The opportunity costs of war in Iraq

As we write, the war in Iraq has moved into its third week. Coalition forces have reached “the gates of Baghdad” and are sending strategic “probes” into this city of 5 million. The languages of medieval siege warfare and of science fiction coexist strangely in this postmodern conflict — a conflict that, even before it began, had prompted a greater proliferation of variant readings than any war in history. These are days of desperate semantics: “liberation” versus “aggression”; “pre-emptive” versus “unprovoked”; “democracy” versus “imperialism.” The converted preach to one another; enmity deepens; political fissures appear within old alliances.

If a more dispassionate language would help, let's try these phrases for a moment: health consequences and opportunity costs. Despite the “surgical precision” of modern weapons and the coalition's plans to deliver humanitarian aid, the war will exact its price in the ancient currency of death, mutilation, shortages of food and water, communicable disease and displacement.1 These costs will be borne by a population whose economic prosperity and health status have already been seriously weakened by more than a decade of sanctions.2 As we write, the International Committee of the Red Cross reports that Baghdad hospitals are facing serious difficulties in coping with a “continuous flow of war-wounded,”3 and the Iraq Body Count Project puts civilian deaths due to military action alone at between 877 and 1050.4 The health costs of the environmental degradation5 caused by bombardment and other military actions (on both sides) are likely to be felt for decades to come; indeed, they may never be fully reckoned.

Less obvious, but also serious, are the opportunity costs of the vast sums required to support the coalition forces and of the use of Iraq's already limited resources on an ultimately futile resistance. Already President George W. Bush has requested an additional US$75 billion from Congress to sustain the war effort. The opportunity cost of each million-dollar missile fired at an abandoned target in Baghdad is not trivial. Total official development assistance from all donor nations to “least developed countries” stands at about US$6 billion a year ($2 billion from the United States and $1.4 billion from the United Kingdom in 2002). The United Nations' Global Fund seeks US$10 billion a year to halt the ravages of AIDS, tuberculosis and malaria. Against such (admittedly selective) points of comparison, the profligacy of this war is hard to fathom.

Equally grave in the longer term will be the fault line that has opened up between member countries of the UN. The authority of the UN Security Council, much challenged in its history, has suffered another, possibly fatal, setback. Will the moral suasion of the UN's humanitarian agencies also diminish and, if so, at what cost to global health? As a human community we can ill afford to deflect money, will and optimism from the economic development of impoverished countries, the creation of stable and adequate supplies of food and water, or the implementation of vaccination and drug access programs. Without multilateral cooperation as a guiding force, how realistic are our hopes for the ratification and enforcement of life-preserving conventions on land mines, environmental protection, children's rights or tobacco control? Damage to the fragile structures of international cooperation may, in the long run, be among the most serious and far-reaching opportunity costs of this war.

With France and Germany in the vanguard, the “coalition of the unwilling” continues to be outspoken against the use of military action as a means of attaining stability and good governance in the Persian Gulf. Canada, reluctant to offend a friend and trading partner, appears to be leading a coalition of the silent. Having rather bravely declined to support the war, our government is trying, less bravely, to keep dissent to the barest whisper. But it is not our business to counsel the government in foreign diplomacy. We will stick to our script by urging our colleagues and professional associations to speak out about the human costs of war and to remind our leaders that, in the longest human horizon, the most effective pre-emptive strikes against global insecurity will take aim at disparities in access to natural resources, economic opportunity, education and health.6 — CMAJ