by Dr Sue Wareham, President, Medical Association for Prevention of War (Australia)

Editors note
We are very pleased to be able to publish this article. The twin pillars of destruction that threaten our lives are war and ecological collapse and they are intertwined in their causes and effects. Within DEA’s sphere of expertise, climate change, Bill Castleden has pointed out in a 2020 submission that “The US Defence Department is that country’s largest single consumer of energy, and is probably the single largest consumer in the world.” and “A global movement to reduce the carbon emissions of the military and to cut arms spending could make the global quest for carbon emission reductions a harbinger of more peaceful co-existence.”

The Human Costs of Iraq and Other Wars

This paper was presented at the Sydney Peace Foundation conference
Iraq Never Again: Building Peace, Ending War
Customs House, Circular Quay, Sydney, April 15 and 16, 2008

Thank you very much to the organisers of this important conference for the opportunity to take part, which MAPW very much appreciates. And I wish to congratulate the Sydney University’s Centre for Peace and Conflict Studies on its 20th birthday, and the International Peace Boat for its 25th anniversary. Both have been consistent voices for peace in a world where such voices are desperately needed.

The human costs of war are so profound and far-reaching that it is impossible to do any more than skim over them in a talk such as this. We know that war brings with it the risk, if not the certainty, of humanitarian disaster, enormous loss of life, destruction of essential services, terrible human rights abuses, floods of refugees, crippling economic cost, and a devastated environment. Iraq is suffering all of these, as predicted over five years ago by many individuals and organizations.

In this talk I will say a little about the situation in Iraq, but I do not want to leave it at that. We need to have ways to move forward to make warfare a discredited and unusable option in resolving conflicts, so I want to offer some thoughts on that too.

The statistics about modern warfare and its impact on civilians are probably familiar to you. During the last 100 years the impact of warfare on civilians has changed dramatically, to the point where warfare can accurately be regarded as an attack on civil society. Most wars in the 18th and19th centuries caused relatively few civilian casualties. In WWI approx 14% of the dead were civilians, in WWII 67%, and in the 1990s an estimated 90% of the dead were civilians. Not only did the % of civilian deaths increase during the century, but the degree of destruction caused in the process increased. Since WW11 there have been more munitions expended for every enemy soldier killed than previously.

In Iraq, mortality estimates vary widely, for obvious reasons. This war, like most, was sold to us on morally righteous grounds. A big death toll does not look good, so the spin doctors have been hard at work. In October 2006 the eminent medical journal The Lancet published a study from John Hopkins Bloomberg School of Public Health in Baltimore, which estimated that the number of conflict-related deaths, above and beyond the deaths that would usually occur, from the start of the war up until July 2006, was 655,000, 92% of those deaths being due to direct violence. In quick response, and in total ignorance of the way in which such studies are conducted, political leaders in the US, the UK and Australia ridiculed the report. It transpired that in the UK at least, government ministers had been advised by their own scientists in the Ministry of Defence that the research was robust and “close to best practice”.

A more recent estimate of the Iraqi death toll was made by the US group Just Foreign Policy in August 2007, and that estimate was over 999,000 – practically 1 million Iraqi deaths due to the invasion.

Deaths are of course only the tip of the iceberg of the humanitarian effects of war. There are in addition injuries, both physical an psychological, on an enormous scale. In Iraq, ongoing suffering is perpetuated by grave problems in the health care sector, including destruction of facilities, the exodus of thousands of doctors and other workers (including university teachers), abduction, killing and torture of doctors, deliberate attacks on hospitals and clinics, and violation of the fundamental principle of medical neutrality.

Children are particularly vulnerable to many of the effects of war, including deprivation, food shortages and outbreaks of infectious illness. (In the1991 Gulf War, the US destroyed 85-90% of Iraq’s electrical generating capacity, in the full knowledge that it would lead to inability to run water treatment plants, and therefore infectious illnesses that would particularly affect children.) The psychological impacts of war on children are incalculable.

A report by Oxfam International in August 2007 estimated that

* · almost a third of the population was in need of emergency aid.
* · 92% of children suffered learning difficulties mostly because of the pervasive climate of fear.
* · More than 800,000 children have dropped out of school.
* · About 40% of Iraq’s teachers, doctors, engineers and other professionals have left the country since 2003.
* · Unemployment rate was 50%.
* · Clean water, sanitation and electricity services were drastically reduced, even compared to 2003 levels after over a decade of economic sanctions.

As an example of one of the many unintended consequences of war, many Iraqi farmers are now turning to growing opium poppies as they can no longer make a living from traditional crops.

The refugee crisis in Iraq is the biggest in the Middle East for 60 years. One in 6 Iraqis have been displaced, either internally (approximately 2.5 million) or into neighbouring countries, especially Syria and Jordan (approximately 2 million), placing enormous strain on those countries. 60,000 people are leaving the country every month. Many of them have limited access to health care in their host country, and many are women and children, who are economically vulnerable.

In relation to US troop casualties, we know that over 4,000 have died. But that again is just the tip of the iceberg. US government figures state that for every US military death in Iraq and Afghanistan there are 16 injuries. Many of these will cause lifelong disability. Increasingly also there is focus on the alarming rates of psychological problems among Iraq war veterans. A study of more than 88,000 of them, published in November last year, found that almost a third suffered a psychological disorder. A 2007 investigation by the CBS television network in the US estimated that, for those veterans aged 20-24, the suicide rate was four times the national average.

The profound psychological impacts of this war on US veterans – and their communities – are compounded by the fact that the troops were told they were going as liberators. Instead they are attacked by Iraqis as hated occupiers.

The economic cost of the war, to the US alone, has been estimated by Joseph Stiglitz from Columbia University and Linda Bilmes from Harvard, at $3 trillion. This estimate takes into account the cost of providing health care and other services to the veterans over coming decades. For comparison, for less than the cost to the US of one month’s combat in Iraq, literacy could have been provided to every illiterate child in the world. Compare the impact this single achievement alone could have had in removing the influence of fundamentalist religious schools in the indoctrination of children if our spending priorities had been different.

The post-invasion state of health in Iraq as at 2007 has been examined by Medact, the IPPNW affiliate in the UK, in their publication, “Rehabilitation Under Fire: Health care in Iraq 2003 – 7” The report emphasised not only physical illness but also mental health problems and the profound impact they have on a country’s future. However the main focus of the report was the policy decisions that have led to the disastrous current situation. Some of them were:

* · A failure of the occupying powers to protect health care facilities (only the ministries for oil and the interior were protected during or after the invasion)
* · During the attacks on Fallujah in 2004, no humanitarian corridor was provided. Elsewhere checkpoints have prevented access to health facilities.
* · Advice from the UN and other sources with relevant experience in health care was largely ignored. The Pentagon had a virtual monopoly on post-invasion reconstruction, including in health care
* · The enforced sacking of Ba’ath party members removed many senior health experts
* · There was insufficient engagement of local experts, and appointment of leaders with little relevant experience.
* · Well-functioning systems such as the Oil-for-food distribution network for food and medicines was undermined by the US drive for privatisation in everything. “International evidence against applying free market principles to the health sector, especially post-conflict, was ignored”. Favourable contracts were awarded to US companies and much Iraqi money was wasted.
* · In drawing up the national formulary of medicines, the Coalition Provisional Authority consulted not the WHO for advice but the US Defence Department.

The Medact report made a series of recommendations for the Iraqi health care situation. They include :

* · Participation by the Iraqis, who must lead all development processes
* · Coordination of all parties, including Iraqi leaders and civil society and international agencies and donors
* · The development of a health policy based on the needs of the Iraqis, not the occupiers
* · Ongoing financial support for humanitarian work in Iraq

The question of what to do about Iraq has no simple answer of course. The legacy that has been created will be with us for decades and longer. For its direct victims the psychological legacy will in many cases pass to their children also. It seems increasingly clear however that for a long as the country is occupied it will not be at peace. The occupying forces must leave. It was reported last November that violence in Basra fell by 90% when the British troops withdrew. In addition, the presence of foreign troops provides good training grounds and combat experience for terrorists, which is the opposite effect of that envisaged by the invasion forces 5 years ago.

Beyond the problem of Iraq is the even more daunting problem of war generally. I want to briefly list just some of many possible ways to proceed if we are to de-legitimise warfare, as indeed we must.

I think the first thing we must do is counter the sense of fatalism that tells us there is nothing we can do to prevent war, a belief that becomes self-fulfilling. It is extremely pleasing to have the issue of illiteracy about non-violence included in this conference, because we are conditioned to believe that only violence works in settling major conflict. In his book, “The Human Potential for Peace”, the anthropologist Douglas Fry examines in detail the available evidence on conflict resolution strategies in a very large number of human societies. He reports on a wealth of cross-cultural information on conflict management, reconciliation and peace-making from around the world, and concludes that humans have a tremendous capacity for resolving conflicts without violence

Similarly Jonathan Schell, in his book ‘The Unconquerable World: How peaceful protest is stronger than war” states that the 20th century was not only the century of total violence but it was also a century of non-violent action, and he gives many examples. Mark Kurlansky’s “Non-violence: The history of a dangerous idea” gives fascinating insights also, as does the splendid recent publication from the Oxford Research Group “War Prevention Works: 50 stories of people resolving conflict” Grass-roots activity is encouraged by the book “Enough Blood Shed: 101 solutions to violence, terror and war” by Mary-Wynne Ashford and Guy Dauncey. Such books should be widely read.

Disarmament education and education about the UN must be strongly encouraged and resourced in all our schools, so that students know of the history and achievements of the UN and the need for disarmament. We hear a lot about the failures of the UN, but very little about its remarkable achievements. This in turn will translate into greater support at a community level for the UN and its goals.

Disarmament must be not only taught but also implemented. Far greater controls on both small arms and larger weapons systems are needed. In this context it is deeply disturbing to note that Armistice Day, November 11, this year will be marked by the opening in Adelaide of the Asia-Pacific Defence and Security Exhibition, an arms fair designed to attract buyers from all over the world. Premier Mike Rann describes the “terrific business and investment opportunities” that it represents. A short term goal for us could be the cancellation of this obscene promotion of death and destruction.

For the world’s most destructive weapons, nuclear weapons, their abolition is long overdue. I want to remind you of the campaign ICAN, the International Campaign to Abolish Nuclear Weapons, whose goal is a Nuclear Weapons Convention to ban these instruments of terror. We have banned dum-dum bullets, biological weapons, chemical weapons and landmines, but not yet the weapons whose destructive capacity far exceeds all of these. I encourage you to visit the ICAN website (www.icanw.org) and see how you can support the campaign.

A further way forward I believe is to join forces with the environmental movement to highlight the terrible environmental costs of war and its preparation. One of the hidden costs of war is the enormous consumption of fossil fuels during the course of military activity. In the US for example, the Dept of Defense is the single largest energy consumer in the country. A study ordered by the Pentagon and released a little over a year ago stated that the military in Iraq and Afghanistan are using 16 times more fuel per soldier than in WW11, and that of all cargo the military transports, more than half of it is fuel. The contribution of the world’s armed forces to climate change deserves much greater attention.

In addition, the world’s armed forces are probably the largest polluters on earth, leaving behind them an array of chemicals, defoliants, landmines, other UXOs, and the degradation of fragile ecosystems (including deserts) from large scale troop movements. We should note that the use of warfare for the acquisition of fuel resources is an additional imperative for greatly and rapidly expanding our use of renewable energies.

Other natural allies in our struggle to prevent war are those advocating greater resources for housing, health care, education, environmental rescue efforts and a host of other needs. Why is Australia spending $62 million per day on our military forces and weapons systems that threaten our neighbours, when so many sectors of our society suffer chronic shortage of funds? A re-ordering of our priorities, in Australia and globally, and especially in the nation that is responsible for over half of the world’s military expenditure, is essential to ensure that true human security is our goal rather than destructive capacity.

Most of you will be familiar with the Global Action to Prevent War program, a far-reaching and comprehensive series of goals to reduce and phase out our reliance on armed conflict. To some it will seem utopian. And yet there is nothing in the program that is beyond human capacity. The GAPW program also requires wide dissemination and study.

There are of course very many other steps that can be taken to reduce both the likelihood and the destructiveness of warfare. You will have many ideas. Among them is ensuring respect for international law

The founders of the United Nations, who had suffered one of mankind’s darkest periods, recognised war for what it is – a scourge. It destroys civil society, undermines human security, violates human rights, squanders scarce resources, pollutes our environment and diverts our attention from real solutions to the problems humanity faces.

In 2005, Harold Pinter was awarded the Nobel Prize for Literature. In his acceptance speech, made in the context of the invasion of Iraq, he talked about the “tapestry of lies” that surrounds us. He stated what he saw as our essential task if we are to prevail. He said,

“I believe that, despite the enormous odds which exist, unflinching unswerving fierce intellectual determination, as citizens, to define the real truth of our lives and our societies is a crucial obligation which devolves upon us all. It is in fact mandatory. If such a determination is not embodied in our political vision we have no hope of restoring what is so nearly lost to us – the dignity of man.”

The real truths to which Pinter refers must be stated again and again, as we denounce the myths that perpetuate warfare, and the myth that there is nothing we can do to prevent it.

We thank Sue for permission to publish