On October 22, 1991, the International Study Team on the Gulf Crisis announced the results of its August 25-September 10 study of infant mortality and morbidity in Iraq. This was the second such investigation carried out since the end of Desert Storm, and its findings proved far more ominous than the first, the Harvard Study done last May.
The recent study concluded that Iraq's child mortality rate has more than tripled since the end of the war. Nearly one million of Iraq's children under 5 years of age (29 percent) are significantly undernourished. And many children show signs of severe psychological trauma; two-thirds of school-age children believe they will not live to adulthood.
Thirty-five researchers from 13 countries, many from universities in the United States and Britain--with assistance from scores of people in the region--conducted the study. Joe Nangle of Sojourners interviewed one of the leaders of the team, Dr. Tim Cote, who works at the National Cancer Institute, a branch of the National Institutes of Health (NIH). A graduate of Howard Medical School and Harvard University, where he received his masters in public health, Cote was an epidemiologist, assigned by NIH to the study of AIDS worldwide, when this article appeared. --The Editors
Sojourners: How did you become involved in this study of the situation in post-war Iraq?
Tim Cote: I heard the head of Physicians for Human Rights on NPR [National Public Radio] reporting on the effects of the sanctions against Iraq before the bombs started falling. I gave him a call and said if he needed some epidemiologists for further study, I'd be interested. Eight months later I got a call back from him, saying that there was a group at the Harvard School of Public Health organizing a study of Iraq.
Sojourners: Was this the first study?
Cote: No, this was the second study. Those in the first study went over to Iraq and basically did a descriptive assessment; they didn't collect any data. They recognized the deficiencies in that approach and organized a more quantitative way of going about it. That's the reason I was called. I was asked to help plan and design the second study.
We realized we'd only have about a week and a half to assess infant mortality in a country of 80 million people. We beefed up the number of interviewers to about 50, mostly Jordanians, who spoke Arabic. We got information from more than 9,000 households on 60,000 children. We put in long, long days. There were another 50 or so people who did other things, such as look at health facilities, at the psychological impact of the war on children, at the infrastructures, the electrical systems, sewage and water plants, the environment.
We all went to Baghdad first. Then we went out to every part of Iraq, wherever there were people. There were very arduous conditions while we were there. The water was filthy. Almost all of us got sick at some point or other. But our suffering was just insignificant compared to the suffering of the people around us. We kept reminding ourselves that we can always go home.
Sojourners: What did you discover in terms of infant mortality and morbidity in Iraq?
Cote: Infant mortality--the number of deaths of children under one year old per 1,000 live births--is an incredibly sensitive measure of the health of a population, because it measures everything from whether the father is employed to whether the mother is getting enough food. The infant mortality rate in Iraq prior to 1991 was 24, and it has risen to 80; it has more than tripled in one year's time. If you look just at the eight months between January and August, and compare 1990 to 1991, mortality in children under 5 just about quadrupled.
We found that probably the major reason for the increase in infant mortality has to do with diarrheal illness. The water treatment facilities had been bombed; they were a high bombing priority, according to the military analyst with us. We found that about 70 percent of the water samples we tested contained fecal coliforms, an indication that sewage has gotten into the drinking water.
We also randomly selected about a fifth of the children who were available to measure them for height and weight. If a child has been growing along just fine, and suddenly somebody shuts off the food, they get thin, and their weight per height is going to decrease. If instead they haven't been getting good food all along, then their height will be stunted.
The first condition is chronic malnutrition, a sign of decreased nutritional reserves. The second is acute malnutrition, a sign of long-term famine. We found very little acute malnutrition--less than 2 percent--but a great deal of chronic malnutrition; about 25 percent of the children were chronically malnourished.
Somebody once said that statistics are human beings with the tears wiped off. If you look at the bar charts, it's hard to imagine the amount of suffering that they represent. The number of children who die is amazing.
Public health in Iraq before the war was quite highly developed; it was a model for the region. So clearly something happened there, and I can't attribute it to anything other than the war or sanctions. I am very concerned that the war was portrayed as a very sterile war, a very clean war, a very surgical war, a very technical war--a war of microprocessors. Iraq has been blown to smithereens, and public health will never be the same there.
Sojourners: Did you have any problems with the Iraqi government?
Cote: No. I guess they recognized that in order to have a credible study, they'd have to keep out of it--which was almost too bad, because they have some excellent professionals. They helped us as far as providing cars and drivers; we didn't have any guides. We did an objective study, and we wanted to make sure no one had any notions that we were led around by the nose, which we weren't.
The study wasn't paid for by the Iraqi government. It was paid for by the MacArthur Foundation, UNICEF, and several small foundations.
Sojourners: Is it true that Harvard would not lend its name to the second study?
Cote: I guess there's been some kind of problem up there in Boston, and I don't know quite what's going on. There's some kind of political business. We called ourselves the Harvard Study Team for the longest time, and then I heard that suddenly we were not to call ourselves that anymore.
I don't care, as long as people look at these results objectively. We made a commitment before we left to be objective. If we had found that infant mortality was just where it was before the war, we would have been happy to come back and report that; but that definitely wasn't the case.
Sojourners: What kind of reception has your study had with our government?
Cote: When it first came out, there was a State Department report to the effect that the Iraqis caused this themselves; it was their own fault. There was a quote from [State Department spokesperson] Richard Boucher that said essentially that groups in Iraq who've always been discriminated against are the ones who have the problem.
If we stratify infant mortality by location, we separate the north and the south from the center. The north has the Kurds, and they have definitely been abused by the Iraqi government. The south has the Shiites--same thing. But in the center there was no civil uprising, and you can see that infant mortality rose in all three places. So if you want to say it's just a problem affecting the minorities, the data just don't support that.
Sojourners: Have you had any direct contact with our government about the study?
Cote: I work for the government [at NIH]. In order to go to Iraq, I had to fill out some forms saying that I would do this on my leave time or vacation time.
We filed our report as soon as we got back. Also we submitted a write-up to the Morbidity and Mortality Weekly Report, which is put out by the [U.S. government's] Centers for Disease Control. The editor was very interested and felt the findings were solid. But when it got to the director's office, he said, "Sorry, this is a political hot potato that we can't touch." They refused to put it out solely on political grounds. In doing that, what they're basically saying is that the mortality of some infants is acceptable and that of others is not.
Sojourners: What were your impressions speaking with people in Iraq?
Cote: My impression was that there is really some incredible suffering going on and that people are trying to keep fairly quiet about it, trying just to get through their days. If you're going to wait for a civilian uprising against Saddam Hussein, you're going to be waiting a long time, because he has very tight control.
The people were wonderful, and they treated me very kindly. I don't think an Iraqi in Iowa or New Hampshire or Alabama would get the same kind of treatment I got. There is a cultural expectation about opening your hearts to foreigners and visitors that goes back to the days when people were traveling around the desert. If you had some food or water and you met someone, you shared it, because the survival of the society depended on hospitality.
There were all kinds of personal experiences. I try not to be persuaded by them, because they're not quantitative and they're not externally verifiable. Our job was to be very focused and objective. Still, you can't deny them.
I went into a house, and there was a child who is 5 years old and hasn't spoken since the bombing eight months ago. I met a man who was crying to me that he just lost his fiancée because she didn't have very simple drugs that were readily available prior to the war. Children who were 5, 6, 8 years old described to me planes coming in and bombing the house I'd just visited.
One woman came running up to me with a big tub on her head, yelling at me in Arabic. She pulled the tub down, and I looked in and saw that the water was gray, very gray and nasty. Even though I couldn't understand a word, I could understand exactly what she was saying.
It was very hard to do this kind of study in a place with so much suffering; when you go to a house and see a baby who's clearly dying of malnutrition and diarrhea, and you know that you're working 16- or 18-hour days with a team of five interviewers, and you've got to go on. You've got to collect the data and get to the next house. I could have spent half the day taking care of that child. Maybe the child would have survived, but then the study wouldn't have gotten done, and the study is important.
Sojourners: Did you have any concerns about going to Iraq?
Cote: I never felt so called to do anything, and at the same time I was afraid. It required some prayerful time and some prayerful people around me as I thought about going, especially when I thought about my 3-year-old son and my wife. Communitas [a Catholic community in Washington, D.C., where Cote worships] was very instrumental. My wife was concerned about the war as well. When the war first broke out, she was glued to the television set and saw the incredible, horrifying slaughter.
Sojourners: Would there be a need to go back, say, in another year for a follow-up study?
Cote: Whether or not there's going to be a need for a follow-up survey, I think what's needed rather than studies at this point is decisions. Somebody's got to take a hard look at the sanctions and ask, Is it worth prohibiting shipments of chlorine for fear of Iraq using it in chemical weapons rather than using it for clean drinking water? And if Iraq is going to import things such as food and medicine, they've got to be able to sell oil.
There are some innocent people caught in the middle of this policy between George Bush and the United Nations and Saddam Hussein. And someone has to do something about those people. Maybe there will come a time, but now is not the time for more studies.
Got something to say about what you're reading? We value your feedback!