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The current edition of The Lancet (27th May 2000, 355) carries two articles on Iraq : 'Sanctions and Childhood Mortality in Iraq' by Mohammed Ali and Iqbal Shah and "Baghdad 2000 - rubbish heaps and cesspits' by Peter Kandela, as well as the following editorial. Both articles can be read in full on the Lancet's website (www.thelancet.com, registration is free). Both The Independent and The Guardian have reported on the articles / editorials. %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% EDITORIAL This week's Lancet (p 1851 and 1893 ) carries two disturbing portraits of the health situation in Iraq, almost a decade after the overt hostilities of the Gulf conflict came to an end. Bringing the tools of epidemiology and demography to bear on war-ravaged areas is always difficult, and Iraq, despite its relatively well-developed infrastructure pre-war, has proved no exception. Earlier studies have been criticised, but Mohamed Ali and Iqbal Shah are very careful to reassure readers that their data from household surveys a year ago in southern/central Iraq and in the autonomous northern region are reliable. Peter Kandela tells us what it is really like in the capital, Baghdad, in April, 2000: "In the terrible afternoon heat . . . children were cooling themselves in a stinking cesspit . . . just a mile or so from the presidential palace". But which presidential palace? This innocent-sounding question sums up persisting doubts about President Saddam Hussein's priorities for his country. Despite the Oil-for-Food programme, his people are undernourished; resources better allocated to rebuilding the country's infrastructure are squandered on presidential pomp; and in the United Nations continuing suspicion of Saddam's intentions means that contracts for anything that might conceivably be weapons-related are put on hold. Last month more than 1000 applications to the UN Office of the Iraq Programme--most of them relating to Iraq's requirements for electricity, water and sanitation, transport, and communications, and valued at US$1·7 billion--were being held up. One very significant problem now is spare parts for the oil industry. There is no longer a UN-imposed ceiling on oil exports; the limiting factor is the state of Iraq's oil- production capacity. On food supplies, there is better news. UN agency reports from the mid-1990s recorded serious undernutrition. The government of Iraq had for a long time refused the plan for controlled exports of oil to be linked to equitably distributed imports of food and medicines, with the UN acting as banker and overseer; as a result, the first food arrived under the Oil-for-Food scheme only in April/May, 1997. Before this, Iraq's own food-rationing plan was yielding only about 1300 kcal daily; the UN's target "bread basket" provides 2150 kcal and next month this may be raised by a further 300 kcal. Whatever doubts there may be about Iraqi government cooperation in other respects, UN staff on the ground in Iraq believe that this sector of humanitarian aid is working well with little evidence of these supplies being diverted to the wrong hands. Nonetheless it would be no bad thing for the World Food Programme to repeat the surveys conducted 3 years ago. Such surveys might reveal neglected subpopulations or defects in the nutritional balance, such as too little protein and fresh fruit and vegetables. A wide range of factors conspires to bring about the current medical situation in Iraq. We cannot single out food shortages, reduced incomes, poor electricity and water supplies, shortages of drugs and medical equipment, the intellectual isolation, or the emigration of Iraqi professionals. The latest evidence shows that in the northern autonomous region child mortality is now improving while in the rest of Iraq it is getting worse. In a way this is a natural experiment but not one from which a practical conclusion can be drawn. Respect for the sovereignty of Iraq is central to UN policy, and the relatively privileged way in which aid is handled in the north cannot simply be extended to the south. The UN Secretary-General recognises that in terms of the United Nations objective to relieve suffering, the Iraq dilemma is almost unresolvable. " . . . here we are", he says "accused of causing suffering to an entire population". The UN risks "losing the argument, or the propaganda war--if we haven't already lost it--about who is responsible for this situation--President Saddam Hussein or the United Nations". Yet even Kofi Annan finds the only solution to be that Iraq complies in full with what the UN Security Council has demanded. The primary responsibility for this disaster is Saddam's. The UN, an increasingly divided UN we should add, has become a secondary perpetuator of it. The courageous policy--one by chance hinted at in the first of last week's Lancet essay series on violence--is to suspend (not abandon) sanctions lest upcoming generations of Iraqis, out of resentment, suffering, and isolation, grow up to be as aggressive as their current leader. -- ----------------------------------------------------------------------- This is a discussion list run by the Campaign Against Sanctions on Iraq For removal from list, email email@example.com Full details of CASI's various lists can be found on the CASI website: http://welcome.to/casi