Excuse the impersonal nature of the greeting. I am writing this from Baghdad where access to e-mail is very unpredictable, so if I do get on tomorrow I want to send this to as many people as possible rather than risk writing individual letters and getting bumped.

I’m here with several public health experts that are attempting to assess the consequences of a U.S. attack on Iraqi civilians. Civilians don’t seem to be part of the calculus of the decision makers in America. I helped plan but didn’t participate in a mission that assessed the civilian casualties after the Gulf War…the majority of which weren’t direct but where children who died of diarrheal diseases caused by bombed water purification plants or pneumonia brought on by an immune system undermined malnutrition. UNICEF research indicates there have at least 50,000 excess child deaths per year over the last decade.

As we toured a water purification facility yesterday that has yet to fully be repaired-the sanctions have kept them from having both spare parts or sufficient chlorine for disinfection, I wondered “what possible thought could military intelligence for that target except the consequences to civilians?”

Then later in the evening someone handed me a Defense Department document declassified after the Gulf War which said, “Failing to secure supplies will result in a shortage of pure drinking water for much of the population, this could lead to increased incidences, if not epidemics of disease…”

Epidemics are numbers, of course. Just before visiting the water treatment center I was in a very sparse children’s hospital, where doctors introduced me to a mother and her two-year old daughter, who is diagnosed with leschmaniasis called ‘kala azar’ here. He said they had insufficient medicine to offer her a full twenty-day course and that it would be kinder to shoot her than let her face the slow wasting and painful death that lies ahead. He said the wards are about to fill with children like her because they don’t have sufficient pesticides to control the sand fly vector. I’ve seldom seen a pediatrician so bitter. He said, “We are a proud and capable country used to providing these things ourselves. Now we beg them from the 661 (sanctions) committee who either deny them or delay them for years.” I don’t think I could contain my rage, if that girl were my daughter, Jesse.

These investigations into the public health consequences of a U.S. attack don’t fully reveal the fear that people live with here…. fear from tthe security and intelligence apparatus of Saddam Hussein, fear their child may die for lack of medicine, fear that the food basket (2100 calorie/person/day which is defined by refugee experts say is the minimal need to sustain human activity), which supports every family in the world’s largest feeding program, would be disrupted by a U.S. attack, fear that the massive unemployment may never end and life return to normal, if they can remember what that was like. Some actually say in resignation, “If a U.S. attack would end all of this, then let’s get it over with…”

Just as it is children and vulnerable populations like pregnant women and the elderly, who have largely paid the consequences for Saddam’s invasion of Kuwait, it is they who will be asked to pay again. Only this time there are no spares…no spare parts for the electrical generators that will be the first targets, no spare chemicals for the water purification plants that will be paralyzed without electricity even if they weren’t targeted again, no spare body fat for the malnourished children and no spare iron stores for the anemic pregnant mothers, no spare food in anyone’s pantry, and one has to wonder about if there is any spare emotional capacity to deal with more tragedy that looms on the horizon.

Sadly, none of our policy makers seem to be asking, if there are alternatives other than war that could achieve America’s objectives. I suppose that Sept 11th has made it difficult to question or stand-up to the tough talk of the President. So I am here with my colleagues to do it with the only language we know…the language of public health…a language sometimes ss so grounded in the human experience that we hope it will break through the language of the DOD…the language of “collateral damage.” Hopefully the report may cause us to ask, “Is there another way, because I don’t want this to be in my name?”

France, Germany, and Russia think there are other ways as do all of Iraq’s Arab neighbors who oppose this war. You would think that if Saddam Hussein is a neighborhood bully-and he surely is-that his neighbors would be most concerned. They fear that if a tough guy from out of town comes into their neighborhood and beats up on him that it will inflame the street for years. They think sanctions have humbled him sufficiently to take the edge off and continue to do so.

The physicians at the pediatric hospital who were most eager to have medical information were happy to know about SatelLife. When I asked for their address, they said their e-mail was shut down by the government, because the system was flooded with messages urging them to surrender rather than resist when the U.S. attacks.

Hope I’ll be able to send this. You are not allowed to use your own computer here for access, so feel free to share this as I don’t have my e-mail address book.

P.S. The pediatrician taking care of the little girl with kala-azar turned to me and said, “It would be kinder to shoot her than let her go home and die the lingering death from kala-azar. He said it in English and the interpreter, by instinct, translated it into Arabic and the eyes of the mother sitting there with the girl in her arms suddenly filled with tears. Writing this letter has helped me deal with a little of the anger I feel.
*Charlie Clements is a public health physician and human rights advocate.