1. CRS conference 4 September 2014

2. Medact Medact is a charity for health professionals and others working to improve health worldwide  it conducts research and analysis  it campaigns and lobbies  it educates and informs  it is independent of powerful interest groups and sees health through the lens of social justice

3. Health workers can act as witnesses and responders  using evidence of the health consequences of war as a contribution to peace building  speaking on behalf of a community that has to care for those affected by conflict and is frequently targeted in war

5. Medact work on Iraq  report launched in November 2002 in the aftermath of the 9/11 attack  a military attack on Iraq was currently threatened  served as a contribution to the movement against war

6. Medact work on Iraq  a military scenario was needed: Medact researched a credible hypothetical scenario based on government reports, non- partisan military and political sources  drew on evidence from previous conflicts of the likely health impact  these conflicts included 1990 to 91 Gulf War, those in Panama, Chechnya, Mogadishu and former Yugoslavia

7. Medact work on Iraq  at the same time there were concerns from FAO, WFP and other UN agencies about the impact of further conflict on Iraqi society http://reliefweb.int/report/iraq/our-common-responsibility- impact-new-war-iraqi-children http://reliefweb.int/report/iraq/our-common-responsibility- impact-new-war-iraqi-children  the International Study Team in January 2003 reported on the state of physical and mental health of Iraqi children finding them much more vulnerable to war than in 1991 http://reliefweb.int/report/iraq/our-common-responsibility-impact-new-war-iraqi- children http://reliefweb.int/report/iraq/our-common-responsibility-impact-new-war-iraqi- children

8. Medact work on Iraq Medact’s report Collateral damage gave a credible war scenario of four elements:  sustained and devastating air attacks on government and military facilities and infrastructure in Baghdad and other major urban areas  landing of ground forces to seize oil producing regions in the south east  gaining control of north Iraq  rapid deployment forces backed by air attacks to take control of Baghdad

9. Medact work on Iraq Medact’s report Collateral damage found that:  the baseline mental and physical health of the Iraqi people was degraded by the 1991 Gulf War, and over 10 years of crippling economic sanctions  health system was greatly deteriorated and ill-equipped to meet any new demands  as a result the Iraqi population was very vulnerable to further military conflict

10. Collateral damage Medact reported: Immediate effects during initial military action, battle of Baghdad, northern Iraq and Basra area:  direct deaths and injuries  damage to infrastructure: electricity, water, sanitation, food supply  setting off public health crisis  damage to hospitals and supply chain

11. Collateral damage Medium term as a result of this damage:  epidemic diseases particularly affecting children  malnutrition  increased maternal mortality- inability to reach skilled care  psychological trauma also affecting children  pollution of the environment from oil spills, fires, depleted uranium used in US bunker busters, cluster bombs

12. Collateral damage Medium term:  risk of internal conflict  global impact- cascading effect on families communities of returning combatants with physical and psychological trauma  burden on neighbouring countries from refugees  disrupted health services unable to cope with demand

13. Collateral damage Long term:  environmental and ecological damage from troop movements and bombardments  cost of war US $50 – 200bn  reconstruction costs, for neighbouring countries and coalition: US $150 – 200bn

15. Collateral damage Human cost:  Medact estimated deaths on all sides in the immediate conflict and the following three months ranged from 48,000 to 260,000  civil war could kill another 20,000 people  deaths occurring later caused by adverse health effects could reach 200,000  the number of wounded, civilians and combatants, could range from 120,000 to 650,000  Medact estimated 300,000 to nearly 4 million deaths in the event of a nuclear attack  IN ALL SCENARIOS THE MAJORITY OF CASUALTIES ARE CIVILIANS

17. Collateral damage The report was disseminated to the media, UK government:  the report was well covered in the media  it was possible for the government to dismiss estimates of deaths  Medact presented report to many peace and community groups  the report was covered in WHO Bulletin http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2572414/pdf/12764524.pdf http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2572414/pdf/12764524.pdf

18. Further Medact reports on Iraq Medact followed up Collateral damage with four reports and two updates subsequent to the 2003 invasion of Iraq examining the ongoing health and health system consequences of the invasion and aftermath

19. Medact work on Iraq Estimations in Medact’s 2002 report have largely been borne out  apart from numbers initially displaced which were less, but those seeking safety in neighbouring countries like Jordan increased to 700,000 by 2009  tragically consequences continue

20. Medact work on Iraq Further from the event in time other factors/ causes have an influence and have been covered in subsequent reports:  dismissal of the Ba’ath party from public office and the military exacerbated civil conflict  failure of CPA to use expert humanitarian advisers and Iraqi expertise impeded effective planning

21. Medact work on Iraq Questions arising as a result of report:  how to convince decision makers and the public to take seriously what we predict is likely to happen  how much can we expect to influence those who promote military action as a solution  would it help to refine how we predict the impact of war on health I will now hand over to Marion who will talk about further work of Medact on Health Impact Assessment