The Faces of "Collateral Damage"
by Charlie Clements
I am a public health physician. In January I participated in a ten-day emergency mission to Iraq, sponsored by the Brooklyn-based Center for Economic and Social Rights. Our task was to assess the potential consequences to Iraqi civilians of a war on Iraq. As a graduate of the U.S. Air Force Academy and a Vietnam veteran, I have some understanding of the potential consequences of the air war we are about to unleash on Iraq as a prelude to an invasion by U.S. troops. The Pentagon will refer to the innocent victims of this assault as "collateral damage," but I've seen their faces, and I think they should have another name. One that occurs to me is "children," since half the population of Iraq is under 18 years old.
Our delegation was composed of six experts in water, sanitation, emergency health services, public health, and food security. We were given access throughout Iraq to clinics, hospitals, food distribution centers, water and sanitation facilities, and electrical generating plants, as well as granted interviews with Iraqi officials, staff of international agencies, civilians, and diplomatic personnel. We had our own translators.
In many ways, the population of Iraq has been reduced to the status of refugees. Nearly 60 percent of Iraqis, almost 14 million people, depend entirely on a government-provided food ration that, by international standards, represents the minimum for human sustenance. They have a very high infant mortality caused by communicable and waterborne diseases. They experience severe problems with their potable water, sanitation, and electrical infrastructures. The health care system can barely cope with the existing disease burden and there are shortages of medicines. Unemployment is at least 50 percent, and those such as physicians who are employed may only make $8–10 per month. There are limited opportunities for education. There is a pervasive sense of despair and uncertainty regarding the future.
The war has yet to start, but we found the Kerbala Pediatric Hospital that we visited already filled beyond capacity, each bed filled with two or three mothers with their ill children. The pediatrician explained that there were only 28 beds for the 54 patients, so at night many of the mothers would shift onto the floor. Most of the children had the telltale signs of malnutrition—thin skin stretched over protruding bellies, eyes that seemed far too large for their small faces, hair with streaks that Western women often pay for at the hairdresser.
We walked up to a bed where a mother was rocking her tiny, crying three-year-old daughter. The pediatrician said the mother had traveled 200 km because she heard the hospital had a supply of Pentostam, the medicine needed to treat kala azar, or leishmaniasis, as we call it. The pediatrician had not told her yet that there is none. He turned to me and said in English, "It would be kinder to shoot the girl here rather than let her return home to the lingering death that awaits her." Our interpreter, by instinct, translated the doctor's comments into Arabic, and the mother's eyes began to overflow with tears.
Leishmaniasis, we learned from the pediatrician, is reemerging because Iraq is not allowed to import the pesticides that once controlled the sand fly, which transmits the disease. Malaria is also reemerging because mosquito control is no longer possible in parts of Iraq. The incidence of water-borne diseases like typhoid is 1,000 percent of what it was just prior to the Gulf War—2,200 cases in 1990 and more than 27,000 in 2001, according to UNICEF.
After saying good-byes at the Pediatric Hospital, we walked across the highway to the Kerbala water treatment plant. There the woman engineer told us much of the diarrheal disease is caused by poorly treated water, because Iraqis are not allowed to import the spare parts for water treatment plants or the chemicals like chlorine and aluminum sulfate necessary to produce clean water. We saw that only about 8 of the 32 electrical motors that turn the large paddles in the flocculation chambers used for settling solids were still functional; the rest had been cannibalized for parts. There was insufficient chlorine, so the two-step disinfection procedure had been reduced to only a single step.
Later, it was not a surprise when WHO and UNICEF staff explained that 40 percent of water samples in Iraq didn't meet standards for potable water, either for bacteria counts or total dissolved solids. We know what happens when bacteria counts are high. The average Iraqi child has 14 episodes of diarrhea a year now, compared to around three before the Gulf War. That is part of the reason that 70 percent of deaths of Iraqi children result either from diarrheal-related diseases or respiratory infections. The diarrheal diseases weaken their immune systems and make them more susceptible to colds that turn into pneumonias. Malnourished children are more vulnerable to both. The facility's chief engineer said that because the sewage treatment plant in South Baghdad is often inoperable due to lack of maintenance and spare parts, most of the city's wastewater was diverted directly into waterways connected to the Tigris and Euphrates Rivers. We then knew why UNICEF estimates that 500,000 tons of raw sewage are dumped into Iraqi waterways daily. These are the same waterways that are the sources of both potable and industrial water.
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