Medical report forecasts huge death toll

(12 November 2002)

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A US-led attack on Iraq is likely to result in between 48,000 and 260,000 deaths during the first three months of combat, according to a study by medical and public health experts launched in Parliament House by the Medical Association for Prevention of War (MAPW) today. Post-war health effects could take an additional 200,000 lives.

On launching the report this morning, Dr Sue Wareham, President of the Medical Association for Prevention of War, called for the Australian government and those supportive of a war with Iraq to read the report thoroughly.

"This report at least deserves a response from those who advocate war against Iraq," said Dr Wareham. "If Prime Minister Howard already understands the human effect of modern warfare, then he has a responsibility to justify to the Australian people our likely involvement in this carnage. If he does not understand, then this report is essential reading for him. But let him not pretend that he just doesnt know."

The report, titled "Collateral Damage: The Health and Environmental Costs of War on Iraq", is based on projections from the 1990-91 Gulf War, which led to an estimated 205,000 casualties. It analyses current U.S. combat scenarios and concludes that a new conflict will be much more intense and destructive than the first Gulf War.

The report forecasts a huge death toll, a massive humanitarian crisis and long term health and environmental damage from any war on Iraq. If nuclear weapons were used, the death toll would rise into the millions. The aftermath of such a military attack could include civil war, famine, epidemics, millions of refugees and economic collapse, according to the report.

General Peter Gration, former Australian Chief of Defence Forces has openly supported the report and the attack scenarios postulated in the report as militarily sound, stating "I thoroughly commend this Report, and its call for humane and wise global leadership. By reminding us of the likely monumental human and environmental costs of a new war with Iraq, it has made a major contribution to the debate at a critical time."

Collateral Damage

The health and environmental costs of war on Iraq

Executive Summary

Up to four million people could die in a war on Iraq involving nuclear weapons. A more contained conflict could cause half a million deaths and have a devastating impact on the lives, health and environment of the combatants, Iraqi civilians, and people in neighbouring countries and beyond. It could also damage the global economy and thus indirectly harm the health and well-being of millions more people across the world.

Researched and written by health professionals, this evidence-based report examines the likely impact of a new war on Iraq from a public health perspective. Credible estimates of the total possible deaths on all sides during the conflict and the following three months range from 48,000 to over 260,000. Civil war within Iraq could add another 20,000 deaths. Additional later deaths from post-war adverse health effects could reach 200,000. If nuclear weapons were used the death toll could reach 3,900,000. In all scenarios the majority of casualties will be civilians.

The aftermath of a conventional war could include civil war, famine and epidemics, millions of refugees and displaced people, catastrophic effects on childrens health and development, economic collapse including failure of agriculture and manufacturing, and a requirement for long-term peacekeeping. Destabilisation and possible regime change in countries neighbouring Iraq is also possible, as well as more terrorist attacks. Global economic crisis may be triggered through trade reduction and soaring oil prices, with particularly devastating consequences for developing countries.

The financial burden will be enormous on all sides, with arms spending, occupation costs, relief and reconstruction possibly exceeding $150-200bn. The US is likely to spend $50bn - $200bn on the war and $5bn - 20bn annually on the occupation. As the report points out, $100bn would fund about four years of expenditure to address the health needs of the worlds poorest people.

Conflict will be more destructive than 1990-1991 Gulf War

The avowed US aim of regime change means any new conflict will be much more intense and destructive than the 1990-91 Gulf War, and will involve more deadly weapons developed in the interim. Furthermore, the mental and physical health of ordinary Iraqis is far worse than it was in 1991, making them much more vulnerable this time round, and even less able to muster the resources needed for recovery and reconstruction.

Thanks to the oil revenues and social policies of Saddam Husseins dictatorship, Iraq pre 1991 had become a reasonably prosperous, urbanised, middle-income country with a modern social infrastructure and good public services. The combined effects of war and sanctions, only partly offset by the humanitarian relief of the Oil-for-Food programme, relegated it to a pre-industrial age, and it now occupies a lowly 126th place out of 174 in the UN Human Development Index

The likely war scenario

The report bases its estimates on data from the earlier Gulf War, from comparable conflicts and crises elsewhere, and from the most reliable recent information on the health status of Iraq. It hypothesises a credible war scenario from current US military strategy, which envisages four different elements: sustained and devastating air attacks on government and military facilities and infrastructure in Baghdad and other major urban centres; landing of ground forces to seize oil-producing regions in the south east; gaining control of north Iraq; and rapid deployment forces backed by air attacks to take Baghdad.

The US goal of leadership change is counterbalanced by Saddam Husseins goal of survival, so a short, clinical campaign is probably wishful thinking. The options open to Saddam Hussein include:
firing oil wells and using radiological or chemical missiles to pollute the sites
paramilitary attacks on Kuwaiti and Saudi oil fields, pipelines and facilities
paramilitary attacks on civilian centres in other Gulf states
paramilitary attacks on targets in the US, UK and other Coalition countries
selective use of chemical and biological weapons (CBW).

The report considers the circumstances in which more substantial use of chemical, biological and nuclear weapons may occur. An Iraqi CBW attack on Israel or elsewhere could provoke immediate nuclear retaliation from Israel, the US and/or UK, while the UK and US have not ruled out the nuclear first-strike option.

Many questions remain unanswered about the aftermath and the likelihood of installing a stable new regime. The current problems of Afghanistan provide a reminder of the huge investment required to rebuild a shattered country, and the reluctance of the global community to support such long-term development.

Alternatives to war

As an objective report by health professionals, the report does not take a political stance on the alternatives to war on Iraq. Its main goal is to aid decision-making and encourage informed public debate by spelling out the true cost of a new war, against which any potential gains from going to war must be weighed. It lists non-violent strategies that have not yet been fully explored - some relating specifically to Iraq, and some to improving the international security context. It concludes that there is an urgent need for humane and wise global leadership which recognises that national security is impossible without international security.

Collateral Damage: the health and environmental costs of war on Iraq was issued in London on 12 November 2002 by the health organisation Medact, the UK affiliate of International Physicians for the Prevention of Nuclear War - winner of the Nobel Peace Prize in 1985. It was released on the same day in the US at the National Press Club in Washington DC and by other IPPNW affiliates in ten other countries.
In Australia, the report was launched at a press conference in Parliament House, Canberra on Tuesday 12 November 2002 with speakers including Dr Sue Wareham, MAPW President; and hosted by Senator Kerry Nettle, Australian Greens. Copies of the report will be distributed to every Member and Senator in Australian Federal Parliament.
The report can also be found on the Medical Association for Prevention of War (MAPW website) at:

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