Effect of the Gulf War on Infant and Child Mortality in Iraq

Ascherio, Alberto; Chase, Robert S.; Coté, Tim; Dehaes, Godelieave; Hoskins, Eric; Laaouej, Jilali; Passey, Megan; Qaderi, Saleh El; Shuqaidef, Saher; Smith, Monica A.; Zaidi, Sarah

doi:10.1056/nejm199209243271306

Cited by 118 publications

(62 citation statements)

References 3 publications

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“…11 Support operations provide supplies and services to assist governments in relieving suffering and responding to crises. 12 Currently, the Army is not specifically organized, trained, or equipped for support operations. Instead, the forces are designed and organized for warfighting.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Care as Part of the US Army Medical Mission in the Global War on Terrorism in Afghanistan and Iraq, December 2001 to December 2004

Burnett¹,

Spinella

Azarow

et al. 2008

Pediatrics

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Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. RESULTS. Pediatric admissions during the study period were 1012 (4.2%) of 24 227 admissions, occupying 10% of all bed-days. The median length of stay was 4 days (interquartile range: 1-8 days). The largest proportion of children were 11 to 17 years of age (332 of 757 children; 44%), although 45 (6%) of 757 children hospitalized were Ͻ1 year of age. The majority (63%) of pediatric patients admitted required either general surgical or orthopedic procedures. The in-hospital mortality rate for all pediatric patients was 59 (5.8%) of 1012 patients, compared with 274 (4.5%) of 6077 patients for all adult non-US coalition patients.CONCLUSIONS. Pediatric patients with injuries threatening life, limb, or eyesight are part of the primary responsibility of military medical facilities during combat and have accounted for a significant number of admissions and hospital bed-days in deployed Army hospitals in Afghanistan and Iraq. Military medical planners must continue to improve pediatric medical support, including personnel, equipment, and medications that are necessary to treat children injured during combat operations, as well as those for whom the existing host nation medical infrastructure is unable to provide care. I N WARTIME, CHILDREN are injured and killed. This tragedy is neither new nor unique to the current conflicts in Afghanistan and Iraq. The circumstances and conduct of this war are unique, however, because the strategy for the war calls for more than the destruction of a fixed definable enemy. The US national security strategy includes "expanding the circle of development" by working with the governments to, among other things, "invest in health care." 1,2 Pediatric patients represent significant proportions of the health care needs in Afghanistan and Iraq, and their treatment must be included if this national security strategy is to be successful.When large-scale conflict has ended but security for civilians cannot be guaranteed, nation-building responsibilities that normally would be met by civilian governmental and nongovernmental organizations fall to the uniformed services by necessity. 3 The same military forces that are engaged in combat one day must maintain stability the next day, while suppo...

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Section: Discussionmentioning

confidence: 99%

Pediatric Care as Part of the US Army Medical Mission in the Global War on Terrorism in Afghanistan and Iraq, December 2001 to December 2004

Burnett¹,

Spinella

Azarow

et al. 2008

Pediatrics

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“…129. See United Nations 1991;and Ascherio et al 1992 vaguer and subtler nuclear threats, and, unlike during the Cold War, U.S. leaders were clear in their own minds that they were bluffing and had no intention of actually using such weapons. There was no tangible preparation for nuclear use.…”

Section: The Vietnam War: a Hard Test For The Taboomentioning

confidence: 99%

The Nuclear Taboo: The United States and the Normative Basis of Nuclear Non-Use

Tannenwald¹

1999

Int Org

412

144

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We have recently witnessed the ftieth anniversary of the bombing of Hiroshima and Nagasaki, the only use of nuclear weapons in warfare. The non-use of nuclear weapons since then remains the single most important phenomenon of the nuclear age. Yet we still lack a full understanding of how this tradition arose and is maintained and of its prospects for the future. The widely cited explanation is deterrence, but this account is either wrong or incomplete. Although an element of sheer luck no doubt has played a part in this fortuitous outcome, this article argues that a normative element must be taken into account in explaining why nuclear weapons have not been used since 1945. A normative prohibition on nuclear use has developed in the global system, which, although not (yet) a fully robust norm, has stigmatized nuclear weapons as unacceptable weapons of mass destruction. Without this normative stigma, there might have been more ''use.'' 1 This article examines this phenomenon in the context of the nuclear experience of the United States.This investigation is motivated by several empirical anomalies in the conventional account-deterrence-of the non-use of nuclear weapons since 1945. First is the non-use of nuclear weapons in cases where there was no fear of nuclear retaliation, that is, where the adversary could not retaliate in kind. This anomaly includes the rst ten years or so of the nuclear era, when the United States possessed rst an absolute nuclear monopoly and then an overwhelming nuclear advantage over the Soviet Union. It also includes non-use by the United States in Vietnam (where the United States dropped tonnage equivalent to dozens of Hiroshima bombs) and in the 1991 Persian For helpful comments and criticisms on presentations of this article, I am grateful to participants in seminars at

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“…36 One reason the infant mortality rate obtained from the International Study Team's August 1991 survey might have been so low is that, in their calculations, the researchers excluded cases that had missing information. 17 The criteria used in the calculations excluded disproportionately more deaths than births, thus causing a downward bias in the International Study Team's mortality estimates, especially those from the prewar period. We cleaned the International Study Team's data by using somewhat different criteria.…”

Section: Data Collectionmentioning

confidence: 99%

“…Throughout the 20th century, wars have had an increased effect on noncombatant populations as a result of economic disruption, destruction of public health infrastructure, population movements, loss of access to medical care, and shortages of food. [17][18][19][20][21][22][23][24][25] Economic declines in some developing countries in the 1980s were expected to result in demonstrable increases in infant mortality. Although homelessness and poverty increased in Latin America, resource shortages did not become severe enough to disrupt long-term trends toward declining infant and child mortality.…”

Section: Introductionmentioning

confidence: 99%

The effect of economic sanctions on the mortality of Iraqi children prior to the 1991 Persian Gulf War

2000

Am J Public Health

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OBJECTIVES: This study examined the effect of sanctions on mortality among Iraqi children. METHODS: The effects of economic sanctions on health are not well known. Past studies on the effect of economic sanctions on mortality have suffered from unreliable data sources and the collinearity of sanctions with other negative economic events. We overcame these weaknesses by using individual child records from a retrospective survey of mothers conducted after the 1991 Persian Gulf War to examine the effect of sanctions on mortality among Iraqi children. Multivariate proportional hazards analysis was used to assess the effect of economic sanctions prior to war (from August through December 1990). RESULTS: We found that after controlling for child and maternal characteristics, when economic sanctions were entered into the proportional hazards equation, the risk of dying increased dramatically. This increase was highly significant statistically. CONCLUSIONS: Innovative application of robust epidemiologic research tools can contribute to assessments of health and well-being even under the methodological and practical constraints of comprehensive economic sanctions, but more research is needed.

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Effect of the Gulf War on Infant and Child Mortality in Iraq

Abstract: These results provide strong evidence that the Gulf war and trade sanctions caused a threefold increase in mortality among Iraqi children under five years of age. We estimate that more than 46,900 children died between January and August 1991.

Cited by 118 publications

References 3 publications

Pediatric Care as Part of the US Army Medical Mission in the Global War on Terrorism in Afghanistan and Iraq, December 2001 to December 2004

Pediatric Care as Part of the US Army Medical Mission in the Global War on Terrorism in Afghanistan and Iraq, December 2001 to December 2004

The Nuclear Taboo: The United States and the Normative Basis of Nuclear Non-Use

The effect of economic sanctions on the mortality of Iraqi children prior to the 1991 Persian Gulf War

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