Abstract
A war will generate huge flows of refugees and a public health crisis.
War planners naturally focus more on destruction than reconstruction, more on achieving their military goals than dealing with the humanitarian crises that conflict can create. This has been true during the U.S. buildup toward possible war with Iraq. Yet failure to prepare adequately for the humanitarian disaster that could follow a U.S. attack might dramatically increase civilian deaths, complicate military operations, and slow efforts to create a stable, peaceful, and prosperous Iraq.
An attack on Iraq, starting with an air assault against Baghdad and other strategic targets, would generate huge flows of refugees and a serious nutritional and public health crisis. More than a million people fled Iraq during and after the 1990-1991 Gulf crisis, when Saddam Hussein crushed ethnic rebellions that the United States refused to support. Surrounding countries, the United Nations, and relief agencies are bracing for flows at least as great this time. There could also be massive internal movement, with people fleeing cities for the country. Many of the roads that U.S. and allied troops would need to bring troops and equipment into Iraq could be clogged with people fleeing for their lives.
Most of Iraq's 24 million people depend on food rations provided under the U.N. Oil for Food Program. Any break in the food pipeline would create a nutritional crisis, forcing hungry Iraqis to besiege invading troops for food.
Relief agencies have been working for years in Afghanistan, but there is little infrastructure to deal with a humanitarian disaster in Iraq. Stockpiling food, assembling supplies and medicine, and building relief teams will take time and money–mainly from the United States. During and immediately after a conflict, occupying forces are often the only source of food and medical care.
If Saddam Hussein were to use chemical or biological weapons to blunt an attack, the humanitarian crisis could be far worse. Thousands of people would be killed or incapacitated, but relief workers–the world's first responders to complex emergencies–would find it difficult to provide aid. Humanitarian workers are completely unprepared to work in the toxic conditions they could encounter in the country.
Clearly, Saddam has the capacity, the will, and the experience to use weapons of mass destruction. He used chemical weapons during the war with Iran and against his own people. In 1988, Iraqi forces killed thousands of Kurds with chemical weapons in the northern Iraqi city of Halabja.
UNSCOM, the first U.N. team to inspect Iraq, reported that by 1991, Iraq had produced 19,000 liters of botulinum toxin, 8,500 liters of anthrax, and 2,200 liters of aflatoxin. The team also found that the country had stockpiled 2,850 tons of mustard gas, 210 tons of tabun, 795 tons of sarin, and 3.9 tons of VX. Iraq had put chemicals and biological agents into a number of weapons, most notably 50 chemical and 25 biological warheads designed for delivery by Scud missiles. Some of these supplies were destroyed, of course, by U.N. teams.
Regardless of whether Saddam used chemical or biological weapons, U.S. forces would find an Iraqi population that has been weakened by public health problems attributable to unsanitary conditions, including polluted water and inadequate nutrition. Much of the Gulf War's damage to water, sewer, electrical, and health systems has been repaired slowly or not at all. Saddam blames the U.N. sanctions; others blame Saddam for bending the sanctions to his political and economic advantage, rather than to his people's welfare. Either way, the people of Iraq have been hurt by the sanctions, which were imposed to compel disarmament and the settlement of various claims by Kuwait.
Despite the efforts of the Oil for Food Program, which uses Iraq's oil revenues to purchase food and medicine, malnutrition remains a serious problem. The U.N. Children's Fund reports that the prevalence of acute malnutrition among children under five in central and southern Iraq rose from 3 percent in 1991 to 11 percent in 1996, when Saddam finally agreed to the Oil for Food Program. Gradual increases in food deliveries since then helped bring the rate down to 4 percent this year. Over all, nutritional conditions are better in the Kurdish areas in the north, where the United Nations administers the program with greater fairness and efficiency than the Iraqi government does in the rest of the country.
As many as a million people have been driven from their homes by the Iraqi government, largely for ethnic reasons. Many of these internally displaced people get little or no food under the Oil for Food Program. The Brookings Institution-SAIS Project on Internal Displacement recently released a detailed study on the Kurds, Shi'a, and others who have been systematically displaced by Saddam Hussein's regime. “In Iraq, the expulsion of people from their homes has long been state policy,” John Fawcett and Victor Tanner write in the report. “Expulsions have been undertaken to punish and subdue recalcitrant populations.”
Because displaced people have been denied assistance by the Iraqi government and gotten little attention from the international community, they are the most vulnerable people in the country today. Fawcett and Tanner note that the country's internally displaced populations represent political and ethnic “fault lines” that will have to be bridged to build a stable post-Saddam Iraq.
The outbreak of conflict would generate a large and immediate need for food, shelter, and medicine, both for refugees and war survivors. But very little relief material is stockpiled in the area. The United Nations and relief agencies are addressing this problem now, but the challenge is complex.
First, nobody knows if or when the United States will attack. The current speculation is that any attack would come in February, creating a greater need for shelter, blankets, and clothing. In addition, humanitarian planners don't know anything about the dimensions or targets of a possible attack–would it be focused on Baghdad or include other major cities, like Basra and Mosul?
Second, no one knows if the war would stay limited to Iraq or spread to other countries, such as Israel, Saudi Arabia, or Kuwait. Both U.N. and U.S. analysts have concluded that Iraq has retained a missile program that could allow it to attack targets in other countries.
Third, planners are worried about the lack of assistance infrastructure in and around the country. Only a few international non-government agencies work in Baghdad, compared to more than a hundred in Afghanistan. As a result, there is no network for distributing aid quickly. The United Nations has less than 1,000 expatriate workers in Iraq, supported by a few thousand Iraqis. Most of the international workers administering the Oil for Food Program would likely leave the country before hostilities started. Because of U.S. sanctions against Iraq, American relief agencies have been largely prevented from operating in or even visiting central and southern Iraq. This has slowed preparations for post-conflict relief operations in the country.
Fourth, any use of weapons of mass destruction would dramatically increase casualties, poison the environment, and impede relief efforts.
No matter how complex the humanitarian challenges, they must be addressed as military plans are made. The humanitarian costs are a necessary part of the calculus of war, and the United States must take the lead in addressing them. Preparing to save the people of Iraq is at least as important as planning to remove the country's president. Avoiding a humanitarian crisis would make it easier to start the long process of building an Iraq that is no longer a threat to its neighbors or its own people.