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The Report of the Iraq Inquiry
Indirect effects of conflict on public health
The health charity Medact considered the direct and indirect effects of the conflict in Iraq
in its November 2003 report Continuing collateral damage: the health and environmental
costs of war on Iraq 2003.117 That report outlined the indirect effects on health arising from:
damage to the environment, including through the use of depleted uranium
ammunition;
damage to Iraq’s water and sanitation and power infrastructure;
the continuing risk of malnutrition and food insecurity;
damage to housing; and
damage to health services.
The report stated that 7 percent of hospitals had been damaged during the major combat
phase of operations, and 12 percent had been looted. UNICEF had reported that the
conflict had led to the breakdown of the cold chain system for storing vaccines, which
meant that some 210,000 newborns had had no immunisations and were at risk from
preventable diseases such as measles.
The report also outlined the physiological and social impacts of the war, and suggested
that Iraq would experience a rise in behavioural and emotional disorders.
Although the report did not attempt to quantify those indirect effects, many of which would
only become apparent over the long term, it concluded that they could prove to be more
significant than the direct effects.
The report made a number of recommendations, including:
Establish health information systems to monitor disease incidence and examine
disease patterns in order to plan effective public health interventions.
Carry out an assessment of the country’s chemical risks and levels of
contamination in addition to surveillance of health effects of environmental risk
factors including depleted uranium.
Fund and rapidly implement the clear‑up of all unexploded ordnance.
Study long‑term effects of the war on mental health and trends in domestic
and criminal violence, and develop effective health care and social policy
interventions.
Fund independent academic institutions or UN agencies to continue monitoring
the health effects of war.”
181.  Discussions continued between senior officials in the FCO and MOD over who
should have responsibility for answering questions on civilian casualties.
182.  The “Count the Casualties” campaign was launched by Medact and IBC on
8 December, through an open letter to Mr Blair.118 The letter stated that without counting
117  Medact, November 2003, Continuing collateral damage: the health and environmental costs of war on
Iraq 2003.
118  Letter Medact to Blair, 8 December 2004, [untitled].
202
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