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[ Presenting plain-text part of multi-format email ] The Lancet: Volume 361, Number 9358 22 February 2003 http://www.thelancet.com/journal/journal.isa Special report The people of Iraq face a grim future with or without a war A United Nations taskforce has estimated that if war breaks out in Iraq at least 7·4 million people will need immediate humanitarian aid but this immense caseload would only represent the people that aid workers could reach. Access to needy civilians in other governorates will either be denied or be impracticable, according a recently leaked UN report written in December, last year. Unlike the 1991 Gulf war, "this confrontation is expected to develop beyond the preparatory, and relatively short, aerial bombardment of infrastructure, towns, and cities into a potentially large scale and protracted ground offensive, supported by aerial and conventional bombardment", said the UN report. The consensus among the aid community is that the Iraqi population, already severely weakened by the Gulf war, 12 years of sanctions, and almost sole reliance upon Hussein's government, will need a long-term, comprehensive aid strategy. According to a report published by the UK's Oxford Research Group (ORG) in October last year, the allies strategy will be to quickly destroy Iraq's military and administrative infrastructure, access to electricity supplies, and any civil activities that could support Iraq's defences. And then draw out Hussein's elite forces, which will be mainly concentrated in and around Baghdad, and to attack them with intense aerial bombardment and ground forces. Other key elements of the campaign will be to secure the major oil producing regions, such as Basra in the south. Troops will also try to gain control of the Kurdish region of northern Iraq, for which preparations have already begun with the repair of three major airfields in the area. Forces will also attack from Jordan, moving swiftly though the deserts in western Iraq towards major cities, such as Baghdad. The most intense fighting will probably be around Baghdad, considering the allies declared ambition for "regime change". But the allies' experience from the 1991 Gulf war suggests that the Iraqi government may use chemical and biological weapons if its survival is threatened. Furthermore it may launch strategic strikes on neighbouring countries, said the author of the ORG report, Paul Rogers, professor of peace studies at University of Bradford, UK. In such circumstances the UK government would be prepared to use a nuclear weapon on Baghdad if allied and civilian casualty rates escalate, warned Rogers. The destruction of command and control systems of the Iraqi military, including dual-use electrical circuits and grids "could destroy power supplies in most parts of the country" said US-based Physicians for Human Rights (PHR), in a statement published in December, 2002. "A public-health emergency created by an impaired infrastructure exacerbates the Iraqi population's vulnerability to disease and hunger, given the already degraded condition of health facilities, potable water, and limited food supply", said PHR. The results of a needs assessment presented in the UN report supports this grim view. 60% of Iraq's population--about 16 million people--are wholly dependent on government distributed food from the UN's oil-for-food programme. During a war, existing supply lines will be either shut down or rerouted. For example, the three northern governorates, home to 3·7 million people, will need access to an alternative supply line of food because established routes from Mosul and Kirkuk in the south will be inaccessible. Iraq has tried to grow its own food but has been crippled by a major drought in the past 3 years, noted Oxfam in a briefing paper published in December, last year. Attempts to irrigate the land have been hampered by the sanctions. The 2002 wheat harvest of 1·6 million tonnes will run out in early 2003, added Oxfam. Currently food is distributed 21 days per month by the government and non-governmental organisations (NGOs) to about 1 million people per day. This "begs the question of how the population's basic needs will be met when government operations and transport and storage infrastructure are disrupted or destroyed by war", said Joel Charny, vice president of policy for Refugees International in a statement published on Feb 5. The UN agrees and said that during a war people will not be able to get to distribution centres. If war breaks out the distribution system will grind to a halt. But if military intervention begins simultaneously from the north and south, the peripheral governorates of Basrah, Maysan, Thi Qar, Muthana, Najaf, Kerbala, and Qadisiyah will be immediately affected, said the report. "Most household food reserves will not last 2 months if distribution were interrupted or suspended." Today, Iraq's health sector has a 4-month supply of basic medicines and medical supplies. But these stocks will be inadequate during and after a war. Immediate health concerns during a war will be conflict-related injuries. But as war progresses there will be a rapid increase in diarrhoeal disease if access to potable water is denied, and if oil wells are sabotaged the contaminated air will cause a simultaneous rise in respiratory infections. Immediate humanitarian needs if war breaks out Bridging, material handling, and transport Food and necessities for 5·4 million people Health supplies for 100 000 injured people Health supplies for 1·23 million highly vulnerable people Health supplies for ongoing needs of 5·4 million people Nutrition supplies for 0·54 million people Water treatment equipment for 5·4 million people Chemicals and consumables for 5·4 million people Sanitation materials and chemicals Source: http://www.casi.org.uk NGOs and allied aid suppliers will have to gear up for "diseases in epidemic if not pandemic proportions", said the UN report. Cholera and dysentery will thrive, as will measles, meningitis and other preventable diseases--due to low vaccination rates. The UN's estimates for southern and central parts of Iraq suggest that, excluding elderly people and patients with chronic diseases, aid workers will be faced with a caseload of 5·2 million vulnerable people. This will include 4·2 million children younger than 5 years old, 1 million pregnant and lactating women, and 2 million internally displaced people. However, if a war begins UN teams will only have immediate access to 1·23 million people in the south. The nutritional status of about 3 million Iraqis will be in a "dire" situation and will require sustained, therapeutic feeding. Among the most vulnerable in this population will be patients in hospital, which have an overall capacity of 27 000 beds, 5000 patients confined to institutions, "comprising orphaned children the severely handicapped, and children in detention, and 21 000 elderly". The infrastructure of Baghdad and the central region of Iraq will be systematically destroyed by allied bombardment and may be sabotaged by retreating government forces. The allies will focus on anything to do with oil and electricity production. The report notes that the "availability of potable water will be curtailed extensively . . . and in the worst case fuel will have to be imported". The loss of electricity and fuel supplies will have a major impact at the household level but should not affect immediate relief efforts. However, just for the northern governorates aid workers will have the immense task of bringing in fuel supplies including 30 million litres of gasoline, 40 million L of kerosene, 30 million L of diesel, and 10 000 tonnes of cooking gas. To complicate matters, there is little storage capacity in this region and available refining capacity will be insignificant. The destruction of electricity supplies will in turn disable water and sewage treatment centres. Currently piped water reaches 45·7% homes but 65% of the water isn't treated. The fleet of water tankers on which half the urban population depends is also falling apart as the supply of spare tyres and parts dwindle. Casualties and deaths for all sides if war breaks out Baghdad Iraqi combatant deaths 12 000-50 000 Iraqi civilian deaths 12 000-50 000 Coalition combatants deaths 1100-5000 Basra, Diyala, Kirkuk, Mosul Iraqi combatant deaths 1200-30 000 Iraqi civilian deaths 1200-30 000 Coalition combatants deaths 60-3000 Within 3 months of end of conventional war Iraqi civilians 44 000-6 000 Iraqi civilian deaths in civil war 420 000 Refugee deaths 415 000-30 000 Children under 5 excess deaths 523 500 Nuclear attack on Baghdad only Deaths 306 600-3 608 000 Total possible deaths on all sides during the conflict and the next 3 months, excluding civil war and nuclear attacks 48 716-261 100 Source: Collateral Damage by MedAct Water treatment plants that have emergency electricity generators cover 70% of the urban population but only 10% of rural people. UNICEF has warned that at least 39% of people will need to be supplied with water rations but the immediate need will be to supply 4·07 million people. The country's sanitation system is also in a sorry state of repair with 500 000 tonnes of raw sewage pumped daily into fresh water sources. Half of all sewage treatment plants do not work and of those that do 25% do not meet Iraq's environmental standards, said Oxfam in a paper published in December, 2002. The UN has noted that of the 5 million people living in Baghdad, 4 million have access to a sewerage system. If electricity supplies are disrupted NGOs are concerned that that only 10% of the sewage treatment plants serving Baghdad have emergency electricity supplies. "It cannot be emphasised to strongly that even a 'best-case' scenario of a limited war of short duration, perhaps comparable to 1991, would have much greater impact on the Iraqi people", said MedAct, the UK affiliate of International Physicians for the Prevention of Nuclear War, in a report published last year. Aside from impact on Iraqis, MedAct noted that the Gulf war had a dramatic effect on neighbouring countries--the clean up costs for Iran, Turkey, Jordan, and Saudi Arabia were $150-200 billion. Trade reduction and soaring oil prices also had "devastating consequences in developing countries" and reduced growth in 40 of them by 1% of gross national product--reaching the UN threshold for disaster relief. MedAct warns that "if the war is likely to cause worse problems than those it sets out to solve, then it is ill-advised under any circumstances, and other options must be explored". Haroon Ashraf _______________________________________________ Sent via the discussion list of the Campaign Against Sanctions on Iraq. To unsubscribe, visit http://lists.casi.org.uk/mailman/listinfo/casi-discuss To contact the list manager, email firstname.lastname@example.org All postings are archived on CASI's website: http://www.casi.org.uk