Human Costs of War in Iraq

Before U.S. bombs and missiles struck their country on March 20, Iraqis had just enough food, water, electricity, medicines, and medical manpower, according to Mike VanRooyen, MD, MPH, who went on an 11-day emergency research mission to Iraq in January. At press time, the war threatened to realize his greatest worry: Iraq’s precarious health system would fail in a crisis.

The mission’s aim was to study the humanitarian impact of the economic sanctions imposed on Iraq since 1990 and the potential consequences of a possible United States–led military intervention in the near future. Estimates of civilian casualties range from thousands to hundreds of thousands.

VanRooyen, co-director of the School’s Center for International Emergency, Disaster,and Refugee Studies (CIEDRS), knows firsthand the horrors of war, having worked in the Sudanese civil war in the 1990s. The associate professor of Emergency Medicine went to Iraq as part of a volunteer delegation led by the Center for Economic and Social Rights, a human rights organization based in New York. The team included experts in food security and nutrition, public health infrastructure, primary health care, emergency and curative medicine, and public health law.

VanRooyen’s role was to take the pulse of the Iraqi health care system. He surveyed 12 hospitals/medical centers and five clinics chiefly in and around two of the country’s largest urban centers, centrally located Baghdad and Basra to the south.

What he found was a fragile health care system that, while functioning “fairly well” at the present, would crack under additional strain. “The health care infrastructure there would be pretty easily overwhelmed with any significant number of casualties,” he says. “They have very little reserve capacity and not enough people trained in trauma and surgical capacities.” Specifically, he detected deficiencies in basic medical equipment, inadequate access to blood supplies, and notable shortages in many medications, such as antibiotics and chemotherapeutic agents. Overall, he says, most hospitals were understaffed, overcrowded, ill-equipped, and poorly maintained.

Prior to the first Gulf War, Iraq’s health care system had several state-of-the-art facilities and was on a par with that of Greece and many other Eastern European countries, VanRooyen notes. The combination of war, a repressive regime, and 12 years of sanctions has left the system a shell.

VanRooyen says the results of the organization’s study are intended to be both a useful tool to public health officials and a reminder to governments and international agencies of war’s human cost.