The humanitarian disaster resulting from sanctions against Iraq has been frequently cited as a factor that motivated the September 11 terrorist attacks. Osama bin Laden himself mentioned the Iraq sanctions in a recent tirade against the United States. Critics of US policy in Iraq claim that sanctions have killed more than a million people, many of them children. Saddam Hussein puts the death toll at one and a half million. The actual numbers are lower than that, although still horrifying.

Changing American policy in Iraq is an urgent priority, both for humanitarian reasons and as a means of addressing an intensely felt political grievance against the United States. An opportunity for such a change may come soon, as the UN Security Council considers a "smart sanctions" plan to ease civilian sanctions. As we work to change US policy and relieve the pain of the Iraqi people, it is important that we use accurate figures and acknowledge the shifting pattern of responsibility for the continuing crisis.

The grim question of how many people have died in Iraq has sparked heated debate over the years. The controversy dates from 1995, when researchers with a Food and Agricultural Organization (FAO) study in Iraq wrote to The Lancet, the journal of the British Medical Society, asserting that sanctions were responsible for the deaths of 567,000 Iraqi children. The New York Times picked up the story and declared "Iraq Sanctions Kill Children." CBS followed up with a segment on 60 Minutes that repeated the numbers and depicted sanctions as a murderous assault on children. This was the program in which UN ambassador (and later Secretary of State) Madeleine Albright, when asked about these numbers, coldly stated, "The price is worth it."

Albright's comments were shocking, as were the numbers, but doubts were soon raised about their validity. A January 1996 letter to The Lancet found inconsistencies in the mortality figures. A follow-up study in 1996, using the same methodology, found much lower rates of child mortality. In October 1997 the authors of the initial letter wrote again to The Lancet, this time reporting that mortality rates in the follow-up study were "several-fold lower than the estimate for 1995--for unknown reasons." While the initial report of more than 567,000 deaths attracted major news coverage, the subsequent disavowal of those numbers passed unnoticed in the press.

The two most reliable scientific studies on sanctions in Iraq are the 1999 report "Morbidity and Mortality Among Iraqi Children," by Columbia University's Richard Garfield, and "Sanctions and Childhood Mortality in Iraq," a May 2000 article by Mohamed Ali and Iqbal Shah in The Lancet. Garfield, an expert on the public-health impact of sanctions, conducted a comparative analysis of the more than two dozen major studies that have analyzed malnutrition and mortality figures in Iraq during the past decade. He estimated the most likely number of excess deaths among children under five years of age from 1990 through March 1998 to be 227,000. Garfield's analysis showed child mortality rates double those of the previous decade.

Ali, a researcher at the London School of Hygiene and Tropical Medicine, and Shah, an analyst for the World Health Organization in Geneva, conducted a demographic survey for UNICEF in cooperation with the government of Iraq. In early 1999 their study surveyed 40,000 households in south-central Iraq and in the northern Kurdish zone. In south-central Iraq, child mortality rates rose from 56 per 1,000 births for the period 1984-89 to 131 per 1,000 for the period 1994-99. In the autonomous Kurdish region in the north, Ali and Shah found that child mortality rates actually fell during the same period, from 80 per 1,000 births to 72 per 1,000.

Garfield has recently recalculated his numbers, based on the additional findings of the Ali and Shah study, to arrive at an estimate of approximately 350,000 through 2000. Most of these deaths are associated with sanctions, according to Garfield, but some are also attributable to destruction caused by the Gulf War air campaign, which dropped 90,000 tons of bombs in forty-three days, a far more intensive attack than the current strikes against Afghanistan. The bombing devastated Iraq's civilian infrastructure, destroying eighteen of twenty electricity-generating plants and disabling vital water-pumping and sanitation systems. Untreated sewage flowed into rivers used for drinking water, resulting in a rapid spread of infectious disease. Comprehensive trade sanctions compounded the effects of the war, making it difficult to rebuild, and adding new horrors of hunger and malnutrition.

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