Sharings with friends - January-March 2003

http://www.timesonline.co.uk/article/0,,2089-628258,00.html

US Marines turn fire on civilians at the bridge of death
Mark Franchetti, Nasiriya

THE light was a strange yellowy grey and the wind was coming up, the beginnings of a sandstorm. The silence felt almost eerie after a night of shooting so intense it hurt the eardrums and shattered the nerves. My footsteps felt heavy on the hot, dusty asphalt as I walked slowly towards the bridge at Nasiriya. A horrific scene lay ahead.

Some 15 vehicles, including a minivan and a couple of trucks, blocked the road. They were riddled with bullet holes. Some had caught fire and turned into piles of black twisted metal. Others were still burning.
Amid the wreckage I counted 12 dead civilians, lying in the road or in nearby ditches. All had been trying to leave this southern town overnight, probably for fear of being killed by US helicopter attacks and heavy artillery.

Their mistake had been to flee over a bridge that is crucial to the coalition's supply lines and to run into a group of shell-shocked young American marines with orders to shoot anything that moved.

One man's body was still in flames. It gave out a hissing sound. Tucked away in his breast pocket, thick wads of banknotes were turning to ashes. His savings, perhaps.

Down the road, a little girl, no older than five and dressed in a pretty orange and gold dress, lay dead in a ditch next to the body of a man who may have been her father. Half his head was missing.

Nearby, in a battered old Volga, peppered with ammunition holes, an Iraqi woman - perhaps the girl's mother - was dead, slumped in the back seat. A US Abrams tank nicknamed Ghetto Fabulous drove past the bodies.

This was not the only family who had taken what they thought was a last chance for safety. A father, baby girl and boy lay in a shallow grave. On the bridge itself a dead Iraqi civilian lay next to the carcass of a donkey.

As I walked away, Lieutenant Matt Martin, whose third child, Isabella, was born while he was on board ship en route to the Gulf, appeared beside me.
"Did you see all that?" he asked, his eyes filled with tears. "Did you see that little baby girl? I carried her body and buried it as best I could but I had no time. It really gets to me to see children being killed like this, but we had no choice."

Martin's distress was in contrast to the bitter satisfaction of some of his fellow marines as they surveyed the scene. "The Iraqis are sick people and we are the chemotherapy," said Corporal Ryan Dupre. "I am starting to hate this country. Wait till I get hold of a friggin' Iraqi. No, I won't get hold of one. I'll just kill him."

Only a few days earlier these had still been the bright-eyed small-town boys with whom I crossed the border at the start of the operation. They had rolled towards Nasiriya, a strategic city beside the Euphrates, on a mission to secure a safe supply route for troops on the way to Baghdad.

They had expected a welcome, or at least a swift surrender. Instead they had found themselves lured into a bloody battle, culminating in the worst coalition losses of the war - 16 dead, 12 wounded and two missing marines as well as five dead and 12 missing servicemen from an army convoy - and the humiliation of having prisoners paraded on Iraqi television.

There are three key bridges at Nasiriya. The feat of Martin, Dupre and their fellow marines in securing them under heavy fire was compared by armchair strategists last week to the seizure of the Remagen bridge over the Rhine, which significantly advanced victory over Germany in the second world war.

But it was also the turning point when the jovial band of brothers from America lost all their assumptions about the war and became jittery aggressors who talked of wanting to "nuke" the place.

None of this was foreseen at Camp Shoup, one of the marines' tent encampments in northern Kuwait, where officers from the 1st and 2nd battalions of Task Force Tarawa, the 7,000-strong US Marines brigade, spent long evenings poring over maps and satellite imagery before the invasion.

The plan seemed straightforward. The marines would speed unhindered over the 130 miles of desert up from the Kuwaiti border and approach Nasiriya from the southeast to secure a bridge over the Euphrates. They would then drive north through the outskirts of Nasiriya to a second bridge, over the Inahr al-Furbati canal. Finally, they would turn west and secure the third bridge, also over the canal. The marines would not enter the city proper, let alone attempt to take it.

The coalition could then start moving thousands of troops and logistical support units up highway 7, leading to Baghdad, 225 miles to the north.

There was only one concern: "ambush alley", the road connecting the first two bridges. But intelligence suggested there would be little or no fighting as this eastern side of the city was mostly "pro-American".

I was with Alpha company. We reached the outskirts of Nasiriya at about breakfast time last Sunday. Some marines were disappointed to be carrying out a mission that seemed a sideshow to the main effort. But in an ominous sign of things to come, our battalion stopped in its tracks, three miles outside the city.

Bad news filtered back. Earlier that morning a US Army convoy had been greeted by a group of Iraqis dressed in civilian clothes, apparently wanting to surrender. When the American soldiers stopped, the Iraqis pulled out AK-47s and sprayed the US trucks with gunfire.

Five wounded soldiers were rescued by our convoy, including one who had been shot four times. The attackers were believed to be members of the Fedayeen Saddam, a group of 15,000 fighters under the command of Saddam's psychopathic son Uday.

Blown-up tyres, a pool of blood, spent ammunition and shards of glass from the bulletridden windscreen marked the spot where the ambush had taken place. Swiftly, our AAVs (23-ton amphibious assault vehicles) took up defensive positions. About 100 marines jumped out of their vehicles and took cover in ditches, pointing their sights at a mud-caked house. Was it harbouring gunmen?

Small groups of marines approached, cautiously, to search for the enemy. A dozen terrified civilians, mainly women and children, emerged with their hands raised.

"It's just a bunch of Hajis," said one gunner from his turret, using their nickname for Arabs. "Friggin' women and children, that's all."

Cobras and Huey attack helicopters began firing missiles at targets on the edge of the city. Plumes of smoke rose as heavy artillery shook the ground under our feet.

Heavy machinegun fire echoed across the huge rubbish dump that marks the entrance to Nasiriya. Suddenly there was return fire from three large oil tanks at a refinery. The Cobras were called back, and within seconds they roared above our heads, firing off missiles in clouds of purple tracer fire.

There were several loud explosions. Flames burst high into the sky from one of the oil tanks. The marines believed that what opposition there was had now been crushed. "We are going in, we are going in," shouted one of the officers.

More than 20 AAVs, several tanks and about 10 Hummers equipped with roof-mounted, anti-tank missile launchers prepared to move in. Crammed inside them were some 400 marines. Tension rose as they loaded their guns and stuck their heads over the side of the AAVs through the open roof, their M-16 pointed in all directions.

As we set off towards the eastern city gate there was no sense of the mayhem awaiting us down the road. A few locals dressed in rags watched the awesome spectacle of America's war machine on the move. Nobody waved.

Slowly we approached the first bridge. Fires were raging on either side of the road; Cobras had destroyed an Iraqi military truck and a T55 tank positioned inside a dugout. Powerful explosions came from inside the bowels of the tank as its ammunition and heavy shells were set off by the fire. With each explosion a thick and perfect ring of black smoke ring puffed out of the turret.

An Iraqi defence post lay abandoned. Cobras flew over an oasis of palm trees and deserted brick and mud-caked houses. We charged onto the bridge, and as we crossed the Euphrates, a large mural of Saddam came into view. Some marines reached for their disposable cameras.

Suddenly, as we approached ambush alley on the far side of the bridge, the crackle of AK-47s broke out. Our AAVs began to zigzag to avoid being hit by a rocket-propelled grenade (RPG).

The road widened out to a square, with a mosque and the portrait of Saddam on the left-hand side. The vehicles wheeled round, took up a defensive position, back to back, and began taking fire. Pinned down, the marines fired back with 40mm automatic grenade launchers, a weapon so powerful it can go through thick brick walls and kill anyone within a 5-yard range of where the shell lands.

I was in AAV number A304, affectionately nicknamed the Desert Caddy. It shook as Keith Bernize, the gunner, fired off round after deafening round at sandbag positions shielding suspected Fedayeen fighters. His steel ammunition box clanged with the sound of smoking empty shells and cartridges.

Bernize, who always carries a scan picture of his unborn baby daughter with him, shot at the targets from behind a turret, peering through narrow slits of reinforced glass. He shouted at his men to feed him more ammunition. Four marines, standing at the AAV's four corners, precariously perched on ammunition boxes, fired off their M-16s.

Their faces covered in sweat, officers shouted commands into field radios, giving co-ordinates of enemy positions. Some 200 marines, fully exposed to enemy fire and slowed down by their heavy weapons, bulky ammunition packs and NBC suits, ran across the road, taking shelter behind a long brick wall and mounds of earth. A team of snipers appeared, yards from our vehicle.

The exchange of fire was relentless. We were pinned down for more than three hours as Iraqis hiding inside houses and a hospital and behind street corners fired a barrage of ammunition. Despite the marines' overwhelming firepower, hitting the Iraqis was not easy. The gunmen were not wearing uniforms and had planned their ambush well - stockpiling weapons in dozens of houses, between which they moved freely pretending to be civilians.

"It's a bad situation," said First Sergeant James Thompson, who was running around with a 9mm pistol in his hand. "We don't know who is shooting at us. They are even using women as scouts. The women come out waving at us, or with their hands raised. We freeze, but the next minute we can see how she is looking at our positions and giving them away to the fighters hiding behind a street corner. It's very difficult to distinguish between the fighters and civilians."

Across the square, genuine civilians were running for their lives. Many, including some children, were gunned down in the crossfire. In a surreal scene, a father and mother stood out on a balcony with their children in their arms to give them a better view of the battle raging below. A few minutes later several US mortar shells landed in front of their house. In all probability, the family is dead.

The fighting intensified. An Iraqi fighter emerged from behind a wall of sandbags 500 yards away from our vehicle. Several times he managed to fire off an RPG at our positions. Bernize and other gunners fired dozens of rounds at his dugout, punching large holes into a house and lifting thick clouds of dust.

Captain Mike Brooks, commander of Alpha company, pinned down in front of the mosque, called in tank support. Armed with only a 9mm pistol, he jumped out of the back of his AAV with a young marine carrying a field radio on his back. Brooks, 34, from Philadelphia, Pennsylvania, had been in command of 200 men for just over a year. He joined the marines when he was 19 because he felt that he was wasting his life. He needed direction, was a bit of a rebel and was impressed by the sense of pride in the corps.

He is a soft-spoken man, fair but very firm. Brave too: I watched him sprint in front of enemy positions to brief some of his junior officers behind a wall. Behind us, two 68-ton Abrams tanks rolled up, crushing the barrier separating the lanes on the highway.

The earth shook violently as one tank, Desert Knight, stopped in front of our row of AAVS and fired several 120mm shells into buildings. A few hundred yards down ambush alley there was carnage. An AAV from Charlie company was racing back towards the bridge to evacuate some wounded marines when it was hit by two RPGs. The heavy vehicle shook but withstood the explosions.

Then the Iraqis fired again. This time the rocket plunged into the vehicle through the open rooftop. The explosion was deadly, made 10 times more powerful by the ammunition stored in the back. The wreckage smouldered in the middle of the road. I jumped out from the rear hatch of our vehicle, briefly taking cover behind a wall.

When I reached the stricken AAV, the scene was mayhem. The heavy, thick rear ramp had been blown open. There were pools of blood and bits of flesh everywhere. A severed leg, still wearing a desert boot, lay on what was left of the ramp among playing cards, a magazine, cans of Coke and a small bloodstained teddy bear. "They are f****** dead, they are dead. Oh my God. Get in there. Get in there now and pull them out," shouted a gunner in a state verging on hysterical.

There was panic and confusion as a group of young marines, shouting and cursing orders at one another, pulled out a maimed body. Two men struggled to lift the body on a stretcher and into the back of a Hummer, but it would not fit inside, so the stretcher remained almost upright, the dead man's leg, partly blown away, dangling in the air. "We shouldn't be here," said Lieutenant Campbell Kane, 25, who was born in Northern Ireland. "We can't hold this. They are trying to suck us into the city and we haven't got enough ass up here to sustain this. We need more tanks, more helicopters."

Closer to the destroyed AAV, another young marine was transfixed with fear and kept repeating: "Oh my God, I can't believe this. Did you see his leg? It was blown off. It was blown off." Two CH-46 helicopters, nicknamed Frogs, landed a few hundred yards away in the middle of a firefight to take away the dead and wounded. If at first the marines felt constrained by orders to protect civilians, by now the battle had become so intense that there was little time for niceties.

Cobra helicopters were ordered to fire at a row of houses closest to our positions. There were massive explosions but the return fire barely died down. Behind us, as many as four AAVs that had driven down along the banks of the Euphrates were stuck in deep mud and coming under fire.

About 1pm, after three hours of intense fighting, the order was given to regroup and try to head out of the city in convoy. Several marines who had lost their vehicles piled into the back of ours. We raced along ambush alley at full speed, close to a line of houses. "My driver got hit," said one of the marines who joined us, his face and uniform caked in mud. "I went to try to help him when he got hit by another RPG or a mortar. I don't even know how many friends I have lost. I don't care if they nuke that bloody city now. From one house they were waving while shooting at us with AKs from the next. It was insane."

There was relief when we finally crossed the second bridge to the northeast of the city in mid-afternoon. But there was more horror to come. Beside the smouldering wreckage of another AAV were the bodies of another four marines, laid out in the mud and covered with camouflage ponchos. There were body parts everywhere. One of the dead was Second Lieutenant Fred Pokorney, 31, a marine artillery officer from Washington state.

He was a big guy, whose ill-fitting uniform was the butt of many jokes. It was supposed to have been a special day for Pokorney. After 13 years of service, he was to be promoted to first lieutenant. The men of Charlie company had agreed they would all shake hands with him to celebrate as soon as they crossed the second bridge, their mission accomplished.

It didn't happen. Pokorney made it over the second bridge and a few hundred yards down a highway through dusty flatlands before his vehicle was ambushed. Pokorney and his men had no chance. Fully loaded with ammunition, their truck exploded in the middle of the road, its remains burning for hours. Pokorney was hit in the chest by an RPG. Another man who died was Fitzgerald Jordan, a staff sergeant from Texas.

I felt numb when I heard this. I had met Jordan 10 days before we moved into Nasiriya. He was a character, always chewing tobacco and coming up to pat you on the back. He got me to fetch newspapers for him from Kuwait City. Later, we shared a bumpy ride across the desert in the back of a Humvee. A decorated Gulf war veteran, he used to complain about having to come back to Iraq. "We should have gone all the way to Baghdad 12 years ago when we were here and had a real chance of removing Saddam." Now Pokorney, Jordan and their comrades lay among unspeakable carnage.

An older marine walked by carrying a huge chunk of flesh, so maimed it was impossible to tell which body part it was. With tears in his eyes and blood splattered over his flak jacket, he held the remains of his friend in his arms until someone gave him a poncho to wrap them with.

Frantic medics did what they could to relieve horrific injuries, until four helicopters landed in the middle of the highway to take the injured to a military hospital. Each wounded marine had a tag describing his injury. One had gunshot wounds to the face, another to the chest. Another simply lay on his side in the sand with a tag reading: "Urgent - surgery, buttock." One young marine was assigned the job of keeping the flies at bay. Some of his comrades, exhausted, covered in blood, dirt and sweat walked around dazed.

There were loud cheers as the sound of the heaviest artillery yet to pound Nasiriya shook the ground. Before last week the overwhelming majority of these young men had never been in combat. Few had even seen a dead body. Now, their faces had changed. Anger and fear were fuelled by rumours that the bodies of American soldiers had been dragged through Nasiriya's streets. Some marines cried in the arms of friends, others sought comfort in the Bible.

Next morning, the men of Alpha company talked about the fighting over MREs (meals ready to eat). They were jittery now and reacted nervously to any movement around their dugouts. They suspected that civilian cars, including taxis, had helped resupply the enemy inside the city. When cars were spotted speeding along two roads, frantic calls were made over the radio to get permission to "kill the vehicles". Twenty-four hours earlier it would almost certainly have been denied: now it was granted. Immediately, the level of force levelled at civilian vehicles was overwhelming.

Tanks were placed on the road and AAVs lined along one side. Several taxis were destroyed by helicopter gunships as they drove down the road. A lorry filled with sacks of wheat made the fatal mistake of driving through US lines. The order was given to fire. Several AAVs pounded it with a barrage of machinegun fire, riddling the windscreen with at least 20 holes. The driver was killed instantly. The lorry swerved off the road and into a ditch. Rumour spread that the driver had been armed and had fired at the marines. I walked up to the lorry, but could find no trace of a weapon.

This was the start of day that claimed many civilian casualties. After the lorry a truck came down the road. Again the marines fired. Inside, four men were killed. They had been travelling with some 10 other civilians, mainly women and children who were evacuated, crying, their clothes splattered in blood.Hours later a dog belonging to the dead driver was still by his side.

The marines moved west to take a military barracks and secure their third objective, the third bridge, which carried a road out of the city. At the barracks, the marines hung a US flag from a statue of Saddam, but Lieutenant-Colonel Rick Grabowski, the battalion commander, ordered it down. He toured barracks. There were stacks of Russian-made ammunition and hundreds of Iraqi army uniforms, some new, others left behind by fleeing Iraqi soldiers. One room had a map of Nasiriya, showing its defences and two large cardboard arrows indicating the US plan of attack to take the two main bridges. Above the map were several murals praising Saddam. One, which sickened the Americans, showed two large civilian planes crashing into tall buildings.

As night fell again there was great tension, the marines fearing an ambush. Two tanks and three AAVs were placed at the north end of the third bridge, their guns pointing down towards Nasiriya, and given orders to shoot at any vehicle that drove towards American positions. Though civilians on foot passed by safely, the policy was to shoot anything that moved on wheels. Inevitably, terrified civilians drove at speed to escape: marines took that speed to be a threat and hit out.

During the night, our teeth on edge, we listened a dozen times as the AVVs' machineguns opened fire, cutting through cars and trucks like paper. Next morning I saw the result of this order - the dead civilians, the little girl in the orange and gold dress.

Suddenly, some of the young men who had crossed into Iraq with me reminded me now of their fathers' generation, the trigger-happy grunts of Vietnam. Covered in the mud from the violent storms, they were drained and dangerously aggressive.

In the days afterwards, the marines consolidated their position and put a barrier of trucks across the bridge to stop anyone from driving across, so there were no more civilian deaths. They also ruminated on what they had done. Some rationalised it. "I was shooting down a street when suddenly a woman came out and casually began to cross the street with a child no older than 10," said Gunnery Sergeant John Merriman, another Gulf war veteran. "At first I froze on seeing the civilian woman. She then crossed back again with the child and went behind a wall. Within less than a minute a guy with an RPG came out and fired at us from behind the same wall. This happened a second time so I thought, 'Okay, I get it. Let her come out again'. She did and this time I took her out with my M-16."

Others were less sanguine. Mike Brooks was one of the commanders who had given the order to shoot at civilian vehicles. It weighed on his mind, even though he felt he had no choice but to do everything to protect his marines from another ambush. On Friday, making coffee in the dust, he told me he had been writing a diary, partly for his wife Kelly, a nurse at home in Jacksonville, North Carolina, with their sons Colin, 6, and four-year-old twins Brian and Evan. When he came to jotting down the incident about the two babies getting killed by his men he couldn't do it. But he said he would tell her when he got home.

I offered to let him call his wife on my satellite phone to tell her he was okay. He turned down the offer and had me write and send her an e-mail instead. He was too emotional. If she heard his voice, he said, she would know that something was wrong.

I request your prayers for peace to resolve the unfortunate and unncessary scenario of war being built up by the Bush administration in Iraq (sufficient cause for any action required to be undertaken in self-defence has not been made by the Bush administration yet) . I pray for peace to prevail all around. Please join me in this prayer. Your prayers do matter and will make a difference.

PS: I share a report "Collateral Damage: the health and environmental costs of war on Iraq" by Medact (which is part of a network of health professionals in 80 countries - International Physicians for the Prevention of Nuclear War - working for the total abolition of nuclear weapons and all weapons of mass destruction). It follows below.

Also, if your computer speakers are on then you will be able to hear Pink Floyd's "Two Suns in the Sunset" play in the background while this mail is open. This touching song's lyrics are descriptive of the dangers and futility of war, and the relevance of us being equal (it goes: "in my rear view mirror the sun is going down...sinking behind bridges in the road...and i think of all the good things...that we have left undone...and i suffer premonitions...confirm suspicions...of the holocaust to come...the rusty wire that holds the cork...that keeps the anger in...gives way...and suddenly it's day again...the sun is in the east...even though the day is done...two suns in the sunset...could be the human race is run...like the moment when your brakes lock...and you slide toward the big truck...and stretch the frozen moments with your fear...and you'll never hear their voices...and you'll never see their faces...you have no recourse to the law anymore...and as the windshield melts...my tears evaporate...leaving only charcoal to defend...finally i understand...the feelings of the few...ashes and diamonds...foe and friend...we were all equal in the end"

This evidence-based report analyses from a public health perspective the health and environmental impact of the previous, ongoing and any future conflict with Iraq, It shows that waging war on Iraq would have enormous humanitarian costs, including disaster for the Iraqi population in both the short and long term, and would create enormous harm further afield to combatants and civilians alike. It concludes by summarising alternatives to war.

The report is by Medact, an organisation of health professionals that exists to highlight and take action on the health consequences of war, poverty and environmental degradation and other major threats to global health. For many years the organisation has highlighted the impacts of violent conflict and weapons of mass destruction and worked to improve the health of survivors of conflict such as refugees. Medact’s overarching conclusion is that war is a major hazard to health and prevention must always be better than cure.

Medact is the UK affiliate of International Physicians for the Prevention of Nuclear War (IPPNW) and shares the federation’s core message of strong opposition to a war or military intervention in Iraq. This report, and also an extended version of it with additional references, can be found on Medact’s website www.medact.org and on the website of IPPNW www.ippnw.org.

601 Holloway Road, London N19 4DJ, UK T +44 (0) 20 7272 2020 F +44 (0) 20 7281 5717

Dr June Crown CBE, President Medact, former President, Faculty of Public Health Medicine, Royal Colleges of Physicians, UK

Richard Garfield, RN, DrPH, Professor of Clinical International Nursing, School of Nursing, Columbia University, and Visiting Professor at the London School of Hygiene and Tropical Medicine

Victor W. Sidel, MD, Distinguished University Professor of Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Past Co-President, International Physicans for the Prevention of Nuclear War

Catherine Ford and Robert Henderson under supervision of Dr Jaime Miranda, International Health and Medical Education Centre, University College London

Report published in association with International Physicians for the Prevention of

Nuclear War (IPPNW), of which Medact is the UK affiliate. IPPNW is the recipient of the 1985 Nobel Peace Prize. IPPNW is located in the US at 727 Massachusetts Avenue, Cambridge, MA;

This report is also being issued on 12 November 2002 by IPPNW and its US affiliate Physicians for Social Responsibility in Washington DC, and by IPPNW affiliates in Australia, Canada, Germany, Guatemala, India, Japan, the Netherlands, the Philippines and other countries.

The financial support of the Polden-Puckham Charitable Foundation is gratefully acknowledged. Thanks also for the helpful comments of Lynn Barnett, Dr Judith Cook, Dr Elisabeth McElderry, Dr Cathy Read, Naomi Richman, Mike Rowson and Dr Robin Stott of Medact; also of Michael Christ, John Loretz and Lynn Martin of IPPNW.

This analysis of the previous, ongoing and likely future conflict with Iraq spells out the potentially enormous humanitarian costs of waging war. It would mean disaster for the Iraqi population, in both the short and long term, and would cause much harm further afield. This evidence-based report draws on best estimates, and concludes with a summary of the alternatives to war. Its value base is that of Medact – an organisation of doctors, nurses and other health professionals undertaking education, research and advocacy on the health impacts of violent conflict, environmental degradation and poverty.

Its likely impact must be taken into account when considering such a step, to ensure that applying this solution to the problems posed by Saddam Hussein is less damaging than the problems themselves. War is a major hazard to health and its impact may be felt months, years or decades later. Modern warfare usually leads to more casualties among civilians than combatants (BMA 2001), while the destruction of roads, railways, homes, hospitals, factories and sewage plants creates conditions in which the environment is degraded and disease flourishes. A population

suffering from the immediate impact of war is more susceptible to further health hazards and less able to mobilise its own resources for survival and reconstruction.

This report describes the immediate and longer-term impact of 1990-1 Gulf War and assesses the effects of establishing sanctions, no-fly zones and the Oil-for-Food programme. It concludes that the health of the Iraqi people is now much worse than it was in 1990. A fresh conflict is likely to be wider-ranging and use a new arsenal of weapons, and its impact is likely to be more profound. The report concludes with a brief summary of the alternatives to war.

In reaching its conclusions our report team reviewed many sources but was hampered by the quality of the data and the many discrepancies. Much data is not available, not collected and/or not published, or its quality is questionable. Statistical, methodological and interpretative errors bedevil most of the available information but erroneous figures are repeated from one apparently authoritative source to the next (Garfield 1999a). More than a decade into one of the major humanitarian disasters of our time, we are left to debate causes and responsibilities without an adequate information base.

The report draws on the best evidence and expert views it could obtain, and in every case shows either the range of credible estimates or the most reliable estimate, erring on the side of caution.The authors of the studies cited here cannot be held responsible for any inadvertently erroneous conclusions.

Four-fifths of Iraq’s 25 million people are Arab, the remainder mostly Kurds. Most of its 62% Shia Muslims live in the south, with the 35% Sunni Muslims dominant in the central region and among the ruling class. Baghdad has five million people; other major urban centres are Diyala, Basra, Mosul, Kirkuk and the Kurdish capital Arbil (The World Guide 2001/2002). Iraq has 10% of the world’s oil reserves, and in the decades before the 1990-1 war it evolved from an impoverished, rural, undeveloped country to a reasonably prosperous, urbanised, middle-income range one with a modern social infrastructure and good public services.

The Iran-Iraq war of 1980-1988 began a year after Saddam Hussein became president. It severely weakened the country militarily and economically, with at least 100,000 Iraqi deaths and many more injured or captured.Yet the civilian infrastructure was relatively unscathed except in the south-east, where the oil-rich area around Basra was hard hit, as it was again in 1990-1.

Health continued to improve in the 1980s, albeit more slowly than before. Infant mortality, an important socio-economic indicator, fell to 65 per 1000 live births just before the Gulf War, better than the developing country average of 76. By 1998 it had risen again to 103, however. Reflecting the huge deterioration in health in the 1990s, Iraq’s under-five mortality rate is now 37th worst in the world – on a par with Haiti, Senegal,Yemen and Uganda (all UN figures; see also Tables 3 and 4, pp 4-5). By 2000 Iraq occupied a lowly 126th place out of 174 in the UN Human Development Index, a league table showing countries’ overall development level (for comparison: the US is 3rd, the UK 10th, Israel 23rd and Iran 95th). In 1990 it was ranked 50th out of 130, and in 1995 106th out of 174 (Unicef 2002).

The threatened war on Iraq could have disastrous short, medium and long-term consequences not only for the Iraqi population and its neighbours, but also further afield. Iraq invaded Kuwait on August 2, 1990. A Coalition of 28 countries led by the US launched Operation Desert Storm on January 17, 1991. After heavy bombing of targets in Iraq and Kuwait, a ground offensive was started on February 24, lasting 100 hours. Iraq withdrew but the massacre of troops retreating from Kuwait continued until a ceasefire two days later. UN resolution 687 required Iraq to implement a programme of disarmament before sanctions imposed in 1990 would be lifted. In March, the Kurds in the north and Shia population in the south rose up against Saddam Hussein but the rebellions were quickly and brutally crushed.

Less than 400 Coalition combatants died in the war and less than 500 were wounded in action. Most of the forces that bore the brunt of the Coalition attack were predominantly Kurdish and Shia conscripts.The most reliable estimates of Iraqi military deaths during the war range from 50,000 to 120,000 (UN 1991, Daponte 1993, Haines and Doucet 1993). When 3,500-15,000 civilian deaths are added the shortterm Iraqi death toll is in the range 53,500-135,000 (Hoogland 1991, Daponte 1993). A further 20,000-35,000 Iraqi civilians died in the uprisings and other postwar violence (UN 1991, Daponte 1993).

Military sources estimate the number of wounded at three times the number of deaths.This would suggest a total of at least 300,000 wounded Iraqi combatants, some of whom would later die or suffer lifelong disability. Later mortality and morbidity among coalition combatants is the subject of controversy; official figures may be underestimated and there is no agreement on, for example, the effects of ‘Gulf War Syndrome’ or depleted uranium exposure.

Iraq’s infrastructure was extensively damaged – roads, bridges, communications, electricity supplies, water and sewage systems, weapons factories, health care facilities, administrative centres, warehouses, homes and much more. This had a catastrophic impact on a highly mechanised, electricity-dependent society (Hoskins 1997). Declassified documents from the US

Defense Intelligence Agency show that a deliberate decision was made to destroy electricity-generating facilities and water storage and treatment, and then put chlorine and medicine on the UN embargo list (Nagy 2001). The wide-ranging and cumulative effects provided the preconditions for famine and epidemic.

Over two dozen chemical, biological and possibly nuclear factories and stores were destroyed or badly damaged, and toxins widely dispersed. A UN mission in March 1991 found 650 out of 1330 active oil wells ablaze, releasing acrid smoke that spread many hundreds of miles and had respiratory and carcinogenic health effects. Many other wells were gushing oil; between four and eight million barrels entered the sea and 35 to 150 million barrels were spilled over up to 60% of Kuwait, evaporating toxins into the air and contaminating groundwater. Bombing and troop movements destroyed hundreds of square miles of desert surface and its delicate ecology. Landmines destroyed the environment as well as killing and maiming humans and animals. The environmental damage was arguably unprecedented (Greenpeace 1992, Hoskins 1997). Biological and chemical pollutants possibly damaged the flora, fauna and food chain, and may have harmed

human health (Hoskins 1997). The impact of depleted uranium from radioactive shell material is a

matter of conjecture (Caldicott 2002).The actual and potential effects on Iraqi and Kuwaiti civilians, as well as combatants on both sides, are not known.

By April 1991 an estimated 1.8 million mainly Kurdish and Shia refugees had fled to the Iranian and Turkish borders. The massive dislocation, travel conditions, squalid camps, malnutrition, harsh weather, inadequate shelter, lack of clean water and minimal health care led to many deaths. Infectious diseases were rife, including measles, diarrhoea, typhoid and cholera, affecting not only the very old Iraqi military deaths and very young but also the victims of landmines and war-related accidents. By May 1991 between 15,000 and 30,000 refugees had died (UN 1991).

Iraq’s oil industry was a major target of air strikes and sanctions. As a result, the 1989 Gross Domestic Product of $66 billion fell 270 times to $245 million in 1992 (Quinn 1994). This massive collapse led to lack of investment in reconstruction. Most of Iraq’s industrial base depended on imports and these rapidly became unavailable.

Food shortages began immediately after the war, attributable to lack of supplies, lack of new crops, hyperinflated prices, damage to infrastructure such as processing plants and warehouses, and the effects of the UN embargo. Rations were only 750-1000 calories per person per day. Most Iraqi families had too little money to meet basic requirements such food and other essentials (Hoskins 1997), and the weakest suffered most. An estimated 110,000 Iraqi civilians died in 1991 from the health effects of the war, bringing the total number of Iraqis who died as a direct consequence of the GulfWar to around 205,000 (Arkin, Durrant and Cherni 1991, Hoskins 1997). The health of many more was weakened in the longer term.Many people were internally displaced (750,000 remain so today) and around 9000 homes were destroyed or damaged. Many were injured through bombing and warrelated accidents and more vulnerable to health risks. Most civilians suffered short-term episodes of posttraumatic stress and a minority would go on to suffer long-term mental health problems, leading sometimes to earlier death through heart disease or depressed immune systems (Hamblen and Schnurr 2002).

A Harvard-based international study team estimated that child and infant mortality increased more than threefold from January to August 1991 compared to the previous six years, corresponding to an excess of about 47,000 deaths among children under five (International Study Team 1991, Ascherio 1992). Thousands of children were handicapped by landmines and other war-related incidents (Hoskins 1997). Table 2 shows how social and economic factors interact to jeopardise Iraqi children’s rights to life and survival (Unicef 2002). Many war widows became sole wage earners, often going hungry to feed their children; possibly 60% suffered from psychological problems, with physical manifestations such as weight loss and difficulty breast-feeding (Hoskins 1997).

Iraqi health services, previously described by WHO as ‘a first-class range of medical facilities’, could not cope. The Ministry of Health was directly hit, telecommunications were lost, and transport capability reduced to 10%, preventing the distribution of essential medical supplies. Primary health care and preventive activities ceased – there was no antenatal care, and immunisation programmes were temporarily reduced leading to a resurgence of preventable diseases (Hoskins 1997). Devastated health services could offer little help to those with mental or physical illness. Mental health care was in any case poorly developed and ill-equipped to deal with war-related mental disorders. Rehabilitation services for war-injured combatants and civilians were minimal.

In summary, the conflict wrought ‘near-apocalyptic results’ on the economic infrastructure of what had been a fairly highly urbanised and mechanised society (UN 1991).‘Now, most means of modern life support have been destroyed or rendered tenuous. Iraq has, for some time to come, been relegated to a pre-industrial age, but with all the disabilities of postindustrial dependence on an intensive use of energy and technology,’ its Ahtisaari mission concluded.

The impact of the war did not end with the conflict and its immediate aftermath. Recovery and reconstruction were hindered by the subsequent actions of Saddam Hussein, the UN and coalition countries. Vulnerable groups suffered further and the longerterm impact was far worse than the immediate direct effects. UN sanctions, the Oil-for-Food Programme and the ‘no-fly zones’ all in different ways influenced health and environmental status, the economy, the rate of reconstruction, and the marked variations in impact on the north, central and southern regions of Iraq.

Comprehensive economic sanctions against Iraq were imposed in 1990 under UN resolution 661 and remain in place to this day. Partly as a result, according to a US academic, ‘the population moved from the edge of first-world status to poor, thirdworld status with staggering speed’ (Pellett 2000).

Oil-for-Food ( OfF) delivered its first goods in 1997. It permits Iraq to sell oil to fund relief, providing commodities but no training or infrastructure development. An average of $18 worth of food and medicine per head per month are distributed. Social decline was already accelerating when it began, and although it has prevented a humanitarian disaster it is reckoned to be far less effective than traditional relief programmes (Garfield 1999b). OfF currently faces serious implementation problems owing to a ‘dire funding shortfall’, its director told the UN Security

Northern Iraq was declared a ‘no-fly zone’ after the Kurdish uprising was crushed in 1991. Another nofly zone was established in the south in 1992 and was extended to the whole country south of Baghdad by US missile attacks in 1996. Between 1991 and 1999 the US and UK flew more than 6000 sorties, dropped over 1800 bombs and hit more than 450 targets in these zones, in which only Iraqi planes are forbidden.Turkey has also bombed the north.

Sanctions and the Iraqi government response together create continuing shortages of governmentsupplied essentials such as electricity, water, food, medicines and basic education, and/or people lack the money to buy them.The UN estimated that 55% of Iraqis lived in poverty and 20% in extreme poverty in the late 1990s. While the situation is improving, people continue to suffer from drastically worse conditions than the pre-sanctions period. Those most likely to be affected by sanctions include pregnant and lactating women, children under five, older people and those with chronic diseases. Garfield suggests an excess of between 344,000 and 525,000 under-five deaths in the 12 years of sanctions – far outnumbering deaths on all sides among combatants and civilians during the war (Garfield and Yamada 2002). Among the children who survive, likely health and social problems include the downward spiral of reduced mental capacity due to malnutrition, reduced educational achievement because of dropping out of school, social deterioration from family breakdown and poverty, and reduced governability through increases

in crime and lawlessness. ‘Excess deaths should thus be seen as the tip of the iceberg,’ Garfield notes. The negative effects of sanctions have been partly mitigated by OfF. Food production increased; rations were usually complete and timely in the centre/south. A large survey in Iraq in 1999 concluded that childhood mortality increased after the war and under sanctions in the south/centre, but began to decline in the north after OfF began (Ali and Shah 2000). Malnutrition among children under five, which rose during 1991-6, has declined throughout the country, especially since 2000. In general social indicators in the north have improved much more rapidly than the centre/south since OfF implementation, and are overall better than ever.

Meanwhile the psychological impact of war, its aftermath and another possible conflict continues to damage mental health. Adults who may hardly have recovered from their experiences of the 1990-1 war and uprisings, and the suffering caused by direct experiences of conflict, bereavement and losses, now face chronic stress from the further threats.Women, especially those bringing up children alone or lacking family support, and children already living in poor circumstances, disabled or lacking strong family support are most vulnerable to emotional disturbance. The experience of another war is likely to magnify psychological disturbance already present in adults and children.

The 1990s saw a decline in schooling. Lower literacy, especially among females, has a known negative impact on health. Before 1990 Iraq was among the forefront of Arab countries promoting education and employment for women, but this has reversed. Widowhood through war, deprofessionalisation, rising unemployment and widening education differentials have all damaged women’s status and prospects. The decline is particularly acute in rural areas, where the almost extinct phenomenon of marrying preadolescent girls has returned. All these factors contribute to a worse state of health for women and a rise in infant mortality and morbidity. Iraqis who have jobs suffer from much more occupational ill health, including accidents and illness. Many work in the informal economy which has few safeguards. Dangerous occupations such as sex work and smuggling have expanded, while social welfare has diminished. Common sights such as children working, begging or living on the streets were rare before the war.

The health sector had greatly deteriorated before OfF, which brought better access to medicines although essential drugs and equipment are still often lacking. Conceptually, too, the health sector was ill equipped to cope with the new demands, and has only slowly begun to shift towards primary health care and public health service to respond to the challenges.

The health of the Iraqi people, previously reasonably good despite life under a brutal regime, suffered enormously from the combined impact of the war and sanctions, and has not returned to prewar levels. OfF has enabled some improvement in recent years, particularly in the north. Overall health remains poor and any new conflict would hit people extremely hard. The baseline of well-being is far lower than in 1991 and the impact would be worse even if an identical war scenario were played out.

The war and its aftermath triggered economic crises and political/social unrest whose effects on health and the environment of Iraq’s neighbours, the Coalition and developing countries were sometimes profound and are still felt today. The Iraqi invasion of Kuwait caused relatively few casualties but the firing of hundreds of oil wells by Iraq was an environmental and economic disaster whose effects were felt as far away as Hawaii and the Himalayas. Clean-up and reconstruction cost $150-200bn. Iran, Turkey, Jordan and to a lesser extent Saudi Arabia had massive influxes of refugees. Jordan lost $32bn worth of trade, tourism, aid and remittances (Gulf Information Project 1994). Officially there were fewer than 500 dead and 500 injured combatants from the Coalition countries but the figures are strongly contested and many more war-attributable deaths must be added in the longer term. The longer-term impact on veterans of exposure to depleted uranium and other toxins is difficult to quantify, as is the extent of Gulf War Syndrome, said to affect over 25,000 US and UK veterans. A third of Gulf War veterans experienced post-traumatic stress disorder.

Coalition countries probably spent around $82bn (in today’s dollars) on the war, the main contributors being Saudi Arabia, Kuwait, Germany and Japan. Most of the US expenditure was reimbursed by its allies (O’Hanlon 2002b). The war cost the UK $3.96bn, of which $1.79bn was recouped in pledges and insurance (National Audit Office 1992). The reduction in growth caused by the doubling of oil prices had the greatest impact in developing countries. The effects exceeded 1% of GNP in at least 40 of them, reaching the UN threshold for eligibility for disaster relief. Resettlement costs and loss of remittances from migrant workers, export earnings, tourism and aid all exacerbated the immediate damage (Overseas Development Institute 1991).

War on Iraq could have a devastating impact of combatants, Iraqi civilians and people in n on the environment of Iraq and on the rest of

• Chemical, biological and possibly radiological pollution of land, sea, rivers, atmosphere

• War, sanctions and UN weapons inspections have reversed and retarded but probably not eliminated Iraq’s chemical, biological and long-range missile capacities

• The US has developed and stockpiled many new weapons of all kinds, such as earth-penetrating

• Possible deaths on all sides during a ‘conventional’ conflict and the following three months range from 48,000-261,000

• If civil war breaks out within Iraq and nuclear attacks are launched, the range is 375,000 to 3,900,000

• Deaths from other indirect and longer-term adverse health effects of the war in Iraq and beyond could total an additional 200,000

• Refugees escaping the conflict die in large numbers and put strain on neighbouring countries; emergency relief costs billions

• Destabilisation of other Middle Eastern countries including domestic unrest, repression

• Possible US and world recession, with greatest impact felt by poorer countries – oil prices up,

• The cascade effect: from the effect on an individual combatant to the effect an injury on one combatant has on other combatants, to their families, to their community, to society in general

• Iraq’s infrastructure, already seriously damaged by the earlier war, will suffer enormous damage in initial air attacks and subsequent urban conflict

• The destruction of roads, railways, homes, hospitals, factories and sewage plants will create conditions in which the environment is degraded and disease flourishes

• Shortages of water, food, and energy resources lead to epidemic diseases that may result in more deaths than those caused directly by the conflict

• Humanitarian catastrophe engulfs already weakened and unhealthy Iraqi civilians – refugees, displaced persons, war-wounded, vulnerable groups especially young children

• People suffering from the immediate impact of war are more susceptible to further health hazards and less able to mobilise their own resources for survival and reconstruction

• Physical health effects include disability, infectious diseases, stillbirths, underweight new-borns, diseases of malnutrition, possibly more cancers

• Mental health effects include post-traumatic stress disorder, long-term psychiatric illness, behavioural disturbance

• Health services, already running well below capacity, cannot cope with immediate demands or offer longerterm rehabilitation or preventive health care

• All sides will pay a heavy financial cost, including arms spending, cost of subsequent occupation of Iraq, relief and reconstruction, possibly exceeding $150-200bn

• The US is likely to spend $50-200bn on the war and $5-20bn annually on the occupation

• A projected war cost of $100bn would fund about four years of health expenditure to address the health needs of the world’s poorest people

Various war scenarios have been proposed in recent weeks, ranging from assertions that the immediate damage will be no greater than that of the war on Afghanistan (where the immediate death toll was less than 5000) to predictions of a nuclear holocaust. Sensible assessment of the impact of an attack on global health and environment must be based on a credible hypothetical scenario. This report, rather than setting out a range from best to worst case, focuses on what is most likely to happen, as described by Rogers (2002a, 2002b), Gordon et al (2002) and O’Hanlon (2002a, 2002b). These predictions are based on government reports and other reliable, nonpartisan military and political sources in the public domain.

Recent estimates of Iraqi capabilities are also drawn on (IISS 2002,‘Blair dossier’ HMG 2002). Whatever broader objectives are proposed or assumed, the avowed aim of a US attack on Iraq has changed from containment to the replacement of Saddam Hussein, in other words ‘regime change’, or at least ‘leadership change’.The conflict will therefore be much more intense and destructive than in 1991, as well as using new, more deadly weapons developed in the interim. Military action against the regime has already begun in the form of air strikes, a regular occurrence over the no-fly zones since 1991 and stepped up in recent months. Forces and military infrastructure are rapidly being built up in the US and its bases in Turkey, Qatar, Kuwait, and on carrier battle groups in the Gulf, and manufacture of weapons and protective clothing is accelerating. US military strategy, whether partnered by the UK and others or going it alone, comprises four main elements – not necessarily in sequence (Rogers 2002a, 2002b).The optimum time to go to war is the winter, aiming to complete operations before the searing Iraqi summer; recent diplomatic manoeuvres mean war is unlikely before the new year.

(1) There will probably be a series of sustained and devastating air attacks on all the main facilities that enable the regime to maintain its survival, including government ministries; air defences; air force and army bases; command, control and communications facilities; any manufacturing facility that has a defence connection; the national electricity supply system; transport; fuel storage; administrative centres; and all other civil activities with a war-support element.The targets will be located not only in Baghdad, but in other cities where Saddam’s military assets and elite forces have already been dispersed and disguised. Cruise missiles, stealth bombers, strike aircraft and B-52 bombers would be used, the latter probably operating from the UK.This will follow the pattern

developed in the Gulf War and also used against Serbia and, to some extent, Afghanistan. Precisionguided conventional weapons will be supplemented by specialised weapons designed to destroy electricity supply networks and computers. In addition, areaimpact munitions, designed to damage and destroy ‘soft’ targets including people, will cause substantial damage.

(2) The second element of the campaign will probably be the landing of ground and amphibious forces to seize the oil-producing region around Basra and the south-east, cutting the regime off from its most important oil supplies. Heavy bombardment and fierce combat are likely.

(3) US and allied troops will attempt to acquire and maintain control of the Kurdish region of North Iraq. Preparations started early this year with US military engineers repairing and upgrading at least three airfields there to operate a range of attack and transport helicopters and aircraft.The base at Zakho is within 200 km of the major northern oil fields, including the important ones around Kirkuk. There are around 5000 troops in the region, including Turkish army brigades as well as US special forces. These operations may possibly be paralleled with forces inserted into the western desert from Jordan. Both actions, in south and north, are likely to be opposed by the regime; massive and continual use of air strikes to limit US casualties would cause many civilian deaths and much damage.The US has made agreements with Kurdish leaders to ensure the local militias’ support, but civil war could erupt in these anarchic conditions, as well as Turkish incursions.

(4) After the major part of the air war and after the regime is cut off from its oil, rapid deployment forces would move towards Baghdad, to force the regime to commit its elite Special Republican Guard and other units to the city’s defence. This would expose the Iraqis to ferocious air attacks with precision-guided munitions, carpet bombing and area-impact munitions. Many of the 375,000-strong Iraqi army are ill-equipped, ineffective and probably unwilling to fight, and will largely be left alone, to form the basis of a peacekeeping force under a new regime. As in the 1991 war, many of the 80,000 reliable core troops will be held back in Baghdad to fight for ‘regime survival’, Saddam Hussein’s primary goal. They probably depend on regime survival for their own long-term well-being. They may be dispersed among the sprawling urban areas of the city, making occupation extremely difficult without causing numerous civilian casualties among its five million people. Even ordinary Iraqi citizens who might desire the end of the regime may be unwelcoming to foreign invaders in the aftermath of air attacks that have taken innocent lives and wrecked homes and schools. Their non-cooperation with the invaders could prolong the fighting. The US hope is that within days Iraqi military communications will be defunct, the regime will be cut off from its oil supplies, and Saddam’s elite forces will be disintegrating; and that the regime will be finished within weeks and replaced by an acceptable leadership. Even if this ‘best case’ occurs, damage to health and the environment will be massive and the effects will be felt by ordinary people for months and years to come. Furthermore, although the regime faces overwhelming military opposition, it has a number of options available that could cause further harm. It may seek to make the war as difficult and protracted as possible, even allowing US troops into Baghdad to maximise US casualties and increase political pressure for a withdrawal. All the following options are possible, and most will probably be used if the regime survives the initial onslaught and is cornered.

• Selective use of chemical and biological weapons, which will force US troops to fight in cumbersome protection suits.