The effect of trade sanctions on health and nutrition

Summary of published paper

Health Centre in Haiti

The most recent RRN network paper^* reviews evidence of the impact of trade sanctions against Cuba, Haiti and Iraq. Although the review deals mostly with impact on health and health services, effects on food security and nutrition are also considered.

General Findings

The countries with the greatest import dependency experienced the greatest decline in child nutrition during sanctions. Sanctions were often associated with a dramatic increase in the price of staple goods. The most affected groups were children under five years of age, pregnant and lactating women, those with chronic diseases and the elderly. Although adequate calories were available in Haiti and Iraq during sanctions, child nutrition suffered. One reason for this appears to have been that women have had to spend more time in income seeking or income substitution activities and have therefore had less time available for child care and feeding. Child feeding problems have been made worse in Iraq where the government insisted on putting infant formula into the ration. This led to a decline in breastfeeding.

Cuba

About half of all proteins and calories were imported prior to sanctions. Importation of foodstuffs declined by about 50% from 1989-93 and milk production declined by 55% from 1989-92. Cuba's response has been to increase equity of resource allocation and prioritise vulnerable groups. Breastfeeding has been actively promoted and the percentage breastfeeding has risen from 63% in 1990 to 97% in 1994. Distribution of food, clothing and other goods to women, the elderly and children has also occurred. Weighing of pregnant women and young children has been promoted and is now routine practice at health centres.

Haiti

The price of staple food increased fivefold from 1991-3 and the value of the national currency plummeted as hyperinflation occurred. Estimated rates of low birth weight increased from 10 to 15%. In addition 7.8% of children under five suffered acute malnutrition compared to 3.4% in 1990. Chronic malnutrition increased from 5 to 23% between 1991-2. An important factor contributing to the nutritional decline has been the mothers' absence from home due to economic activity resulting in less attention to breast feeding, weaning foods for the young and care for sick children.

Iraq

Iraq was about 70% dependent on imported food prior to sanctions. From 1991-6 acute malnutrition among under fives rose from 3% to 11% while chronic malnutrition rose from 19% to 31%. The percentage of children born in hospitals under 2.5 kg rose from 5% to 22%. In 1996 the Oil for Food (OFF) programme was implemented. The programme had a number of beneficial effects; the price of non-rationed food declined, rationed foods provided more meals per month and people were spending less of their total incomes on food. This led to a reduction in chronic malnutrition in the north followed by some reduction in the centre and south by mid-1999.

Conclusions

Trade sanctions which have the greatest impact on the health of the general population occur in countries that are heavily dependent on imports. Paradoxically, however it has been shown that indices like infant mortality rates have declined in some embargoed countries even during periods of severe resource shortages. This occurs when scarce resources are distributed more efficiently and national leaders mobilise child health activities, e.g. breast feeding initiatives in Cuba and promotion of community nutrition programmes in Iraq.

The review concludes that the objectives of a trade sanctions regime should be better determined in the light of the extensive experience in the 1990s. Sanctions are seldom associated with a hoped for overthrow of repressive regimes, military action is needed for that. The review further argues that; i) sanctions may be a form of collective punishment which is illegal and abhorrent under both international and customary law and that, ii) when a few individuals are at fault, asset freezing, halting of cultural exchanges and travel bans may result in the desired policy changes.

There is currently an emerging hope that such targeted sanctions will avoid the major humanitarian impacts described above while affecting the offending policies of the sanctioned regime more effectively. However, the authors caution that humanitarian damage will occur when targeting is not precise, when elites respond by punishing other nationals or when capital shortages occur in an unstable political environment. Thus, improved monitoring, expanded humanitarian action, and the modification of national policies to protect the most vulnerable with simple low cost public health actions will still be needed to reduce humanitarian damage.

^*Garfield.R (1999): The Impact of Economic Sanctions on Health and Well-being. Relief and Rehabilitation Network Paper No 31, ODI, London.