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------- Forwarded message follows ------- Date sent: Fri, 18 Aug 2000 02:24:32 +1000 To: (Recipient list suppressed) From: Lynette Dumble <email@example.com> Subject: [GSN] Part 2: Economic Sanctions - Annals of Internal Medicine exposed as agent of State Dept! "http://www.annals.org/issues/current/full/200008150-00018.html#top" Annals of Internal Medicine, 15 August 2000 Volume 133 Number 4 LETTERS Economic Sanctions and Embargoes Letters on: Pages 308-312 TO THE EDITOR: Physicians are compelled to relieve suffering. The Ethics and Human Rights Committee's recommendations (1) to ameliorate the public health effects of sanctions are a welcome first step toward helping vulnerable people in the affected countries. Although we should investigate and analyze the public health effects of sanctions and embargoes, we should never forget that the biggest threats to public health in the sanctioned nations are their leaders. In the Balkans, Slobodan Milosevic has unleashed wars over the past decade that dramatically affected the public health of nearly all the former Yugoslav republics, while spilling over the borders of Yugoslavia into Macedonia and Albania. Like Saddam Hussein, this indicted war criminal does not hesitate to cause his people, and especially the vulnerable groups, to bear the enormous public health consequences of his political self-preservation. Yugoslavia and Iraq are only two examples of countries whose tyrannical leaders cause real threats to public health. If physicians are to be concerned about the public health of these nations, the issue becomes how best to deal with the public health threat. The only alternative to embargoes, other than war, is to rescind sanctions completely. To do this is to unleash these despots on their own people and their neighbors, precipitating even larger public health crises. If the members of the American College of Physicians-American Society of Internal Medicine are to wade into the public health controversy surrounding sanctions and embargoes, we must do so with the sober realization that good intentions toward the affected nations may have unintended consequences. There will always be suffering in nations as long as irresponsible leaders govern them. While we are obligated to do whatever possible to relieve that suffering, we cannot be blind to the realities of complex humanitarian emergencies. To do so puts the College at risk for becoming a cheap propaganda tool for the real public health problems. Michael Brumage, MD Pearl City, HI 96782 References 1. Morin K, Miles SH. The health effects of economic sanctions and embargoes: the role of health professionals. Ethics and Human Rights Committee. Ann Intern Med. 2000;132:158-61. ============= TO THE EDITOR: Morin and Miles (1) do a great service to the medical community and the general public by detailing the ethical issues involved in the imposition of harsh economic sanctions that so clearly affect the health and well-being of target populations, who are always the most vulnerable sectors bearing the brunt. Secretary of State Madeleine Albright's counterpoint editorial (2) claims that Iraq is now importing as much food now as before the Gulf War. Because she does not cite any source for this claim, I regard it as skeptically as I do many other such "statistical" claims by the State Department that are demonstrated to be meretricious and patently false on further examination. Whether Albright's claim is true or not is beside the point. As Morin and Miles point out, the humanitarian crisis engendered by sanctions such as those currently used against Iraq does not cause one-dimensional damage. The long-term effects of malnutrition are not overcome quickly; many are permanent. Compounding the problem are the health effects of substandard medical care, caused by de facto embargoes on so many items necessary for even standard medical care. Finally, what good is adequate nutrition if contaminated water is used to wash it down, thanks to the deliberate bombing of the civilian infrastructure by the "allied" forces during the Gulf War? Ken Freeland Houstonians against U.S. Military Involvement Houston, TX 77004 References 1. Morin K, Miles SH. The health effects of economic sanctions and embargoes: the role of health professionals. Ethics and Human Rights Committee. Ann Intern Med. 2000;132:158-61. 2. Albright MK. Economic sanctions and public health: a view from the Department of State [Editorial]. Ann Intern Med. 2000;132:155-7. ===================== TO THE EDITOR: I would like to congratulate Annals for publishing the papers on the ethics of sanctions and the effects of sanctions on the health of nations, particularly Cuba (1, 2). As part of the wider international medical community, I take exception to the offering of propaganda space to the U.S. Secretary of State, Madeleine Albright (3). Because of the prestigious reputation of Annals, I fear that Ms. Albright's comments might attain some validity. It seems obvious that she must not have read the two articles she refers to in her editorial (3). An even cursory glance at the Table in Dr. Barry's article (1) would suggest that the "failed" system of government in Cuba has certainly not failed its own people. With regard to Albright's comment about "the challenge of responding to regimes that ignore international law and run roughshod over the rights of their own people," surely a case could be made for removing the plank from one's own eye before the splinter from one's neighbor's. It is Albright's own administration that violates international law, as explicitly pointed out by Morin and Miles (2). Finally, Albright's comments under the heading "Helping the People of Cuba" prompt my earnest hope that the people of my country are spared any consideration of Albright's condescending and dangerous "benevolence." I congratulate Annals for highlighting the appalling situation caused and perpetuated by what I perceive as an illegal blockade against a country whose only crime is to seek an independent course for its own people. This is a cause that Ireland has fought for (to international acclaim) for 700 years and that was cherished in the United States until recently. David P. Hickey, FRCSI Beaumont Hospital Dublin, Ireland References 1. Barry M. Effect of the U.S. embargo and economic decline on health in Cuba. Ann Intern Med. 2000;132:151-4. 2. Morin K, Miles SH. The health effects of economic sanctions and embargoes: the role of health professionals. Ethics and Human Rights Committee. Ann Intern Med. 2000;132:158-61. 3. Albright MK. Economic sanctions and public health: a view from the Department of State [Editorial]. Ann Intern Med. 2000;132:155-7. =============== TO THE EDITOR: Madeleine Albright (1) ignores recommendations from recent United Nations agency reports (2-4) and simply restates State Department policy. Surely we can expect initiatives from the U.S. government that go beyond the demonization and denunciation of Iraq's political leadership. Iraq's humanitarian budget comes from sale of its oil, the proceeds of which are placed in a United Nations escrow account. Each contract submitted by the Iraqi government must be approved by the United Nations Sanctions Committee, which consists of representatives of Security Council member states. If a single member questions a contract, it is placed on "hold." It is not surprising that most holds are placed by the United States. As of 15 November 1999, the value of contracts on hold exceeded $1 billion (5). This figure had not substantially changed as of 5 June 2000 according to the United Nations Office of the Iraq Programme. According to the Secretary-General's report of 12 November 1999 (2), nearly 18% of all applications for humanitarian supplies to Iraq have been placed on hold. In the health sector, such items have included growth media, diagnostic tests, diagnostic equipment using computers (such as computed tomographic scanners and x-ray machines), ventilators, and intensive care unit monitoring systems. Health professionals can play an important role as advocates and mediators in the sanctions debate. Iraq's 10 medical colleges are in desperate need of continuing education materials and recent textbooks for their medical libraries. Opportunities should be created for senior Iraqi physicians and academicians to meet with their U.S. counterparts in conferences and workshops to foster the kind of "people-to-people" ties that are now possible in our relations with Cuba. Leila Richards, MD, MPH Brooklyn, NY 11201 References 1. Albright MK. Economic sanctions and public health: a view from the Department of State [Editorial]. Ann Intern Med. 2000;132:155-7. 2. United Nations Security Council. Report of the Secretary-General pursuant to paragraph 6 of Security Council resolution 1242 (1999)S/1999/1162, 12 November 1999. 3. United Nations Security Council. Review and Assessment of the Implementation of the Humanitarian Programme Established Pursuant to Security Council Resolution 986. S/1999/356, 30 March 1999. 4. UNICEF. Situation analysis of children and women in Iraq. Baghdad: UNICEF; 30 April 1998. 5. United Nations Office of the Iraq Programme. "http://www.un.org/depts/oip" ================== TO THE EDITOR: Hans von Sponeck, the former United Nations Humanitarian Coordinator for Iraq, predicted that in 20 years, universities in the United States will be using the sanctions on Iraq as an example of how not to pursue foreign policy. The publication of articles on the effects (1) and rationalization (2) of embargoes on Cuba and Iraq holds promise of accelerating realization of von Sponeck's vision. Morin and Miles (3) provide a welcome departure from ethical neutrality toward moral responsibility in international health scholarship. Madeleine Albright's editorial (2) is essentially an exercise in personalized blame and elaboration of her 1996 judgment, as articulated in an interview on the television show 60 Minutes. In that interview, she maintained that the death of thousands of Iraqi children is "worth it." Illustrative of ahistorical analytical reductionism, Albright's editorial circumvents the framework of asymmetrical "new"-world-order global power and regional geopolitics, within which sanctions are selectively imposed and human suffering is reproduced. The humanitarian pretense, similar to the vocabulary of "collateral damage," is contradicted by credible evidence of deliberate destruction of Iraq's public service infrastructure, notably electrical-power generation and distribution facilities, so as to "degrade the will of the civilian population" (4). As a consultant to the United Nations Children's Fund (UNICEF), I reviewed Iraq's health situation before and after 1990. This exercise brings into focus the combined adverse effects of infrastructure destruction and the imposition of sanctions. Particularly relevant in this regard is the temporal specificity of serious compromise of the role of the welfare state. As for the "oil-for-food" program mentioned by Albright in her editorial, this is hardly a solution to the complex of adverse effects of sanctions (5). Consideration of related factors, such as soaring inflation, declining health services, and erosion of the skills of health professionals, is imperative in any analysis that claims scientific validity. Soheir A. Morsy, PhD Washington, DC 20016 References 1. Barry M. Effect of the U.S. embargo and economic decline on health in Cuba. Ann Intern Med. 2000;132:151-4. 2. Morin K, Miles SH. The health effects of economic sanctions and embargoes: the role of health professionals. Ethics and Human Rights Committee. Ann Intern Med. 2000;132:158-61. 3. Albright MK. Economic sanctions and public health: a view from the Department of State [Editorial]. Ann Intern Med. 2000;132:155-7. 4. Cruise Missiles: Proven Capability Should Affect Aircraft and Force Structure Requirements. Document 95-116. Washington, DC: General Accounting Office; 1995. 5. El-Bayoumi A. Sanctions, strikes and oil for food: humanitarianism of the "new" world order. AAUG Monitor. 2000;15:10-4. =================== TO THE EDITOR: Madeleine Albright asserts that in Cuba, "food and medicine have always been exempt from sanctions" (1). Yet Cuba's health system (operated by the Cuban government) is absolutely banned by the U.S. embargo from purchasing basic foodstuffs and is severely restricted from purchasing medicines and medical equipment from U.S. companies worldwide. The State Department has knowingly made false and misleading statements to Congress and the public about the Cuban embargo to obfuscate the agency's role in violating the most basic of universally recognized human rights. By repeatedly carrying out such deception, the State Department has made a significant contribution to blocking legislation to restore shipments of food and medicine essential to the health of Cuba's civilian population. The Table outlines other falsehoods promulgated on the Internet by the State Department through its Fact Sheet, originally published on 5 August 1997 ("http://www.state.gov/www/regions/ara/fs_cuba_healthcare_970805.html"). One can only assume that the misrepresentations are deliberate because they were brought to the attention of the State Department by me (2-4) and other people (5) over the past 2 years. On 24 July 1997, the State Department told the Los Angeles Times that it would evaluate research data on the issue and would correct any errors in its Fact Sheet. No correction has been forthcoming, and the agency is now refusing to respond or otherwise discuss the scientific data. The deception is being maintained by a "wall of silence." While a difference of opinion over what is the best foreign policy is one thing, deliberately misrepresenting the facts is quite another, especially when the consequence of the deception contributes to the denial of food and medicine to civilians. Anthony F. Kirkpatrick, MD, PhD University of South Florida Tampa, FL 33612-4799 References 1. Albright MK. Economic sanctions and public health: a view from the Department of State [Editorial]. Ann Intern Med. 2000;132:155-7. 2. Kirkpatrick AF. The US attack on Cuba's health [Editorial]. CMAJ. 1997;157:281-4. 3. U.S. House Committee on Ways and Means, Subcommittee on Trade. The State Department changes the record on Cuba: U.S. Agencies and World Health Organization misrepresented. Testimony by Anthony Kirkpatrick and Harry Vanden. Washington, DC: 7 May 1998. 4. Kirkpatrick AF. Role of the USA in shortage of food and medicine in Cuba. Lancet. 1996;348:1489-91. 5. Impact of US Embargo on Health and Nutrition in Cuba. Washington, DC: American Association for World Health; 1997. ================= TO THE EDITOR: The articles on economic sanctions (1-3) add importantly to the discussion of humanitarian damage (4). Although Madeleine Albright states that the Clinton Administration fully supports humanitarian goals, the accompanying papers show that it has not. Nonetheless, her call for a partnership with the public health community to make further progress is a commendable challenge. The impact of sanctions on civilians relates to the more general increasing impact of wars on civilians. Globalization, inexpensive weapons, and shrinking attention to the differentiation of military targets from civilian victims leave civilians at increasing risk. By any accounting, far more civilians have died after the 1990 Gulf War than did troops during the war (5). The principle of balancing military necessity with humanity, mentioned in the American College of Physicians-American Society of Internal Medicine position paper (2), has been, and continues to be, observed mainly in the breach. The paper highlights the importance of monitoring humanitarian conditions when embargoes are instituted. Remarkably, despite the provision of billions of dollars in Iraqi assets for relief supplies and an unprecedented increase in child mortality, such monitoring still does not exist in Iraq. The State Department's call to avoid the "premature lifting of sanctions" ignores the College's position that food and medicine should not be sanctioned to begin with. Reduced official U.S. limitations on humanitarian goods in some sanctions ignore the frequent observation that sometimes insurmountable impediments remain. For example, the $100 million in licensed donations of medical goods for Cuba actually resulted in less than $10 million in delivered value. This in no way makes up for the United States-imposed prohibition against direct Cuban purchases, which generates excess embargo-related costs to the health system of an estimated $45 million each year. The State Department, of course, responds mainly to perceived national interests and legislative mandates rather than humanitarian concerns. Thus, partnership with the public health community is essential to better separate political from humanitarian issues in sanctions. The College's position paper is a useful initiative toward this goal. Richard Garfield, RN, DrPH Columbia University New York, NY 10032 References 1. Barry M. Effect of the U.S. embargo and economic decline on health in Cuba. Ann Intern Med. 2000;132:151-4. 2. Morin K, Miles SH. The health effects of economic sanctions and embargoes: the role of health professionals. Ethics and Human Rights Committee. Ann Intern Med. 2000;132:158-61. 3. Albright MK. Economic sanctions and public health: a view from the Department of State [Editorial]. Ann Intern Med. 2000;132:155-7. 4. Garfield R. The impact of economic sanctions on health and well-being. London: Overseas Development Institute; 1999. Relief and Rehabilitation Network Paper 31. 5. Garfield R. Morbidity and mortality among Iraqi children from 1990-1998: assessing the impact of economic sanctions. Goshen, IN: Fourth Freedom Forum. 1999; Occasional Paper Series 16. ======================= TO THE EDITOR: The articles on economic sanctions (1-3) miss the most crucial point; specifically, that they are illegal under international law. Madeleine Albright (2), a staunch defender of "international norms" and human rights, would have us believe that the United Nations or United States "does not intend to create unnecessary hardships for innocent people, especially children and infants." Morin and Miles (3) advocate the desire to "amend the structure and application of economic sanctions ... to better protect the health of all populations." Morin and Miles are deluding themselves, and Ms. Albright is misleading the public. Woodrow Wilson disclosed the absolute truth when speaking on economic sanctions in Versailles in 1919: "A nation that is boycotted is a nation that is in sight of surrender. Apply this economic, peaceful, silent, deadly remedy and there will be no need for force. It is a terrible remedy. It does not cost a life outside the nation boycotted, but it brings pressure upon the nation which, in my judgement, no modern nation could resist" (4). Note the word "deadly"sanctions are intended to kill civilians! As such, they are illegal under international law (Protocol I, Part IV, Section I, Chapter III, Article 54 of the Additional Protocols to the Geneva Conventions-1977; International Conference on Nutrition, World Declaration on Nutrition, Food and Agricultural Organization/World Health Organization, 1992; United Nations General Assembly Resolution 44/215 [22 December 1989]"Economic measures as a means of political and economic coercion against developing countries"; the Constitution of the World Health Organization, 1946; and the Universal Declaration of Human Rights, 1948). There is only one way to amend economic sanctions, and that is to abolish them now and forever. The American College of Physicians-American Society of Internal Medicine, the American Medical Association, and other U.S. public health organizations would do well to join the chorus of international voices advocating the total abolition of this "peaceful, silent, deadly remedy." Natalia Ganson-Myshkin, MD Boston, MA 02124 References 1. Barry M. Effect of the U.S. embargo and economic decline on health in Cuba. Ann Intern Med. 2000;132:151-4. 2. Morin K, Miles SH. The health effects of economic sanctions and embargoes: the role of health professionals. Ethics and Human Rights Committee. Ann Intern Med. 2000;132:158-61. 3. Albright MK. Economic sanctions and public health: a view from the Department of State [Editorial]. Ann Intern Med. 2000;132:155-7. 4. Carter BE. International Economic Sanctions: Improving the Haphazard U.S. Legal Regime. Cambridge, United Kingdom: Cambridge Univ Pr; 1988:9. =========== TO THE EDITOR: I appreciate the courage of Annals in devoting attention to the morally complex subject of embargoes and how they may affect health (1-3). I humbly take issue with Secretary of State Madeleine Albright's position that the U.S. embargo has permitted generous donations of medical sales and medical equipment to Cuba. Ms. Albright carefully uses the word "licensed" with regard to "$45 million in medical sales in 1998 and the first half of 1999 and more than $100 million in humanitarian donations" (2). In actuality, licenses do not equate to material sent to or received by Cuba. The complexity of the on-site verification process required by the United States after a license is obtained (verification that materials are not being sold for Cuban government use) has made donations difficult to deliver. Indeed, Disarm, a peace and social justice organization that has been granted licenses for more than $191 million in humanitarian aid to Cuba over 5 years, specifically noted that Cuba has been able to receive only a fraction of Disarm licensed material ($47 million over 5 years [Schwartz R. Personal communication]). Moreover, humanitarian aid does not necessarily reflect actual Cuban needs. Indeed, in 1991, before the Cuban Democracy Act limited trade in food and medicine, business with U.S. subsidiaries had reached $718 million; thus, $45 million in medical sales in 1998-1999 is a fraction of Cuba's needs even if 100% of materials are received (4). At the recent United States-Cuba trade conference, the president of the Cuban Chamber of Commerce, Hector Perez, was quoted as saying that despite the U.S. State Department's claim of $45 million in licensed medical sales, "zero" had reached Cuba (5). The Fourth Geneva Convention of 1949 and the Additional Protocols of 1977 mandated that food and medical supplies to civilians should be unhindered even in war. United States-owned companies dominate the world market in medicines and medical equipment, a domination that restricts the Cuban people's access to such supplies. Ms. Albright's statement that food and medicine are now exempt from U.S. sanctions against Cuba is misleading. Her carefully worded editorial cannot disguise the fact that delays in licensing, shipping, and on-site verification requirements make charity to Cuba an unacceptable alternative to free trade in medicine and food. Michèle Barry, MD Yale School of Medicine New Haven, CT 06520-8025 References 1. Morin K, Miles SH. The health effects of economic sanctions and embargoes: the role of health professionals. Ethics and Human Rights Committee. Ann Intern Med. 2000;132:158-61. 2. Albright MK. Economic sanctions and public health: a view from the Department of State [Editorial]. Ann Intern Med. 2000;132:155-7. 3. Barry M. Effect of the U.S. embargo and economic decline on health in Cuba. Ann Intern Med. 2000;132:151-4. 4. Denial of Food and Medicine. The Impact of the U.S. Embargo on Health and Nutrition in Cuba. Washington, DC: American Association of World Health; 1997. 5. Fletcher P. US health care firms probe tricky Cuban market. 25 January 2000. "http://www.cubanet.org/CNews/y00/jan00/26e11.htm" Last accessed 17 July 2000. --------------------------------------------------------------------<e|- Need A Credit Card? 0% Interest-Up To $7500 Credit Limit-Everyone Approved http://click.egroups.com/1/8463/14/_/487598/_/966527329/ --------------------------------------------------------------------|e>- ------- End of forwarded message ------- -- ----------------------------------------------------------------------- This is a discussion list run by the Campaign Against Sanctions on Iraq For removal from list, email firstname.lastname@example.org Full details of CASI's various lists can be found on the CASI website: http://welcome.to/casi