This paper reviews the impact of trade embargoes on health, health services and food security drawing on data from Cuba, Haiti and Iraq. The argument is made that the impact of trade embargoes encompasses much more than restrictions on the availability of medicine. The case studies also suggest that mothers and children are not necessarily the only vulnerable group, and that studying changes in the health and mortality of under fives is more indicative than those of infants under one year old. The examples of Cuba and Iraq also highlight the importance of strengthening health monitoring systems, and of reforming health policy towards focused public health measures to maximise the use of scarce resources and stimulate preventive measures. However, trade embargoes cause macroeconomic shocks and economic and social disruption on a scale that cannot be mitigated by humanitarian aid, and which affects the well-being of a population beyond their state of health.
Three prerequisites for effective humanitarian advocacy are, therefore, reliability of data, integrity of the source and a credible link between the observed outcomes and the existing sanctions regime. The last section of the paper critically examines the current practice of measuring health impacts of sanctions, with particular emphasis on the case of Iraq. It identifies persistent weaknesses and suggests steps for improvement in future humanitarian assessments.
Improved practice will require:
- A better assessment of vulnerabilities but also of existing strengths.
- More valid indicators and appropriate methods to measure the impact of sanctions on vulnerable groups.
- More potent advocacy that clearly shows how vulnerable populations have been affected and what needs to be done to achieve better outcomes rather than more inputs (underpinned by points 1 and 2).