1	Health Consequences of the War in Iraq Barry S. Levy, M.D., M.P.H. November 7, 2006 Updated February 15, 2007
2	Context Iran-Iraq War (1980-1988) 500,000-1 million people killed 1-2 million people wounded 2.5 million people uprooted Persian Gulf War (Gulf War I, 1991) Tens of thousands of people died Many injuries and chronic illnesses More people died after the war, including an estimated 400,000 children
3	Gulf War II March 2003 invasion: WMD Al Qaeda May 2003: “Most hostilities over.” “Mission accomplished.” Most health consequences of the war have occurred since
4	Health Consequences Direct impacts on health Adverse effects on health services Damage to health-supporting infrastructure Refugees and internally displaced persons Impact on human rights Diversion of resources Impacts on environments
5	Direct Impacts on Health U.S. military personnel More than 3,000 deaths More than 23,000 wounded Mental health disorders
6	Direct Impacts on Health Iraqis Sample survey (2004) of 1,000 households 100,000 excess deaths Most among women and children Violent deaths increased > 50-fold, most due to Coalition air strikes
7	Direct Impacts on Health Iraqis Sample survey (2004) 100,000 excess deaths Most among women and children Violent deaths increased > 50-fold, most due to Coalition air strikes Sample survey (2006) 600,000 excess deaths
8	Direct Impacts on Health Iraqis Childhood malnutrition Peaked during mid-1990s Mainly due to sanctions on imports Today: one-fourth of children are chronically malnourished, many more underweight
9	Adverse Effects on Health Services Emergency departments not functioning Hospitals, other health facilities damaged Public health laboratories damaged Access to health services restricted Public health programs affected Many health workers have left Iraq
10	Damage to Health-Supporting Infrastructure Water and sewage treatment facilities Much GI illness, including fatal diarrhea 500,000 tons of sewage dumped into rivers Food supply and food security affected One-fourth dependent on free food Power generation unpredictable Transportation and communication systems
11	Refugees and Internally Displaced Persons Gulf War I: 500,000 refugees Many internally displaced persons Gulf War II: 1.8 million refugees 2 million internally displaced persons
12	Impact on Human Rights During regime of Saddam Hussein Many serious human rights violations Many people killed Many political prisoners
13	Impact on Human Rights During Gulf War II Preemptive war violated UN Charter Torture and mistreatment of prisoners Women’s rights violated Freedom of speech restricted
14	Diversion of Resources “Every gun that is made, every warship launched, every rocket signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and not clothed.” - Dwight D. Eisenhower
15	Diversion of Resources Diversion of personnel Two-thirds of 330,000 National Guard troops have served in Iraq or Afghanistan (average: 15 months) Communities feel their absence
16	Diversion of Resources Potential uses in the United States of $204 billion initially appropriated for war in Iraq (choose one) 3.5 million elementary school teachers 24,000 new elementary schools 27 million Head Start places for children 40 million university scholarships 1.8 million affordable housing units 3.2 million port container inspectors Health services for 46 million currently uninsured
17	Diversion of Resources Potential uses internationally of $204 billion initially appropriated for war in Iraq (all of the following for almost 3 years) Cut world hunger in half Launch global comprehensive HIV/AIDS program Fully immunize all children in developing world Provide clean water and functioning sewage systems for unmet needs worldwide
18	Impacts on Environments Physical environment 10-12 million landmines and units of unexploded ordnance 8,000 barrels of hazardous substances Desert ecology disrupted 1,000-2,000 tons of depleted uranium (DU)
19	Impacts on Environments Sociocultural environment In Iraq: Damage to religious and cultural institutions Looting of the National Museum Substantial increase in crime Disruption of everyday life In United States: Tripling of divorces among U.S. Army officers War serves as an example: Violence settles disputes
20	Impacts on Environments Economic environment For Iraq: High unemployment Lagging oil production For United States: $378 billion allocated for war $2 billion per week Total cost could surpass $2 trillion
21	Health Consequences Direct impacts on health Adverse effects on health services Damage to health-supporting infrastructure Refugees and internally displaced persons Impact on human rights Diversion of resources Impacts on environments