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BMJ 2003;326:520 ( 8 March )

Perinatal mortality in Iraq more than tripled since sanctions

Roger Dobson Abergavenny
More than 3000 children are dying every week in Iraq as a result of the decade long embargo that was enforced on the country after its invasion of Kuwait, a new report says.

It puts the total increase in the number of children who have died as a result of the embargo at around 1.6 million since 1990, with year on year increases.

In this period the number of major operations on children has more than halved, paediatric laboratory investigations have dropped by a similar proportion, and the number of low birthweight babies has increased sixfold.

The report shows that the quality of health services, especially for children, has declined sharply in Iraq since sanctions were enforced, in August 1990. It details how Iraq has become a nation with many health indicators that are at or below levels more traditionally associated with some of the world’s most undeveloped and poorest nations.

"The gap with other developing countries is increasing as indicated by perinatal, neonatal, infant and maternal mortality rates. These figures imply a dangerous deterioration in health services," says the report in the Journal of Maternal-Fetal and Neonatal Medicine (2003;13:64-7).

The report, written by a paediatrician at the Saddam College of Medicine in Baghdad, adds, "In Iraq, social and economic circumstances have deteriorated, and in particular the health services; thus child mortality followed by infant mortality have increased." The report shows that in the first three months of last year the increase in the total number of child deaths put down to the embargo was in excess of 44 000.

It says that in 2001 the total number of deaths among children aged more than 5 years passed the 100 000 mark for the first time. The main causes of perinatal and neonatal mortality were respiratory distress syndrome (66% of deaths), sepsis (20%), and asphyxia (10%), followed by congenital malformation (3%) and congenital infection (just under 2%). It says that in the 1980s, before the sanctions, the average perinatal mortality in Iraq was estimated at 28 per 1000 live births, but that the average mortality in the 1990s was an estimated 107 per 1000 live births. Maternal mortality is 294 deaths per 100 000 live births, and mortality has increased mainly among women aged between 30 and 35 years of age and adolescents.

"The important causes of neonatal death are low birth weight, perinatal infections and birth asphyxia due to foetal hypoxia. Many of these deaths can be avoided with simple, practical and affordable interventions," says the report.

The report also details the deterioration in laboratory investigations and surgical operations. In 1990 the average number of laboratory investigations a month was 1 091 230, which was itself a drop of 27% on 1989. In 2001 the average monthly number of laboratory investigations had decreased further to 623 775.

In 1990 the average number of operations a month was 8668, a drop of 43% from 1989. In March and February last year only 6000 operations were carried out in each month.

The report says that in 4.5% of registered births in 1989 the babies weighed less than 2.5 kg. By 2001 that percentage had increased to 24.7%, three times the percentage in other countries.

"Thus, there is a tremendous increase in the percentage of low birth weight, which is one of the important causes of the increase in neonatal mortality and morbidity. This has occurred in the last 10 years after the Gulf conflict and sanctions when much was destroyed (water supply, electricity, buildings, roads, communications, even schools and hospitals)," says the report.

Rosemary Hollis, director of the Middle East programme at the Royal Institute of International Affairs, one of the world’s leading centres for the analysis of international issues, criticised the balance of the article.

She said, "I don’t think it washes to put all the blame on the Iraq government or to put it all on the sanctions themselves. It is miserable combination which is the result of disastrous policy failure.

"Unwittingly by setting up a sanction regime that was run through the Iraqi regime in terms of the food distribution, the UN Security Council cemented in power what had been a rather shaky government system." 

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