Map of life expectancy at birth from Global Education Project.

Monday, September 10, 2007

The unrecognized tragedy of Iraq

Due to my mystical powers of precognition, I can report that Gen. Petraeus will tell Congress today that the so-called "surge," in other words the escalation of the U.S. troop presence in Iraq, has brought about substantial reductions in violence and improved the prospects for political reconciliation. These gains are fragile, however, and we must not risk losing them by reducing the troop presence or making any changes in strategy. We should take another look at what we ought to be doing in six months.

Now that I have demonstrated my psychic powers, let's consider the situation in Iraq from a reality based perspective. I'm not an expert on Iraqi "politics," which would really mean the byzantine and largely secretive pattern of shifting alliances among various armed factions -- the kind of situation the political scientists call "praetorian politics." I doubt that anybody really is.

But I do know something about public health. Iraq today doesn't have functioning vital records or disease surveillance systems, so we don't exactly know what's going on in terms of population health. Here's the WHO page on Iraq, and as you can see, GDP per capita, life expectancy at birth, probability of dying under age five, and probability of dying between 15 and 60 years are "not available." Somehow they came up with a number for healthy life expectancy from 2002, but that's irrelevant now. Health care spending per capita is given as $135 per capita in 2004, but who knows where they got that from. Given the corruption in the health ministry, I'm sure a lot of it was stolen. If you click through to health indicators, you'll see that they do give numbers for 2004, with life expectancy at birth given as 51 for males. I doubt that number has any substantial basis, which is why they kept it off the front page, I assume.

The health care resources in central Iraq, where most of the violence and instability are concentrated, are overwhelmed. Two-thirds of the physicians have fled the country, hospitals face shortages of drugs and supplies and don't even have electricity most of the time. Much of the population doesn't have safe drinking water, and childhood malnutrition is widespread. (UNICEF's last report on this is based on 2005 data, and the situation has surely gotten worse. UNICEF's data on under 5 mortality are from 1999.) It's a pretty fair bet that the direct effects of violence account for a small percentage of preventable deaths in Iraq right now.

It is worrying, to say the least, that there is now a substantial cholera outbreak in Iraqi Kurdistan, the most peaceful, stable, and prosperous part of what was once Iraq. (Kurdistan is now de facto independent, and is not occupied by foreign troops, so it has to be considered separately from the conflict zone, with the exception of the southern area around Kirkuk which is contested between Kurds and Sunni Arabs.) Whisker sent me this link to an update on the outbreak, which is concentrated in Sulaymaniyah, Kirkuk and Erbil provinces. This does not appear to be a highly virulent strain, and it has been persistent but has not shown obvious signs of becoming more prevalent, although statistics are not of the highest quality.

The real danger, however, is that this outbreak could spread south, to the most troubled parts of Iraq, where an already debilitated population, a health care system in a state of near-collapse, and sewage flowing through the streets would almost certainly produce much more severe consequences. As I'm sure most readers already know, cholera is a water-borne disease that is spread through contamination of drinking water by feces. With many people now taking water directly from the Tigris, it is actually surprising that we haven't yet seen this epidemic emerge in Baghdad and environs. If we do, it will be really bad news. Cholera sufferers can be brought through successfully with a simple sugary rehydration solution, but in central Iraq today, most people will not get even that, without a major mobilization. It is hard to imagine that the Iraq disaster could get a whole lot worse, but this is one way it very well might, without any sectarian bloodbath or terrorist depradations. I wonder if General Petraeus is planning for this particular eventuality?

Update: I probably should have linked to this Oxfam international report in the first place. Oxfam estimates that:

# Four million Iraqis – 15% - regularly cannot buy enough to eat.
# 70% are without adequate water supplies, compared to 50% in 2003.
# 28% of children are malnourished, compared to 19% before the 2003 invasion.
# 92% of Iraqi children suffer learning problems, mostly due to the climate of fear.
# More than two million people – mostly women and children - have been displaced inside Iraq.
# A further two million Iraqis have become refugees, mainly in Syria and Jordan.

But hey, we're kicking ass!

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