I RECENTLY returned from an emergency public health mission to Iraq where I helped assess the consequences of a war on the civilian population, which has in many ways been reduced to the status of refugees.
Nearly 60 percent of Iraqis, about 14 million people, depend entirely on government-provided food rations that, by international standards, represent the minimum for human sustenance. Unemployment is greater than 50 percent, and the majority of those who work earn between $4 and $8 a month. (The latter is the salary of a physician in a primary health center.)
Hospital wards are filled with malnourished children, I learned as part of a six-person delegation on a 10-day mission to Iraq in January sponsored by the Brooklyn, N.Y.-based Center for Economic and Social Rights.
We were told at a children's hospital about newly emerging diseases that had previously been controlled when pesticides could be imported. We saw a mother who had traveled 120 miles with her young daughter, who suffered from leishmaniasis, a parasitic disease that is fatal if not treated. She came to the hospital because she heard it had a supply of Pentostam, the medicine needed to treat the disease. There was none.
The pediatrician turned to me and, in English, said, "It would be kinder to shoot her here rather than let her go home to face the lingering death that awaits her." Our interpreter instinctively translated the doctor's comments into Arabic and the mother's eyes instantly overflowed with tears.
UNICEF estimates there were 500,000 excess child deaths in Iraq in the decade after the 1991 Persian Gulf war. These children and that girl must be counted as "collateral damage" from the war. With half the population of Iraq under age 18, can we make war on Saddam Hussein and not make war on children?
The food distribution program funded by the U.N. oil-for-food program is heavily dependent upon the transportation system. When U.S. forces sever transport routes to prevent Iraqi troop movements and resupply, it will cause a humanitarian burden that our military may not be prepared to shoulder.
We are told that U.S. aircraft will disperse millions of graphite filaments that will paralyze the nation's electrical grids. The poorly functioning electrical system, which is literally held together with bailing wire because the country has been unable to obtain spare parts due to sanctions, will fail. Yet the system is essential to the public health infrastructure.
Unable to import chlorine and aluminum sulfate to purify water, the water treatment system is a victim of sanctions. There are epidemics of some waterborne diseases. The incidence of typhoid, for instance, has increased nearly 1,000 percent, from 2,200 in 1990 to more than 27,000 in 1999. In the aftermath of the electrical failures, the ailing sanitation system will stop working entirely. Pregnant women, malnourished children and the elderly will be most vulnerable.
It's hard to estimate how many civilians will die. A consensus estimate was that 10,000 died during the bombing campaign of the gulf war. That figure will surely climb because the U.S. government has promised that precision-guided munitions will strike Iraq every four minutes for the first 48 "shock and awe" hours of the war.
U.S. warplanes will target Republican Guard units, the intelligence and security apparatus and command-and-control centers situated in highly populated areas such as Baghdad, Basra and Mosul. In Iraq, 70 percent of the population lives in urban areas. Unable to meet the population's acute medical needs now, Iraq's health care system would be overwhelmed in such an assault.
I have not taken into account the use of weapons of mass destruction, the possibility that the war will ignite massive civil disorder, the destruction of the oil fields or what would happen if U.S. troops became bogged down in house-to-house fighting in Baghdad.
More troubling, if the United States pursues this war without the backing of the U.N. Security Council, it will undermine a half-century of efforts to establish a community of civilized nations governed by the rule of law. Such an act on our part would also violate the U.N. Charter and make a mockery of the institution we have helped to fashion in the hopes it would help prevent crimes against humanity. Many might define the consequences of such an attack on the population of Iraq as just that.
Mr. Hussein is a thug. He needs to be contained. Many former U.N. weapons inspectors believe he has been "de-fanged." His neighbors no longer fear him. There are many Iraqis who want him removed, but not by a U.S.-led war.
Against the short-term gain of removing Mr. Hussein, we must take into account that we may well unleash forces of hatred and resentment that could haunt us for decades in every corner of the world.
Charlie Clements is a public health physician and CEO of WaterWorks, a Santa Fe, N.M.-based not-for-profit organization that assists U.S. communities without running water or sewers. He is also a Distinguished Graduate of the Air Force Academy and a Vietnam veteran.