Reflections – October 2013
Friends:Those who’ve followed these postings know that my legal battle with the federal government over a $16,000 fine (for traveling to Iraq to bring medicine without a U.S. license) has ended. The judge dismissed the government’s efforts to collect saying the government waited too long to sue. See Bert’s Case for a history of the legal issues, including our earlier suit against the government for crimes including genocide and terrorism.
In my June posting, I wrote how I’d read an article in the Pacific Standard magazine (psmag.com) called “The Iraq Sanctions Myth.” It claimed that the deaths of hundreds of thousands of Iraqi children “almost certainly never happened.” I responded to the author of the article, Professor Michael Spagat, in my post. Since then, he and I have corresponded by email half-a-dozen times.
In this back-and-forth, I have included Sarah Zaidi, a woman I know and we both respect for her work on the issue of sanctions. And, very recently, I spoke with Kenneth Pollack of the Brookings Institute about Iraq sanctions after his talk at Seattle’s Town Hall. This correspondence among the four of us lasted much of the past three months.
I am pleased to say that in all of these emails there was courtesy and a common effort to exchange information we each considered important. My task today is to begin by representing – as honestly and as correctly as I can – the case that Professor Spagat makes. Then I will present my own reasons why I believe otherwise – in the spirit of a shared search for the truth.
Professor Spagat points to four health surveys in his article and correspondence with me: they all show a continuing overall improvement in a relatively low level (for Iraq) of child mortality over the years of 1991 to 2004. Not one of them shows any significant increase in child mortality during the 1991 year of the Gulf War, in the years directly after, or through to 2004.
Professor Spagat contrasts the length of these surveys, continuing to 2003 or 2004, with the UNICEF survey that covered only the eight years ending in 1998. He does not mention in his article the New England Journal of Medicine survey of 1992 which covered only the first eight months of 1991. Professor Spagat considers that this eight month period is so brief that it represents only an unimportant “spike” in the data. He points to the three or four health surveys in his article as more representative of the underlying reality because they survey a longer period of time than the two surveys I mention.
He concludes in an email to me, “… the UNICEF survey was later buried by [these] four subsequent surveys.” If everything else were equal, I would agree that’s a fair conclusion.
Here are my reasons for believing that everything else is not equal.
I begin with the child mortality survey in the 1992 New England Journal of Medicine (NEJM).
The NEJM article states: “Conclusions. These results provide strong evidence that the Gulf war and trade sanctions caused a threefold increase in mortality among Iraqi children under five years of age. We estimate that an excess of more than 46,900 children died between January and August 1991.”
And further, “Results. … The age-adjusted relative mortality for the period after the war began, as compared with the period before the war, was 3.2 (95 percent confidence interval, 2.8 to 3.7).” (Even at the lower confidence level of 2.8, over 41,000 excess deaths of Iraqi children were estimated to have occurred since the start of the 1991 war.)
These numbers mean that the deaths of Iraqi children increased from approximately 14,600 before the war to 61,300 deaths during the first two-thirds of 1991. Even if somehow deaths returned to the pre-war level for the last third of 1991, child mortality would still have doubled for the year. (This is consistent with the plot of the UNICEF survey in Professor Spagat’s article. Meanwhile not one of the other surveys plotted by Professor Spagat shows any significant change in 1991. Adding to this strangeness is a general agreement of all survey plots before the 1991 war.)
I can come to only a few possible explanations for this: 1) the doctors from Harvard, Johns Hopkins, and Oxford employed such a methodology that their survey incorrectly led to a tripling of child mortality when none occurred; 2) the assumptions used in the methodologies of the surveys done after 2003 caused a failure to report a doubling or tripling of child mortality in 1991; or 3) there was fraudulent manipulation involved in gathering and/or interpreting the data of the earlier two surveys – or in the four other surveys which failed to show any increase due to the 1991 Gulf war.
Simply put, it does not seem plausible to me that the vast discrepancy of results between the surveys being discussed – a doubling and tripling of child mortality versus a continual improvement – can be accounted for within any reasonable margins of error. I will return to this later, except to add here that the NEJM survey is the only one I know of that was done entirely without using any Iraqi personnel; from the NEJM Report, “The survey was made independently of the Iraqi government by a team of international researchers.”
The second major point I draw from the NEJM survey is its identification of the causes of the deaths in 1991 and the conditions which led to those deaths.
Mike Spagat emailed me, “… in the speculative section at the end [of the NEJM report] … they definitely don’t make unsafe water due to infrastructure damage the exclusive, or even the main, cause of the excess deaths they claim occurred in 1991.”
Here is what the NEJM Report says in its discussion of what caused the excess deaths:
The destruction of the supply of electric power at the beginning of the war, with the subsequent disruption of the electricity-dependent water and sewage systems, was probably responsible for the reported epidemics of gastrointestinal and other infections. These epidemics were worsened by the reduced accessibility of health services and decreased ability to treat severely ill children. Increased malnutrition, partly related to the rising prices of food, may also have contributed to the increased risk of death among infants and children.
The hypothesis that the excess mortality caused by the war was due to infectious diseases and to the decreased quality and availability of medical care, food, and water is consistent [with the data from our survey]. This pattern resembles that observed in the less-developed countries, where diarrhea and respiratory infections account for most deaths in infancy and childhood.
Mike Spagat has not been to Iraq; Kenneth Pollack was in Iraq only after the U.S. invasion. Sarah Zaidi was in Iraq multiple times during the sanctions period; I made nine trips to Iraq during this time. I witnessed the residual effects of the war and ongoing sanctions. I know the conditions I saw. I know what the doctors and ordinary people told me. I’ve seen the children who look several years younger than their real age because of stunting. I’ve seen children whose reddish hair color shows the effect of vitamin deficiency.
Here is what Sarah Zaidi, with her medical background, wrote of her visits to Iraq:
“The children of Iraq over the sanctions decade experienced not only death but also many other losses—undernourishment (chronic stunting), education, poor sanitation and water, poor health, traumatized adults, missing parents, and fractured households and communities. However, there are many other stories that go untold of burn victims unable to get any treatment or those suffering from chronic diseases unable to get medication. One very poignant memory I have of 1995 is visiting a hospital in Baghdad and speaking to a surgeon with burns over 70% of his body. There was no treatment, and he was waiting to die. Yet he gave me an interview of the conditions he faced in his surgical work since sanctions compared to before the war. Another story (capture[d] frequently in hospitals) was of young man who stepped on a landmine, and had to lose his leg because of gangrene. No treatment.
These are some of the reasons I find it impossible to believe that the physical conditions I witnessed could continue to exist without having a huge impact on child mortality.
Sarah Zaidi wrote me the following: “I feel that excess deaths lie somewhere between the conservated [sic] estimate of 228k deaths estimated by Richard Garfield for the Fourth Freedom Forum and 500k. The figure may not be as high as 1 million but nonetheless these are children who should have not died and only did as a result of a tragic war and sanctions.” I agree.
Professor Spagat presents the four health surveys done after 2003 as evidence that the two earlier surveys I point to were “buried” by these later, longer-ranging surveys.
I argue that the NEJM survey has the greatest credibility because of its independence from any Iraqi personnel and its extensive description of what caused the excess deaths.
I think that both Mike Spagat and I agree that there may have been manipulation of the data and/or interpretation in one or the other sets of health surveys. If so, then the question becomes, Which set of surveys to believe?
I quote again from my previous post the British foreign journalist Robert Fisk:
The evidence of massive human suffering was now overwhelming. A UN humanitarian panel on sanctions reported in 1999 that “the gravity of the humanitarian situation of the Iraqi people is indisputable and cannot he overstated. Irrespective of alleged attempts by the Iraq authorities to exaggerate the significance of certain facts for political propaganda purposes, the data from different sources as well as qualitative assessments of bona fide observers and sheer common sense analysis of economic variables converge and corroborate this evaluation.” (my emphasis)
Clearly the U.S. and UK have shown their willingness to misrepresent and lie to get us into war with Iraq. Economic sanctions were used for 12 years to try to overthrow Saddam Hussein; instead they did kill hundreds of thousands of Iraqi children. Now the U.S. is using this weapon against Iran. But to do so, the U.S. has a strong motive to hide from U.S. and world public opinion that economic sanctions can be a silent deadly killer.
As I wrote in June, There is nothing that the U.S. can do to hide its early actions. But creating or manipulating health surveys to show that no Iraqi children died as a result would be very ‘useful’: it would eliminate a crime from the history books it wishes written. And it would more easily enable the U.S. to employ sanctions to coerce other nations. Simply put, the conclusion that seems most likely to me is that some party covertly falsified survey health data. The party with the greatest motive and capability still seems to me to be the United States.
I feel sad to consider that my country might be doing this. I might wish to deny the evidence that seems so likely to me. That would be like denying the Holocaust. However, even if my strong suspicion proves true, I want to state that I have no reason to think that Professor Mike Spagat is knowingly involved in this process. Rather I hope that he will re-examine all the data I’ve tried to present and re-consider his conclusions.
I’d like to make two points to Kenneth Pollack, after my brief meeting and email with him. One does not need to be an epidemiologist to weigh the information Mike Spagat and I have presented to form a reasoned opinion; logic, common sense, and honesty are most what is needed. And I’d repeat again, I hope you’ll use your influence to prevent the war-desiring powers from blocking a lessening of sanctions in return for Iranian concessions; if this is done it will lead to war as surely as it did in Iraq.