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[casi] Fw: Biological warfare and the people of Iraq

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Dear all,
here is a very important article, that certainly will interest many of you, and especially Tom Nagy.
It has been published this month in the International Journal of Epidemiology 
( - a paysite) and the Deutches Aerztebladt 
It has been written by Ian Roberts, Professor of Public Health, London School of Hygiene and 
Tropical Medicine, University of London WC1B 3DP - E-Mail:
His conclusion: "any malevolent intervention that causes infection in the civilian population 
constitutes an attack with a biological weapon." is very important. He argues that the wars against 
Iraq and the sanctions are a form of biological warfare.
I suggest you all to read this article.
Dirk Adriaensens.

Biological warfare and the people of Iraq

The only property of microorganisms that enables them to be used as biological weapons is

their capacity to cause infectious disease. People may be deliberately exposed to pathogenic

microorganisms in a variety of ways but it is the fact of exposure rather than the method of

delivery that determines whether disease will result. Because the ability to cause infection is

the defining aspect of a biological weapon, then any malevolent intervention that causes

infection in the civilian population constitutes an attack with a biological weapon.

Microorganisms are necessary but not sufficient in the causation of infectious disease and

other causal factors are required for infection to occur(1). Host resistance is an important

factor in the chain of causation leading to clinical infection (2). Whether or not exposure to a

microorganism causes disease depends on whether or not the exposed individual is

susceptible or immune. Dietary deficiency of key vitamins and micro-nutrients increases

susceptibility to a number of infectious agents and also increases the likelihood that infectious

disease will result in severe illness and death. Vitamin A and zinc deficiency impair the

ability of the immune system to fight infection and the ability of mucous membranes to resist

infection.2,3 Indeed, the decline in infectious diseases in high income countries is more

readily attributed to increased host resistance from better nutrition than to a reduction in the

virulence of the relevant microorganisms. It follows that any malevolent intervention that

impairs the ability of a civilian population to resist infection constitutes biological warfare.

In public health practice, prevention involves removing one or more of the components in the

chain of causation leading to disease. From an epidemiological perspective, causation and

prevention are two sides of the same coin (1). For this reason, a consideration of the actions

that can prevent infectious disease from occurring after exposure to a biological agent can

help to identify the other components in the causal chain. For example, following an attack

with anthrax, spores can be washed off with soap and water and oral antibiotics can be given

to prevent infection from developing (4). If an anthrax attack occurred in situations where

antibiotics were unavailable then some cases of anthrax infection would be attributable

to their absence. Consequently, any malevolent intervention that destroys a populations'

ability to respond effectively to infectious diseases constitutes a biological attack.

These rather mundane scientific considerations have important implications for how

biological warfare is defined in the context of the current conflict in Iraq. First, it implies that

the Anglo-American bombing of water supplies, sanitation plants, and the power plants that

are necessary for their functioning, constitutes a biological attack. Standard texts on biological

weapons point out that three factors must be taken into account in selecting a biological agent

for a biological attack: ease of manufacture, stability and lethality. Despite widespread public

concern about the use of anthrax, smallpox and plague, all three are difficult to manufacture

and disseminate. Anthrax requires sophisticated methods of manufacture and virulent stock is

hard to find. The only confirmed sources of smallpox are in the US and Russia, and plague is

both difficult to obtain and difficult to weaponize.4 On the other hand, the microbial agents

that can cause devastating epidemics of diarrhea are ubiquitous, lethal and are readily

disseminated by destroying the civilian sanitation infrastructure by bombing or otherwise

destroying water sanitation and sewage disposal systems. These actions will ensure that food

and water supplies to the civilian population will quickly become contaminated. Because the

feces of infected persons will further contaminate the water supply and because there will be

extensive person to person transmission this strategy has the potential to result in extensive,

population wide and self propagating epidemics. The scope for civilian casualties with such

an approach is massive in comparison with the use of agents such as anthrax for which there

is no evidence of person to person transmission. Declassified documents from the American

Defense Intelligence Agency show that during the 1991 Gulf War, the 'Allies' deliberately

targeted Iraq's water supply. Twelve years later, half the water treatment plants are still out of

action (5).

Second, the economic sanctions imposed by the Nations Security Council that have caused

widespread dietary deficiencies throughout the civilian populations, seriously reducing the

ability of the population to resist infection, constitutes a form of biological warfare.

Microorganisms that pose little threat to those with intact immune systems can be highly

lethal to those with impaired immunity as a result of micronutrient deficiency and

malnutrition. For example, life threatening diarrhea can be caused by ubiquitous microbes

such as E. Coli that reside in the gastro-intestinal tract and common respiratory viruses can

cause highly lethal pneumonia. As a result of the sanctions against Iraq there has been a more

than doubling of the infant and under five mortality rates, with most of the excess child deaths

being due to diarrhea and pneumonia exacerbated by malnutrition.6 The imposition of

economic sanctions in Iraq is as much a form of biological attack as was the distribution of

anthrax in the US mail system.

Third, the destruction of the Iraqi populations' ability to respond to outbreaks of infectious

disease by restricting the importation of essential medicines and medical equipment, by

destroying the public health infrastructure and by overwhelming the capacity of the healthcare

system to respond effectively constitutes a further biological attack.

Fourth, having destroyed Iraq's water and sanitation systems, leaving the civilian population

highly vulnerable to major epidemics of infectious disease, the failure to restore the public

health infrastructure and provide safe water supplies to homes and hospitals constitutes a

biological attack. In this context, recent reports that reconstruction contracts may be

awarded to the US company Bechtel are a particular cause for concern. In 1999, a Bechtel

subsidiary took over the control of the public water system in Cochabamba in Bolivia and

within weeks doubled and tripled the water rates for some of the poorest families in South

America resulting in massive public demonstrations.7 Also, we must not forget that in the

case of Afghanistan, despite the Bush administration's claim that 'the US will not walk away

from the Afghan people,' the administration subsequently forgot to ask for any money for

humanitarian and reconstruction costs in its 2003 budget.

The full extent of civilian casualties resulting from the war on Iraq will become clear in the

coming weeks and months. An effective humanitarian response must be mounted urgently to

reduce the death toll from this appalling episode in the history of biological warfare.


1. Rothman KJ. Modern Epidemiology. Little, Brown and Company, Boston, 1986.

2. Stephensen CB. Vitamin A, infection and immune function. Annu Rev Nutr 2001;21:167-


3. Berger A. What does zinc do? BMJ 2002;325:1062

4. Levy BS, Sidel VW (eds) Terrorism and Public Health. ISBN 9-780195158342

5. Sengupta K. The Independent. Saturday April 19, 2003

6. Arnove A (ed). Iraq Under Siege: The deadly impact of sanctions and war. Pluto Press,

London 2003.

7. Palast G. New British Empire of the dammed. Observer. Sunday April 23, 2000

Ian Roberts

Professor of Public Health

London School of Hygiene and Tropical Medicine,

University of London WC1B 3DP


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