Among the many shocking details of the Abu Ghraib debacle is the Taguba report's estimation that more than 60 percent of the detainees were civilians "of no intelligence value," many of whom were nevertheless denied release. It is not yet known how many of the prisoners subjected to the outrageous abuses and tortures now coming to light were, in fact, civilians charged with either petty crimes or no crimes at all.
The images of Iraqi protesters, many of them family members of detainees, appealing to international journalists outside Abu Ghraib brought to mind the undeniable fact that, while conditions in Iraq may be better than they were under the rule of Saddam Hussein, and may be improving still, the lives of millions of individual Iraqi citizens are in shambles.
"You cannot rebuild a society with people that are in pain," says Dr. Lynn Amowitz, a senior medical researcher with Physicians for Human Rights (PHR), an international human rights organization that is based in Boston, Mass., and Washington, D.C. Amowitz conducted a study of 2,000 households in southern Iraq, documenting some of the dangerous gaps in the renascent Iraqi public-health system. The most troublesome issues are in women's health and mental health, according to Amowitz, two areas that are "incredible issues in every redeveloping country, every developing country, every postwar conflict."
Iraq, though, has a medical history that sets it apart from other recent reconstruction efforts, with an excellent health-care infrastructure dating back to the 1970s, before Saddam Hussein's rise. But neglect under Hussein's rule, combined with the damage done in the two wars of the last 15 years, has produced a situation where less than 50 percent of childbearing women receive any prenatal care and the maternal mortality rate approaches three out of every 1,000 births.
The problem, Amowitz says, is that reconstruction efforts are not working toward a sustainable system of care. Reconstruction is typically carried out by the United States Agency for International Development (USAID). But USAID and the nongovernmental organizations that it contracts with were sidelined in the Iraqi redevelopment, as the mission was tasked to the Coalition Provisional Authority. To the Department of Defense, "Reconstruction meant rebuilding hospitals," Amowitz said. "But you need a really strong primary care base, and there was not a lot of that done over the last year. There was reconstruction of primary health-care clinics, but you need to pay the doctors, you need to provide public-health education."
What's more, Amowitz insists, reconstruction cannot stop at the level of repairing facilities. "It's one thing to repair a water tap," she says, "but then you need the education on keeping the water clean from the tap to the home, and those programs didn't exist in the funding for last year."
The mental-health situation is similarly discouraging. In PHR's survey, the first to assess mental-health statistics in the country's history, seven percent of Iraqis reported attempting suicide in the past year (compared with a global rate of .016 percent, according to the World Health Organization), and 27 percent reported serious contemplation of suicide -- this in a society that places a tremendous stigma on suicide. Amowitz says she's not surprised: "Virtually every other household had someone who was tortured, disappeared, or abused [in the past decade]. Forty-seven percent of households … . Most of these abuses happened in the home, so the entire household was witness to about 50 percent of these abuses. And then you think of the household next door. It goes on. It's a huge number of people that are in pain."
The PHR findings are consistent with reports that have come from Amnesty International; Medact, a London-based organization that looks at the health impacts of violent conflict; and similar observers. Amnesty International has "had reports from all categories [of human-rights abuses] in all regions," according to spokesman Alistair Hodgett. "It's a spiral, unfortunately, in which the civilian population of Iraq are continuing victims, as they were over previous decades of Iraq's history."
Beyond these desperate conditions, there is the matter of civilian casualties. Nothing is officially known about the number of Iraqi deaths over the past year, whether military, insurgent, or civilian. As General Tommy Franks declared during the Afghan war, "We don't do body counts."
This unwillingness to assess civilian casualties has angered many in the humanitarian community. "They claim that they're doing everything they can to minimize civilian casualties, that it's such a high priority … and yet they're making no effort to find out how effective they are," points out Hamit Dardagan, principal researcher of Iraq Body Count, a multinational research group that has undertaken the difficult task of tabulating the many deaths reported in various news outlets. The group currently estimates the civilian death toll at between 9,148 and 11,005, deriving those figures from a careful analysis of worldwide news reports and updating data sometimes months after the incidents occur.
"The early-breaking reports are wrong one way or another," says Dardagan. The group has yet to publicly assess the consequences of the fighting in Fallujah for this reason, preferring to wait "for the reporting to settle down." The group's results are imprecise, but they are nevertheless considered the most comprehensive data available on civilian casualties to this point.
The project has received some criticism for giving the same weight to Arab media like Al-Jazeera as it does to more accredited sources such as The Associated Press. Dardagan argues that this is necessary to get the fullest information available, saying the group doesn't "ask what position someone takes on the war; we ask what is their physical position to the incidents that they're providing information on."
Hospitals tend to have the best overviews of the casualties, Dardagan has found, but they know less about the details behind the injuries -- whether their patients were victims or instigators, for example. Iraq Body Count "take[s] the view that a person is innocent until proven guilty -- that they're considered civilian unless reported to be a combatant," and does not differentiate between Iraqis killed as a direct result of coalition actions and those killed by suicide bombings and other insurgent violence.
"If you start a war," Dardagan explains, "there's going to be collateral damage on both sides. If you start firing on armed people, they're going to fire back, and there will be people caught in the crossfire."
Jeffrey Dubner is a Prospect editorial intern.