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[casi] New estimates of 'excess' childhood mortality, 1991-98

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New evidence on the impact of war and sanctions on childhood mortality in Iraq, 1991-98

The July issue of Population Studies (an international journal for demographers and other 
population scientists) contains an article entitled ‘Annual mortality rates and excess deaths of 
children under five in Iraq, 1991-98’.  It was produced by demographers at the London School of 
Hygiene and Tropical Medicine (the public health school of London University) and UNICEF. Although 
broadly in line with the commonly mentioned estimate of total deaths of under-fives (derived from a 
preliminary report from UNICEF), the estimates in this paper were produced using the most robust 
methods available and include estimates of mortality in the first month and first year of life.  
Here is the authors’ summary of the paper:

         Data from two parallel household surveys conducted in Iraq by UNICEF in 1999 show that 
under-five mortality declined steadily from 1974 to 1990, reaching about 63 per thousand live 
births in the period 1986-90. It then rose dramatically to 118 per thousand in 1991, the year of 
the Gulf War. The number of ‘excess’ under-five deaths  (ie the number in excess of the number 
predicted from past trends) in Iraq between 1991 and 1998 was calculated assuming that, instead of 
the rates measured by the 1999 survey for this period, either (a) average mortality rates for the 
period 1986-90 had been maintained, or (b) mortality had continued to decline at the rate observed 
between 1974 and 1990. According to these calculations, the estimated number of excess deaths 
resulting from the Gulf War and its aftermath up to 1998 was between 400,000  (assumption a) and 
500,000 (assumption b).

There is a pre-publication version of the paper at

Subscribers to the print version of the Journal will be able to access the published version online 
later this month at

Points to note in the paper

1. Childhood mortality rates in the South/Centre of Iraq declined steadily from the mid-1970s until 
the first Gulf War. In 1991, rates for infant mortality (deaths in the first year of life) and for 
those under five years of age soared to levels higher than those of the mid-1970s and stayed higher.

2. Childhood mortality rates in the North of Iraq (the region placed under UN administration after 
the war) were much higher than those in the South/Centre until the early 1980s, but were declining 
to converge with those of the South/Centre by the end of the 1980s.  In 1991, the rates surged to 
the high levels of the late 1970s but declined sharply after the war, until 1993. From 1993 to 
1998, the rates were stable at levels similar to those achieved in the South/Centre in the prewar 

3. The authors of the article explicitly confine themselves to mortality estimates and do not 
attempt to explain or comment on their findings. They do however give references to explanatory 
literature, including UN reports that point to plausible reasons why (years before the 
implementation of the Oil-for-Food programme in 1997) child mortality rates declined in the North 
but not the South/Centre. For example, an FAO report cited refers to the North’s greater 
self-sufficiency in food – the region has “9% of the land area of Iraq but nearly 50% of the 
productive arable land”. The same report attributes the fact that famine was averted to ‘The 
effective nation-wide rationing system set up by the Government of Iraq in 1991” (Food and 
Agricultural Organization. 2000. Iraq. Assessment of the Food and Nutrition Situation. Rome: FAO.)

John Simons

Managing Editor, Population Studies

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