the effective delivery of medical and 
health-related materials. 

Michele Barry published "Effect of the U.S. Embargo and Economic Decline on 
Health in Cuba."  She travels to Cuba as a member of a working group for the 
Social Science Research Council.  She writes about the health care system of 
Cuba which in the late 1980s and 1990s was far better than in other Latin 
American countries.  However, the fall of the Soviet Union and mergers of 
U.S. pharmaceutical and biotechnology companies have created a "progressive 
lack of critically needed medicines, diagnostic tools, vaccines, and medical 
machinery that had previously been available or affordable.  She documented 
food shortages and stated that the median weight of children and adults has 
decreased dramatically because the amount of food supplied at workplaces and 
schools has been substantially reduced.  

Several public health catastrophes on the island have been directly 
attributed to the U.S. embargo.  In 1992 and 1993, more than 50,000 cases of 
optic and peripheral neuropathy occurred.  This epidemic was attributed to 
reduced nutrient intake, which was caused by food shortages, and local 
tobacco use, which increased the risk for blindness.  Use of costly 
multivitamin supplements dramatically decreased the incidence of blindness.  
An additional epidemic of esophageal stenosis in toddlers who inadvertently 
drank liquid lye is believed to be the result of a soap shortage that caused 
Cubans to use lye as a substitute.  A 1994 outbreak of the Guillain-Barre 
syndrome in Havana was caused by water that had been contaminated with 
Campylobacter species because chlorination chemicals were not available for 
purification.  Serious shortages of insulin, other medications, and vaccines 
have also taken their toll, especially on the health of children.  

The article discusses the more recent developments in the ambulatory 
treatment of  HIV-positive individuals which both has reformed the previous 
system, provided excellent care, and resulted in the lowest reported 
prevalence of HIV in the hemisphere.  

The SSRC has initiated requests for proposals for academic collaboration 
between scholars in Cuba and North America (Http://, 
and U.S. medical student rotations and residency rotations will be permitted 
in rural Cuba under the sponsorship of a nonprofit US organization, Medical 
Education Cooperation with Cuba (MEDICC) 

She states, "The U.S. embargo against Cuba, one of the few that includes both 
food and medicine, has been described as a war against public health with 
high human costs."  She recommended that medicine, food, and water 
purification materials should be made available or, preferably, should be 
exempt from sanctions.  Official monitoring of the effects of economic 
sanctions on civilian populations should become a high priority.  

In an Addendum: In August 1999, the US Senate voted 70 to 28 in favor of 
eliminating unilateral export bans in an amendment to next year's 
agricultural appropriations bill.  This would have effectively ended the 
embargo on exporting food to Cuba.  The U.S. House of Representatives 
subsequently deleted this amendment in a House-Senate closed committee 
session.  The US. Senate leaders are planning yet another vote on legislation 
(Dodd/Serrano legislation S. 926/H.R. 1644) that would permit the sale of 
food and medicine to Cuba.  The date for this vote was not available at the 
time this article went to press.  

Finally, the Madeleine K. Albright editorial:  
She cites "overwhelming evidence" of the need for continuing sanctions as a 
means of pressure against Saddam Hussein.  She states the U.S. took the lead 
in offering the "oil-for-food program, but that "Saddam long resisted this 
plan because he wanted to use his people's suffering to mobilize public 
opposition to sanctions."  She states that Iraq is now importing as much food 
and exporting almost as much oil as it did before the Gulf War.  She cites 
the disparity between the situation in Northern Iraq compared to the area 
controlled by Saddam Hussein's government as further evidence that Saddam 
Hussein is causing the suffering of the Iraqi people.  According to the UN, 
the Iraqi government has spent only $9.5 million of the $25 million that has 
been set aside for nutrition supplies for vulnerable children, pregnant 
women, and nursing mothers.  Other charges include $300 million in 
undistributed medical supplies, ordering of expensive equipment when primary 
care needs are unmet, and diversion of food and medicine purchased under the 
oil-for-food program.  She stated that they also have evidence that the Iraqi 
military bulldozed 160 homes in the town of Almasha in June 1999 after local 
citizens protested the governments failure to distribute food and medicine.  
She also states that the regime is squandering money on palaces, etc.....

She also says that Cuba is another government that blames its failures on the 
sanctions.  Within the limits of the 1992 Cuban Democracy Act, the Department 
of Commerce licensed approximately $45 million in medical sales in 1998 and 
the first half of 1999 and more than $100 million in humanitarian donations 
of medicine and medical equipment.  

Any help that you could provide in finding credible sources to quote in 
answer to the Albright editorial would be appreciated, or better if you know 
of a physician who could quickly respond, please let me know. 

Connie Hammond
Columbus, Ohio

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