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[casi] Continuing Collateral Damage #1

Continuing Collateral Damage:

The health and environmental costs of war on Iraq

Executive Summary

The war on Iraq and its aftermath exacted a heavy toll on combatants and
civilians, who paid and continue to pay the price in death, injury and
mental and physical ill health. Between 21,700 and 55,000 people died
between March 20 and October 20, 2003 (the date on which this report went to
press), while the health and environmental consequences of the conflict will
be felt for many years to come.

This toll is calculated in a comprehensive, independent survey written and
researched by health professionals for the Iraqi Health Monitoring Project,
managed by Medact and part-funded by Oxfam and the Polden-Puckham Charitable
Foundation. Its conclusions are based on the best available information on a
range of health indicators from sources in the public domain, and
observations from expert individuals and organisations in and outside Iraq.

The impact of war on health is usually assessed primarily in terms of its
most direct and visible effects - death and injury through conflict. Between
7,800 and 9,600 Iraqi civilians are estimated to have died in this way, and
394 Coalition combatants. Estimates of the number of Iraqi military deaths
range from 13,500 - 45,000. In the absence of official body counts, the
final toll will probably never be known. In addition, thousands of
combatants on both sides as well as civilians suffered severe injuries,
including amputations and mental trauma that triggers psychiatric disorders.

The full effects of war are, however, felt through many other less direct
but potentially equally deadly or more deadly pathways. Here the death toll
and disease burden could be numbered in tens of thousands. Yet it may never
be known for certain, owing to the lack of accurate data, lack of
functioning health information systems, lack of commitment to collecting or
disseminating the data, and the absence of agreed conceptual models for
measuring the effects of conflict on health.

The report assesses the impact of the war on the determinants of health,
including limited access to clean water and sanitation; poverty and
household food security; environmental degradation; disruption of social
systems and public services, including health services; and social
breakdown. There has been deterioration in all these determinants. The
health of the Iraqi people is generally worse than before the war. And as
documented in our earlier report, Collateral Damage: the health and
environmental costs of war on Iraq (issued 12 November 2002), that state of
health was already poor by international standards; any fresh conflict was
likely to lead to further decline, at least in the short to medium term.

The impact of the war on the Iraqi environment is also documented. This
includes extensive pollution of land, sea, rivers and the atmosphere that
may have spilled over to neighbouring countries. Oil well fires created oil
spills and toxic smoke. Troop movements destroyed fragile desert ecology.
Explosive remnants of war and land mines killed and maimed people and
animals and polluted the landscape. Bombardment destroyed topsoil and
arable/grazing land as well as the physical infrastructure of buildings,
roads, railways, power stations, sewage plants and telecommunications.

The report analyses the postwar occupation and reconstruction of Iraq from a
health perspective. While acknowledging efforts to provide emergency health
relief and restore battered health services, it notes that long-term health
and wellbeing will depend on restoration of security, revitalisation of the
economy, and reconstruction of all services that impact on health as well as
regeneration of health services.

The report also advocates the need to study the long-term effects of war on
mental and physical health, an internationally neglected issue despite the
continuing presence of conflicts around the globe whose massive health and
human cost is seldom fully counted.

Finally, the report's recommendations include a proposal for the
re-establishment of an Iraqi health sector based on the principle that
health and health care are fundamental social rights. Health system
reconstruction provides an opportunity to correct past mistakes in the
organisation of health services. It can be an important aspect of
nation-building, and promote healthy inter-community and international
relationships through which, as the World Health Organisation points out,
health can act as a 'bridge to peace'.

Continuing Collateral Damage: the health and environmental costs of war on
Iraq is issued in London on 11 November 2003 by the global health
organisation Medact, the UK affiliate of International Physicians for the
Prevention of Nuclear War (IPPNW) - winner of the Nobel Peace Prize in 1985.
It is being released on the same day in Boston Massachusetts by IPPNW and by
other IPPNW affiliates in 12 other countries.

The report can be found in English, Arabic and Italian on the Medact website and the IPPNW website, as can additional
working papers on issues arising from the report.

This Executive Summary is also available in Arabic, Sorani and other
languages on these websites.

press release               Wednesday 5 November 2003


Health of Iraqi people is worse following war says new report

The war in Iraq was declared officially at an end six months ago, but the
health and environmental costs of the conflict are still being felt. Drawing
on sources within and outside Iraq, the international health charity Medact
says that the health consequences of the 2003 war on Iraq will be felt by
its people for years, maybe generations.

The report, Continuing Collateral Damage: The health and environmental costs
of war on Iraq 2003, will be released on November 11 in London and 13 other
countries. It follows Medact's initial report on Iraq, 'Collateral Damage',
which was published in November 2002, prior to the war.

The findings have emerged from a comprehensive independent survey assessing
the health and environmental impact of the war undertaken by Medact since
March 2003. The research was carried out by an international team of authors
and advisers, all experts on health and conflict.

The new report estimates that more than 20,000 Iraqis have died between the
start of hostilities and when the report was finalised late last month. The
number of people affected by the aftermath of the war is still rising as the
Iraqi people continue to pay the price in death, injury and mental and
physical ill health.

'Limited access to clean water and sanitation, as well as poverty,
malnutrition, and disruption of public services including health services
continue to have a negative impact on the health of the Iraqi people,' says
the report's author Dr Sabya Farooq.

Because of the continuing insecurity and alarming deterioration in the
health of Iraqi people since the war, Medact is calling on the occupying
forces and UN agencies to:

         Further investigate the current and long-term health impacts of
the war.

         Ensure that all reconstruction of public services including health
is fully funded

         Carry out their obligation under the Geneva Convention to maintain
law and order and  to protect hospitals, health professionals and those who
provide humanitarian aid.

Note to editors

The report will be launched in London at a press conference

on Tuesday 11 November from  0915 - 1000

at the British Medical Association, Tavistock Square, London WC1.

The press conference will be followed by a seminar from 1000 - 1300 in the
same location with members of the Nobel Peace Prize-winning organisation
International Physicians for the Prevention of Nuclear War (IPPNW) to
discuss issues arising from the report.

The report will also be issued on November 11 or 12 by IPPNW affiliates in
13 countries:  Australia, Belgium, Canada, Finland, France, Germany, India,
Italy, Japan, the Netherlands, Norway, Switzerland, and by Physicians for
Social Responsibility and  IPPNW in New York.

The report, an Executive Summary and additional material will be available
at and from 0900 on November 11.

The report will be available in English, Arabic, German and Italian. The
Executive Summary will be available in English, Arabic, Sorani Kurdish and
other languages.

The report is published in association with IPPNW and was part-funded by
Oxfam and the Polden-Puckham Charitable Foundation.

Available for interview:

Sabya Farooq, author of the report.

Jane Salvage, editor of the report and author of Collateral Damage: the
health and environmental costs of war on Iraq (Medact 2002)

Dr June Crown, President, Medact and former President, Faculty of Public
Health Medicine of the Royal Colleges of Physicians, UK.

Mike Rowson, Director, Medact tel 07703 21 4469.

plus medical experts on specific topics such as mental health and war, and
the health impact of the weapons used.

For more information and to arrange interviews contact Project Co-ordinator
Gill Reeve on 020 7324 4740/4739; 020 7485 3067 (h) 07791 470486 (m);

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