Child malnutrition in Iraq

Paging Dr. Lott……

It makes even grimmer reading for anyone concerned about the Iraqi people.

What is wrong with this site. Whole lines are missing and partially missing from posts.

I’m curious.. how often do the pro-war bloggers (OxBlog, etc.) get all sceptical when faced with statistics that support rather than cast doubt upon their position?

Whenever one of these reports gets published we are suddenly surrounded by keen amateur experts in epidemiological methodology whose position often amounts to little more than “I don’t like these statistics therefore they must be wrong…”.

Assuming this report is true, why didn’t it show up in the Lancet study? That’s a seriously-meant question–the two things that surprised me about the Lancet paper was that the death rate from American violence was so high and that the death rate from drinking dirty water was so low.

I think the Lancet study makes a pretty convincing case for a skyrocketing death rate from violence, but why did they miss the deaths from diarrhea? Not enough children in the sample?

Matt, nevermind statistics, what I find impressive is that people who swallowed things like the WMD / Al Qaeda in Iraq allegations, the belief that the Bush admnistration was in good faith, the belief that the basic driving force for war in Iraq was a humanitarian concern, etc. etc. those people now pretend to get all Champions of Healthy Skepticism at the mere hint that maybe things are not going as well as those who had an interest in supporting the war predicted. Like they were such outrageous suggestions, too. You’d almost think they were doubting a report that aliens had landed in Baghdad.

And they still get treated as if they were intellectually honest. That’s what’s more amazing.

I think the Lancet study makes a pretty convincing case for a skyrocketing death rate from violence, but why did they miss the deaths from diarrhea?

They did find an increase in infant mortality; the increase in violent deaths was even greater, and adult deaths were the more significant driver of the overall death rate.

Actually, I’m not so sure; the guy quoted in the WaPo and AP stories is Jon Pedersen of the Fafo institute in Norway, which suggests that the malnutrition data is advance release from this survey and the fieldwork was done between March and June of this year.

White man’s burden revisisted.

dsquared,

The Post says:

After the rate of acute malnutrition among children younger than 5 steadily declined to 4 percent two years ago, it shot up to 7.7 percent this year, according to a study conducted by Iraq’s Health Ministry in cooperation with Norway’s Institute for Applied International Studies and the U.N. Development Program. The new figure translates to roughly 400,000 Iraqi children suffering from “wasting,” a condition characterized by chronic diarrhea and dangerous deficiencies of protein.

What is the source of that acute malnutrition prevalence from two years ago? It’s not on the Fafo Institute site. The UNICEF site hints at some sort of study in their statistics labeled 1995-2002, so I’m starting to think what was used is the Ali et al. studies referred to in the Lancet paper –but no, that can’t be it either, because one of them is from the year 2000, and one of them is from 1993-1998.

I must be missing something obvious, but where’s the reference to the earlier study?

ps — for a pre-propaganda view of the number of deaths under the Saddam regime — one that argues for a lower number, which would argue that the increase to 7.7% is, indeed, an indictment of occupation incompetence — see this article by Matt Welch in a 2002 issue of Reason, http://reason.com/0203/fe.mw.the.shtml

The oxblog skepticism amounts to nothing more than claiming, without any evidence at all, that the decline from 11 percent to 4 percent is a pseudo-statistic.

Perhaps I’m wrong here, but Oxblog is claiming that the WaPo story relies on statistics collected under Saddam, which means that while they might be accurate, we should approach them with a good amount of skepticism. This sounds about right to me.

These are statistics for infant malnutrition, not mortality. They are collated by weighing and measuring children. Unless the Iraqi propaganda department had developed a method by which Iraqi children were able to convincingly lie about their height, I am not sure how this argument could be made to work.

Unless the Iraqi propaganda department had developed a method by which Iraqi children were able to convincingly lie about their height, I am not sure how this argument could be made to work.

You’re right, that doesn’t seem plausible. But there are a lot of other, more real-world selection biases to choose from, right? One could imagine that, say, malnutrition was more prevalent in certain regions of Iraq, or in hospitals, or in urban centers, etc., and the Health Ministry encouraged use of those children in the studies.

It doesn’t even need to be as devious as that. Perhaps the field workers in the baseline study neglected to ferret out such sources of selection bias, and confined their interviewing to the regions with a higher degree of consent, which tended to be those with a higher prevalence of malnutrition.

Any critique by a supporter of the Iraqi war (which I’m not) is not ipso facto ridiculous, as tempting as it might be to think that. OxBlog pointed out that the original source for the baseline figure might be helpful to have, and I haven’t seen anything yet to argue that point.

Roger,

I’m willing to accept your suspicions of OxBlog’s motives. So let’s leave them out of this. The only reason I brought up OxBlog is that I thought they made a good point. In the next paragraph, I’ll pretend it’s my own idea.

The problem I wanted to point out is this. In the Washington Post article, it was said that the quoted study demonstrated an increase in acute malnutrition among children of 7.7 percent from two years ago.

I was wondering what study of two years ago was meant. I assume either (a) I’m not well-informed enough to find it; or (b) the Post article is inaccurate in this (small) respect. When the baseline study is pointed out to me, I would be interested in reading it, to see whether any epidemiologic biases are muddying the results.

That’s all I was curious about.

Yes Javier – skepticism for the opposition; but pure faith and submissive credulity for the “official” statistics released, or withheld for strategic purpose, by the “good guys”.
Isn’t there a clinical psych term for that pathologically narrowed focus? Where the limits of context are artificially truncated, so that events and motives can be viewed as isolated within controllable parameters? And then one for the character weakness that gives in to that fake version of the real – because it’s safer, more comfortable, and promises greater reward.
Eventually, if we can just get through this messy part.

Yes Javier – skepticism for the opposition; but pure faith and submissive credulity for the “official” statistics released, or withheld for strategic purpose, by the “good guys”.
Isn’t there a clinical psych term for that pathologically narrowed focus? Where the limits of context are artificially truncated, so that events and motives can be viewed as isolated within controllable parameters? And then one for the character weakness that gives in to that fake version of the real – because it’s safer, more comfortable, and promises greater reward.
Eventually, if we can just get through this messy part.

Zachry, fair enough. I imagine there should be something about this on the websites of the parties involved — for instance, Norway’s Institute for Applied International Studies. I’d go there to check out the baseline.

But imagine, for a second, that you are satisfied. Is that it? What I can never understand about the pro-occupation people is that, given the goals to which they say they are committed, they don’t find stats like these infuriating enough to demand, from their own side, a much higher standard of competence. Nobody says you have to give up your reasons for supporting the war. But why not give a little feedback to the side that you support? It never happens. There was a story in the Independent yesterday. The reporter is embedded with a marine corps around Falluja. She obviously liked them. They are all gung ho. But the captain said, what I can’t figure out is why they aren’t spending the 18 billion in reconstruction money they were supposed to. What is the hold up?

Exactly. This man is committed as committed can be. But he at least is asking the right questions, rather than defending the indefensible.

Yes Javier – skepticism for the opposition; but pure faith and submissive credulity for the “official” statistics released, or withheld for strategic purpose, by the “good guys”.

Do you have any evidence that the writers for Oxblog had uncritical faith in statistics that worked to justify the war on humanitarian grounds? I’m not willing to condemn them so easily unless I do have such proof, which I currently don’t. Maybe you can drum up some. Anyway, it is mostly irrelevant to the topic–are the statistics in question biased? If Oxblog is right, then we have reason to suspect that they are.

javier, I don’t know if this constitutes proof, but check out this Adesnik post from 4 Feb 2003. If Oxblog is irrelevant to discussion about Iraq, it is because they have made themselves so.

Crooked Timber should let someone fix the mt-comments.cgi so that it posts a response page THEN processes the comment, or does both at the same time. I bet 5 minutes of rewrite would fix all the multiple posts.

Oxblog smoksblog. Here’s what is going on in Iraq. One side is trying to rebuild Iraq and provide an atmosphere where the young don’t go hungry. Another side is working hard to prevent that from happening. Ask yourself two questions 1. Which side is right and which side do I support?

Zackary, there is some information about the 2002 nutrition survey here.

Tim,

That’s a link to the article in the Post, which doesn’t say much of anything about the 2002 study.

But now, trying to see what you might have found there that I missed, I see a sentence in the article I didn’t notice before: “The [Nutrition Research Institute at the Health Ministry] has been involved with nutrition surveys for more than a decade; the latest one was conducted in April and May but has not been publicly released.”

Thus I assume that both this year’s results and the results of two years ago are not publicly available. (They certainly aren’t anywhere on the Web.) Since, as I pointed out above, there might be many possible biases in such data, I think skepticism about these particular studies is warranted until one can judge selection methods and the like.

Again, the result is plausible, and the situation in Iraq is undeniably awful. But anyone who reads the epidemiological literature should realize what biases can creep in in the best of situations. I wouldn’t doubt that the same might be happening here.

. . . Oh! Here’s something interesting – a report from WHO entitled “Health Conditions of the Population in Iraq Since the Gulf War.” According to this report, the proportion of wasting among children in Iraq was 3% in 1991 and 12% in 1995. The cite is the Food and Agriculture Organization (a UN org, I assume), but again, no selection methods are given.

I’ll shut up now. The point once more: skepticism about the result is warranted for epidemiologic reasons, and does not necessarily indicate hard-heartedness or Rumsfeldism.

Oops sorry, I meant to link to this page

Ah, that’s more like it! Thanks! Here’s what seems to be the central paragraph about how the study was done:

“The new data on child health comes from a UNICEF-supported household survey of malnutrition among children under five that was conducted in the south and center of Iraq by the Iraqi Ministry of Health and the Central Statistical Organization in February 2002.”

Now I’d like to know if there’s anything different about the south and center of Iraq compared to the rest of it. (I guess that’s excluding the Kurdish region? Excuse my Iraq-ignorance.)
And, of course, there’s still the nagging question about selection methods.

The link to the full study is broken, though. So frustrating! I’ve e-mailed UNICEF to see if I can get a copy.

“One of the points made most insistently by critics of the Lancet study was that they disbelieved the claim that infant mortality had increased since the war.”

Really? Isn’t that obvious? If terrorists are blowing up the countries infrastructure, bombing the water treatment plants, and targeting anyone who’s trying to run government services, then I would have thought it to be expected that child mortality, and mortality from decease and terroist attacks amongst the rest of the population, would go up. That’s indeed what I thought made up a lot of this ridiculous Lancet figure. But as we know, most of these deaths were absurdly blamed on US arial bombardments; I think the events in Falluja, and the fact that we now have documented evidence of locals claiming, without embarrassment or hesitation, that the dead men found with guns they are digging graves for, were woman and children, of just civilian men out for a walk, puts the Lancet study to bed once and for all. This is precisely why this sort of study has never been conducted in a live war zone before, and why it must never happen again to avoid phoney statistics being used for propagandist purposes in this way. The Lancet authors knew this, but they pressed ahead anyway – shame on them.

This child malnutrition figure also puts shame on anyone who supports the terrorist, and their campaign to assassinate government officials, aid workers like Margaret Hassan, and target the key infrastructure needed for the Iraqi people. Nobody could now credibly argue that a troop pull out is the right thing for Iraqis, or that it was wrong to go into Falluja and deal with these fuckers, so that aid agencies can return to Iraq without fear of being beheaded. I’m glad that’s over and done with.

George, have to disagree. First, the question isn’t whether to side with Zarqawi or the Americans. There are plenty of other groups in Iraq, from Sadr and Chalabi, that bizarre duo, to the Communists. Second, both the terrorists and the Occupiers are using the same tactics — terrorist bombing, torture, etc. In the American case, there are reports that the troops used white phosphorus in Fallujah, making that form of warfare the moral equivalent of Saddam’s war against the Kurds. Third, the U.S. has banned aid workers from its prison and holding centers, bombed hospitals, and kept the red cross from delivering timely aid in Fallujah. So if you are concerned about Iraqis getting help from aid workers, you might be interested to know that the Red Cross has denounced both the insurgents and the Americans.

Not only do I support a troop pull out, I believe that if a schedule of withdrawal had been drawn up last year, there would be less violence this year. After the destruction of Fallujah, the presence of occupation troops has moved from being arguably positive to being inarguably negative. They are simply being used as instruments of the ethnic cleansing of the Sunnis. A weapon in the hand of an ex-Ba’athist appointed by the American chosen IGC. There’s no difference between Iraq and, say, American support for the death squad regimes in El Salvador.

I’d have to say you’re wrong on that, Roger. Of course, the legal international security forces are not in anyway using the same tactics, or are equivalent to, the terrorists they are trying to stop. You will already have seen the extraordinary lengths the US has gone to protect civilians in the critical operation to secure Falluja for the Sistani backed elections, so I don’t have to mention that.

The whole operation was designed to rid the town of the illegal insurgency that was using Falluja as a base to launch attacks on Iraq’s state infrastructure, to assassinate anyone working for the legal government, and murdering anyone trying to rebuild the country. Al Qaeda’s headquarters have been discovered, along with their torture cells, removing any doubts some may have had about the rightness of the mission. There are of course mistakes and various incidents that don’t always meet the extremely high standards we expect, which are to be investigated, but clearly there is no moral equivalence between the US forces and the terrorists, and it would be absurd for anyone to suggest there was.

The red cross do indeed have access to prisoners. The Americans very much want the aid agencies to come back to Iraq, which is why the Falluja operation was such a necessity. You are right that it is an irony that aid agencies based in London – that have nobody on the ground in Iraq, and release statements based on what they have picked up off the evening news – would voice concerns about such a critical operation for the future of Iraq. But that is the nature of the beast, I’m afraid. In the case of the Iraqi red crescent trying to get into Falluja, it was extremely impractical and dangerous for them to be roaming the streets at that time; the Iraqi ministry of health was already taking case of business, which is why initial reports of a humanitarian crisis proved totally unfounded.

White phosphorus is a standard fireball weapon used on enemy bunkers and vehicles, and is not equivalent to a chemical weapon in any sense – that’s why you don’t have to wear protective equipment like a chemical suit to use it, and why there is contamination. To compare the careful use of this weapon to the deliberate and indiscriminate gassing of 7000 civilians in Halabja, would be crass in the extreme.

I was pleased to have seen the Iraqis object to any sort of time table on the withdrawal of the international security forces at the Egyptian conference. To do so would have given the terrorists a date which they could plan to hold out until, which would embolden them.

We should never let down brave Iraqis democrats, such as Dr Allawi, who opposed Saddam’s regime every day it was in power over 25 years; especially at this extremely important time for Iraq. The elections that some falsely claimed would never happen, leaving egg on their face, are only weeks away. We can only leave when Iraq is victorious.

George, from the bottom first:
The incursion into Falluja was objected to by Iraq’s current “interim” president, while it was supported by Allawi — who is misrespresented by your account. He isn’t a brave man who opposed Saddam Hussein, but a cowardly hit man for Saddam Hussein who turned against him and proceded to employ exactly the tactics that the insurgents now employ against the Iraqi/American government.

The invasion of Fallujah was not, as you say, an example of humanity. Rather, it was designed to be inhuman. First, no effort was made to involve any agency in the construction of refugee camps before the assault, even though the Americans announced it in order to drive around 200,000 people from the city. Those people underwent a culling, as Americans wouldn’t allow young men to leave. Then, the assault began with the bombing of a hospital. The heavy use of force has the consequences we can see on this site: fallujapictures.blogspot.com/ . Judge for yourself about the ferocity of the attack.
The use of white phosphor has the effect, according to the San Francisco Chronicle, of burning the skin — of, in effect, operating like napalm. So yes, it is like Hussein’s use of chemical warfare. It is not a harmless substance, nor is meant to be.
The ghost prisoners at Abu Ghraib have been admitted to by the Pentagon. They were specifically kept from the Red Cross.
As for the cages and torture chambers found in Fallujah — I have no doubt Zarquawi’s group uses torture. And I have no doubt the Americans do, too. As for the Mukhabaret that the CIA is reconstructing, I suspect they probably do too. I agree that “we should never let down brave Iraqis democrats.” That is why we should support the overthrow of Allawi through peaceful means. One way of doing this is to support letting Al Jazeera and other media operate in Iraq — at the present time, Allawi’s government, operating according to the traditional Saddamist template, is trying to suppress any media that isn’t pro-government, as well as using the courts and various militia to ban or kill his opposition.

Hopefully, the election to come will spin out of the hands of the Americans. In which case, we might have an interim government that demands a timetable for withdrawal. This is probably much too optimistic a hope — the Americans have managed many a faked election, and I expect this one to be run on the Marcos standard. In the run up to this one, however, the Americans are using a tool even I did not expect — the exaggeration of religious differences, the identification of Allawi with Shiite force against the Sunnis, and the general tactic, so successful for Milosevic in Serbia, of exterminating some enemy. Clever, inhumane, and ultimately what one would expect from the Bush crew.

Juan Cole’s post about the lack of moral equivalence was, frankly, a little odd coming from someone who thinks the Lancet study should be taken seriously and also given what he has said both before and after that one. I agree that one shouldn’t compare the actions of a soldier in combat (even if it turns out to be a war crime) to the cold-blooded killing of a hostage. One action is bad (if it was a war crime) but the other is worse. But Abu Ghraib is on the same level as hostage-killing, and bombing Fallujah with the hope (admitted in the press) that the suffering of the civilians would drive a wedge between them and the insurgents is what I’d call terrorism.

Rule of thumb–when someone says there is no moral equivalence between the actions of X and Y, there’s probably a good argument for saying that there is.

>>>The article makes grim reading for anyone concerned about winning the hearts and minds of the Iraqi people.

Are you moved to take action to aid these children? Are they on your Holiday wish list yet?

There are hospitals, schools, and food suppliers who have been risking their lives to do so. At least one prominent CARE worker has been butchered by the enemy simply for doing good deeds. The Red Cross workers and their depots are also targets of the enemy.

And more than a few people in Coalition and Iraqi uniforms have been at risk — some killed — in protecting the providers of aid.

Human shields may or may not be effective but I wonder how grim things need to get before someone among the commentators on this popular website organizes care packages or lobbies their Representatives to push for getting even more aid to the Iraqi people.

Maybe the voices of the American people can light a fire under the arses of the UN to get itself onside with the Iraqi people and make a full court press.

>>>What I would like to know is — are the Americans using the same Iraqi mass grave diggers that Saddam employed as they dump the “insurgent” bodies in Falluja. Wouldn’t that be neat? Getting an Iraqi industry back on its feet again. We really are a highly moral people.

There’s ambiguity in your bold remarks. Are you one of “the Americans” or are you one of the “highly moral people” you mock?

Look, if the death toll escalated among civilians to the extent that the Lancet has guesstimated, then, the volume of burials would hardly go unnoticed. That study and this new one on malnutirtion both would face a similar constraint in the collection of valid data. Their guesstimates deserve greater scrutiny all round.

As for the deaths of the enemy combattants, their aim was to kill women and men in uniform. To kill Iraqis and other Coaliton members in uniform. To kill civillians — Iraqis of all faiths, ethnicities, sexes, and ages. To demoralize the good people like yourself who watch from a distance. They’d kill you and me if they thought it would terrorize even more Americans and Iraqis. Want to come with me to see for yourself?

Besides, they ran their own little cottage industry in the manufacture of instruments of terror in Falluja. The dismembered and unburied bodies on their watch may be worthy of mockery as well, perhaps?

Reread your comments and see if you can return to tell the group her that you are proud of what you wrote.

roger, in this instance sophistry is both an unaffordable indulgence and an evasion of responsibility. Are you proud of the following comment you made upthread?

>>What I would like to know is — are the Americans using the same Iraqi mass grave diggers that Saddam employed as they dump the “insurgent” bodies in Falluja. Wouldn’t that be neat? Getting an Iraqi industry back on its feet again. We really are a highly moral people.

—

To reiterate to roger and to other commentators and readers here: if the post at the top of this thread nudged your complain-o-meter, have you plans to take action, or have you already taken action of some sort, to address the reported malnutrition in Iraq?