AIDS Treatment
Changing Course
Advanced Training
Research Briefs
Investigator Profile
Around & About
POV


To get data for his research, Dr. Richard Garfield routinely takes a 10-hour flight to Jordan, followed by a tortuous 15-hour drive through the desert to Baghdad, Iraq's capital.

That's because Dr. Garfield, the Henrik H. Bendixen Clinical Professor of International Nursing in the School of Nursing, is one of less than a dozen researchers around the world who assess conditions in countries under economic sanctions. And good data requires legwork.

In a decade of research, Dr. Garfield has found embargoes hurt the sanctioned countries, and usually harm civilians more than regimes. But politics and poor data influence the quality of the research reports about these countries. So Dr. Garfield now is trying to develop standard methods for researchers to use in future analyses of any sanctioned country.

To update his prior work in Iraq and to work on his new methodology, Dr. Garfield visited the country in May, his fourth trip since 1996. He gathered data on nutrition, water supply, income, and housing. Even though conditions remain dire for much of the population, he found the Iraqi government is doing a better job getting food to its people: The rate of malnourished children lowered slightly since his August 2000 visit.

However, malnutrition and other health issues still plague Iraqi society. "What's needed inside Iraq is better health education to help families focus resources on their vulnerable members, such as pregnant women and kids," Dr. Garfield says. Medical care remains poor. Dirty water and high infection rates still are robbing nutrients from kids, he adds.

The United Nations imposed economic sanctions on Iraq in 1990 after Iraq invaded Kuwait, which led to the Gulf War in 1991. The sanctions were amended in 1996 to allow the government to sell oil and use the proceeds to buy food, medicine, and other humanitarian goods. The Oil for Food program keeps people from starving but families still spend much of their disposable income on food because the rations are just enough for survival. "The program is only one part of the country's poor overall economy, which does not allow a decent standard of living for its citizens," Dr. Garfield says. The United Nations has vowed to keep the sanctions unless Iraq allows weapons inspectors back into the country to investigate allegations that Iraq is developing weapons of mass destruction.

The problem with sanctions is that rogue governments remain in power but the embargoes wreak havoc on citizens’ health, healthcare, education, security, and life itself, Dr. Garfield says. The United Nations estimates that from 1991 to 1999, 500,000 children out of a population of 23 million died as mortality rates increased because of the sanctions and the indirect effects of bombing during the Gulf War, such as destroyed water supplies. Dr. Garfield's analysis puts the toll closer to 300,000. He is not interested in "splitting hairs" about which number is more accurate because the important point is that hundreds of thousands of largely preventable deaths have occurred.

"Sanctions can be a less harmful tool of foreign policy than war, but when large groups of people are exposed to risks due to worsened conditions of life for a long period of time, the death toll mounts," Dr. Garfield says. "The figure of 300,000 excess deaths among children under 5 is at least four times greater than all the deaths on all sides during the Gulf War itself."

Besides analyzing his latest data from Iraq, Dr. Garfield is developing a manual for the United Nations about living conditions assessments, in part, so future studies will be easier to compare. Such guidelines also should enable different agencies to cooperate more effectively. Many agencies and individuals have done studies in countries with humanitarian crises, but few have described their methodologies and even fewer have used respected, comparable methods. With war, crises in governance, and the underlying problems in poor country data sources, such careful methodological approaches are essential if the information is to be useful and respected. He is basing his methods review on U.N. sanction effects in five countries—Haiti, Iraq, Sierra Leone, Liberia, and the former Yugoslavia. Only Iraq and Liberia still have sanctions.

Dr. Garfield has found being a faculty member at an academic medical center critical to his ability to perform independent assessments. He believes he has better access to information as a neutral third party acting between governments and the United Nations, for which he frequently consults. He also takes pains to be honest and forthcoming about his activities to allay any fears that he might be a spy or have ulterior motives.

He is concerned about what another war with Iraq—as the Bush administration is considering—will do to the country's people. "The progress made in living conditions likely would be wiped out if the United States attacks Iraq, judging from what happened in the Gulf War," Dr. Garfield says. "Bombing their water and electricity systems and other infrastructure would likely eliminate many of the improvements made since 1996, and would lead to more devastation."


[Top]