The humanitarian disaster resulting from sanctions against Iraq has been frequently cited as a factor that motivated the September 11 terrorist attacks. Osama bin Laden himself mentioned the Iraq sanctions in a recent tirade against the United States. Critics of US policy in Iraq claim that sanctions have killed more than a million people, many of them children. Saddam Hussein puts the death toll at one and a half million. The actual numbers are lower than that, although still horrifying.

Changing American policy in Iraq is an urgent priority, both for humanitarian reasons and as a means of addressing an intensely felt political grievance against the United States. An opportunity for such a change may come soon, as the UN Security Council considers a “smart sanctions” plan to ease civilian sanctions. As we work to change US policy and relieve the pain of the Iraqi people, it is important that we use accurate figures and acknowledge the shifting pattern of responsibility for the continuing crisis.

The grim question of how many people have died in Iraq has sparked heated debate over the years. The controversy dates from 1995, when researchers with a Food and Agricultural Organization (FAO) study in Iraq wrote to The Lancet, the journal of the British Medical Society, asserting that sanctions were responsible for the deaths of 567,000 Iraqi children. The New York Times picked up the story and declared “Iraq Sanctions Kill Children.” CBS followed up with a segment on 60 Minutes that repeated the numbers and depicted sanctions as a murderous assault on children. This was the program in which UN ambassador (and later Secretary of State) Madeleine Albright, when asked about these numbers, coldly stated, “The price is worth it.”

Albright’s comments were shocking, as were the numbers, but doubts were soon raised about their validity. A January 1996 letter to The Lancet found inconsistencies in the mortality figures. A follow-up study in 1996, using the same methodology, found much lower rates of child mortality. In October 1997 the authors of the initial letter wrote again to The Lancet, this time reporting that mortality rates in the follow-up study were “several-fold lower than the estimate for 1995—for unknown reasons.” While the initial report of more than 567,000 deaths attracted major news coverage, the subsequent disavowal of those numbers passed unnoticed in the press.

The two most reliable scientific studies on sanctions in Iraq are the 1999 report “Morbidity and Mortality Among Iraqi Children,” by Columbia University’s Richard Garfield, and “Sanctions and Childhood Mortality in Iraq,” a May 2000 article by Mohamed Ali and Iqbal Shah in The Lancet. Garfield, an expert on the public-health impact of sanctions, conducted a comparative analysis of the more than two dozen major studies that have analyzed malnutrition and mortality figures in Iraq during the past decade. He estimated the most likely number of excess deaths among children under five years of age from 1990 through March 1998 to be 227,000. Garfield’s analysis showed child mortality rates double those of the previous decade.

Ali, a researcher at the London School of Hygiene and Tropical Medicine, and Shah, an analyst for the World Health Organization in Geneva, conducted a demographic survey for UNICEF in cooperation with the government of Iraq. In early 1999 their study surveyed 40,000 households in south-central Iraq and in the northern Kurdish zone. In south-central Iraq, child mortality rates rose from 56 per 1,000 births for the period 1984-89 to 131 per 1,000 for the period 1994-99. In the autonomous Kurdish region in the north, Ali and Shah found that child mortality rates actually fell during the same period, from 80 per 1,000 births to 72 per 1,000.

Garfield has recently recalculated his numbers, based on the additional findings of the Ali and Shah study, to arrive at an estimate of approximately 350,000 through 2000. Most of these deaths are associated with sanctions, according to Garfield, but some are also attributable to destruction caused by the Gulf War air campaign, which dropped 90,000 tons of bombs in forty-three days, a far more intensive attack than the current strikes against Afghanistan. The bombing devastated Iraq’s civilian infrastructure, destroying eighteen of twenty electricity-generating plants and disabling vital water-pumping and sanitation systems. Untreated sewage flowed into rivers used for drinking water, resulting in a rapid spread of infectious disease. Comprehensive trade sanctions compounded the effects of the war, making it difficult to rebuild, and adding new horrors of hunger and malnutrition.

Sanctions opponents place the blame for Iraq’s increased deaths squarely on the United States and the continuing UN sanctions. Certainly the United States bears primary responsibility for the war and unrelenting sanctions. Washington has pursued a punitive policy that has victimized the people of Iraq in the name of isolating Saddam Hussein. The United States has continued to bomb Iraq over the years, and if some in Washington get their way, it will soon launch new military attacks in the name of antiterrorism.

The government of Iraq also bears considerable responsibility for the humanitarian crisis, however. Sanctions could have been suspended years ago if Baghdad had been more cooperative with UN weapons inspectors. The progress toward disarmament that was achieved came despite Iraq’s constant falsifications and obstruction.

Also significant has been Iraq’s denial and disruption of the oil-for-food humanitarian program. UN officials proposed the relief effort in 1991 when evidence was first reported of rising disease and malnutrition. The idea was to permit limited oil sales, with the revenues deposited in a UN-controlled account, for the purchase of approved food and medical supplies. Baghdad flatly rejected the proposal as a violation of sovereignty. Concern about worsening humanitarian conditions led the Security Council to develop a new oil-for-food plan in 1995. It increased the level of permitted oil sales and gave responsibility for relief distribution in the south-central part of the country to the Iraqi government. Again Iraq rejected the program, but after further negotiations, Baghdad finally consented in 1996, and the first deliveries of food and medicine arrived in 1997.

The oil-for-food program was never intended to be, and did not provide, the needed economic stimulus that alone could end the crisis in Iraq. But it was a bona fide effort by the Security Council to relieve humanitarian suffering. If the government of Iraq had accepted the program when it was first proposed, much of the suffering that occurred in the intervening years could have been avoided.

The Security Council has steadily expanded the oil-for-food program. In 1998 it raised the limits on permitted oil sales, and in 1999 it removed the ceiling altogether. Production has risen to approximately 2.6 million barrels per day, levels approaching those before the Gulf War. Oil revenues during the last six months of 2000 reached nearly $10 billion. This is hardly what one would call an oil embargo. Oil exports are regulated, not prohibited. Funds are still controlled through the UN escrow account, with a nearly 30 percent deduction for war reparations and UN costs, but Baghdad has more than sufficient money to address continuing humanitarian needs. Said Secretary General Kofi Annan in his latest report, “With the improved funding level for the programme, the Government of Iraq is indeed in a position to address the nutritional and health concerns of the Iraqi people.”

Not only are additional revenues available, but the categories for which funds can be expended have been broadened to include oil production, power generation, water and sanitation, agriculture, transportation and telecommunications. The program is no longer simply an oil-for-food effort. The emphasis has shifted from simple humanitarian relief to broader economic assistance and the rebuilding of infrastructure.

Despite these improvements, Baghdad has continued to obstruct and undermine the aid program. Iraq has periodically halted oil sales as a way of protesting sanctions. During the first half of 2001, oil sales were approximately $4 billion less than in the previous 180-day period. According to Annan, the oil-for-food program “suffered considerably because…oil exports…[have] been reduced or totally suspended by the government of Iraq.” In June and July 2001, as the Security Council considered a new “smart sanctions” plan, Iraq again withheld oil exports to register its disapproval of the proposal. The result was a further loss of oil revenues and a reduction of the funds available for humanitarian needs.

The differential between child mortality rates in northern Iraq, where the UN manages the relief program, and in the south-center, where Saddam Hussein is in charge, says a great deal about relative responsibility for the continued crisis. As noted, child mortality rates have declined in the north but have more than doubled in the south-center. The difference is especially significant given the historical pattern prior to the Gulf War. In the 1970s child mortality rates in the northern Kurdish region were more than double those in the rest of the country. Today the situation is reversed, with child mortality rates in the south-center nearly double those in the north. The Kurdish zone has enjoyed a favored status in the relief program, with per capita allocations 22 percent higher than in the south-center. The region contains most of the country’s rain-fed agriculture. Local authorities have welcomed the continuing efforts of private relief agencies, and have permitted a lively cross-border trade with surrounding countries. But these differences alone do not explain the stark contrast in mortality rates. The tens of thousands of excess deaths in the south-center, compared to the similarly sanctioned but UN-administered north, are also the result of Baghdad’s failure to accept and properly manage the UN humanitarian relief effort.

Despite the evidence of Baghdad’s shared responsibility for the ongoing crisis, sanctions opponents have continued to direct their ire exclusively at the United States and Britain. To parry this criticism, and to further expand relief efforts, Washington and London have developed a smart-sanctions plan to lift most restrictions on civilian imports, while retaining a tightly enforced arms embargo. Under the US/British plan, civilian imports would be permitted to flow freely into Iraq. Weapons and military-related goods would continue to be prohibited, and dual-use items would be subject to review. Oil revenues would still flow through the UN escrow account, but there would be no limits on the volume or range of civilian goods that could be purchased with these funds. While not a formal lifting of sanctions, the proposed restructuring plan would further remove restrictions on the civilian economy and provide additional relief for the Iraqi people. Most governments have supported the plan, and fourteen of the fifteen members of the Security Council were prepared to vote in favor when it was considered in July. Russia balked at the proposal, however, primarily out of economic self-interest, with Baghdad promising lucrative contracts to Russian oil companies in exchange for Moscow’s support for a complete lifting of the sanctions. The plan was shelved, but it is expected to come up again at the Security Council in December.

Many peace and religious groups opposed the smart-sanctions plan when it was proposed. Some condemned the proposal even before the details were announced, flatly asserting that smart sanctions kill children. A more effective response would be to highlight the shortcomings of the plan and urge further steps toward the easing of civilian sanctions. Such steps would include permitting foreign investment in Iraq, eliminating restrictions on non-oil exports, and providing cash for the purchase of food and other goods from local producers rather than foreign suppliers. It is also important, peace and human rights groups surely would agree, to maintain military sanctions until Iraq complies fully with the UN disarmament mandate and permits a final round of weapons inspection.

We can and must do more to help the Iraqi people. The more credible we are, the more effective we will be.