• health services research

Economic sanctions are usually applied by governments or the United Nations Security Council (UNSC) to individuals, companies or countries.1 Such sanctions may be appropriate when applied to individuals or companies. Economic sanctions on countries, however, cannot be justified in any circumstances. There is overwhelming evidence of the adverse effects of economic sanctions on both the health and nutrition of the civilian population.2 It is usually the most disadvantaged sections of society, who experience the greatest harm.

Economic sanctions are the modern equivalent of a siege. Sieges have usually been applied to cities, for example, Sarajevo and Aleppo, whereas economic sanctions are applied to countries. The effects of both sieges and sanctions are similar: depriving civilians of access to basic services as well as food and medicines. The UNSC has unanimously adopted resolutions demanding the lifting of sieges3 and stating that the use of such sieges against civilian populations in Syria were illegal under international humanitarian law.4 The devastating impact of sieges on health, medical services and access to food and other basic services have been highlighted by researchers.5 6 It is unfortunate that the global superpowers that dominate the UNSC recognise the indiscriminate impact of sieges on civilians, but not economic sanctions.

Economists have studied the effect of economic sanctions on 98 countries over a period of 35 years.2 Their results suggest that UN sanctions reduce life expectancy by 1.2–1.4 years and that sanctions by the USA reduce life expectancy by 0.4–0.5 years.2 Their work suggests that an increase in child mortality and deaths due to cholera alongside decreased spending on public health were the main reasons for the decreased life expectancy.2 They also identified that women were more severely affected by sanctions. They have previously demonstrated that economic sanctions by the USA increase poverty among the poorest people.7 Economic sanctions are usually applied by rich countries on poorer countries and this is likely to result in increased inequalities.

The devastating effect of economic sanctions by the UNSC on child health have been extensively reported for Iraq. Infant mortality increased from 47 to 108 per 1000 live births and under 5 mortality increased from 56 to 131 per 1000 live births, following the imposition of economic sanctions in 1990.8 One group have estimated that 567 000 children died as a result of the economic sanctions.9 Nutritional problems, an increase in infectious diseases and an increase in low birth weight were all reported.10

Iran has experienced economic sanctions by both the UNSC and the USA. The UNSC lifted their economic sanctions in January 2016 and the USA reimposed their economic sanctions in November 2018. The availability of medicines in Iran was significantly reduced during the UNSC sanctions.11 Concern was raised that publishers of medical journals were refusing to consider papers from Iran in case they were in breach of US sanctions.12 A systematic review identified 55 papers documenting the adverse health effects of sanction on the population of Iran.13

The impact of economic sanctions on the most disadvantaged is highlighted by a review of the impact of economic sanctions on 71 countries from 1990 to 2012 and HIV in children.14 AIDS-related death rates increased by approximately 1% in children with HIV and new infection rates increased by 2.5%.14

The USA has imposed economic sanctions on more countries than any other country.7 One country in particular, Cuba, has experienced economic sanctions by the USA for 60 years. The sanctions are comprehensive (including food, medicines and medical equipment) and have extraterritorial components which effectively make it difficult for other countries to trade with Cuba. These extraterritorial components have been declared illegal by the British Government. In January 2019, the Conservative Minister for Europe and the Americas stated in the House of Commons ‘that under the UK Protection of Trading Interests Act 1980, it is illegal for UK companies to comply with extraterritorial legislation such as the US embargo’.15 The European Union has also stated that the extraterritorial aspects of the US sanctions are illegal.16 Each year the UN General Assembly votes overwhelmingly for the sanctions to be lifted.

A comprehensive report by Oxfam details the impact of the US sanctions on Cuba.17 It highlights difficulties in obtaining basic medical supplies such as syringes, masks, ventilators, medicines as well as the raw materials needed to produce vaccines, medicines and sanitary hygiene products.17 Shortages of food and other basic products affect the most vulnerable in Cuba and the tightening of the sanctions has increased inequalities in Cuba.17 Even collaboration between Cuban and American scientists has been blocked by the US sanctions.18 President Obama and others have recognised that the sanctions against Cuba were ineffective.19 20 Unfortunately, both President Trump and Biden have expanded the sanctions. American health professionals have called for the lifting of sanctions on Cuba.21 The impact of the sanctions has been exacerbated by the COVID-19 pandemic.22 23

The legality of economic sanctions on countries has been questioned.24 25 The use of indiscriminate weapons on a civilian population is recognised as unlawful. The Fourth Geneva Convention of 1949 was an attempt to protect civilians from harm during wars.26 Subsequent protocols adopted in 1977 tried to ensure greater protection for civilians.26 As health professionals, we are concerned about the indiscriminate effect of economic sanctions on countries on the human rights and health of civilians.

Economic sanctions on countries are inconsistent with the UN Convention on the Rights of Children and in particular articles 24, 26 and 28 which concern the rights of children to access healthcare, social welfare and education.27 Every nation has ratified the Convention, with the exception of the USA. We call on paediatric professional organisations of member states of the UN Security Council to lobby their governments to recognise that economic sanctions cause more harm than good to children in poor countries. The American Academy of Pediatrics and the Royal College of Paediatrics and Child Health (UK) should take the lead on this issue and issue statements calling on their governments and the UN to stop using economic sanctions on countries.

We call on the International Committee of the Red Cross to work with health professionals and their organisations, and other relevant parties to amend the Geneva Convention by adopting a new protocol recognising that:

1. Extraterritorial economic sanctions are illegal under international law and should be banned immediately.

2. Economic sanctions on a country are inhumane and should be banned as soon as possible.