Last year as we wrote the editorial for our holiday issue1 we wondered where the events of September 2001 would lead us. Twelve months later, we wonder if we've been led to the brink of war. Frustrated by the amorphous quality of the enemy, the campaign against terror has the hard target of Iraq in its sights. We cannot presume to second-guess “intelligence” or to judge the degree of economic self-interest in the West's goals of regime change and disarmament, but there can be little argument about the human cost of war.2 As many as 86 000 civilian deaths are attributable to the Gulf War in 1991,3 a figure that does not take into account the health effects of massive environmental degradation in Iraq and Kuwait. Nor does it include the impact of the more indirect aggression of sanctions.
A UK affiliate of International Physicians for the Prevention of Nuclear War estimates the potential casualties in a “conventional” war on Iraq at between 48 000 and 261 100.3 If chemical, biological or nuclear weapons are used, the toll will be exponentially higher and the environmental cost incalculable. Ironically, the UN resolution authorizing war on Iraq should weapons inspections fail was approved barely a month after the WHO launched a campaign to combat all forms of violence with a report that, among other things, outlined risk factors for “collective violence,” including social inequity (including in health and education), economic decline, repressive governance and the deterioration of public services.4
The violence that Saddam Hussein has inflicted on his own people cannot be glossed over. But “regime change” will not be sufficient to remove the risks to health and well-being that plague the people of Iraq, let alone restore an economy that plunged from a gross domestic product of $66 billion in 1989 to $245 million in 1992.3 Any tactical plan must include reconstruction.
For the grim reasons we all know, Western foreign policy has concentrated on matters of national security in this past year, deflecting attention from the risk factors for collective violence. Despite US President Bush's pledge to the Millennium Development project to fight poverty, disease and environmental degradation, the US falls $60 billion a year short of the target while its annual military spending has increased by about the same amount.5 In Canada, intellectuals and military advisors alike urge us to increase our military capacity to exert more influence on the international stage. Ah, but what of our capacity for influence in international aid, which stands, unimpressively, at about 0.25% of GNP?
The deadly business of military risk management must not cause us to lose our grip on the armamentarium of peace: water, food, health care, education and economic development. As UN Secretary-General Kofi Annan has said: “Today's real borders are not between nations, but between powerful and powerless, free and fettered, privileged and humiliated. Today, no walls can separate humanitarian or human-rights crises in one part of the world from national- security crises in another.”6 — CMAJ