AFRO-NETS> Iraq War, Middle East conflict, health and development in Africa

[A Odutola <chpss_abo@yahoo.com>]

Iraq War, Middle East conflict, health and development in Africa
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A short commentary

The U.S. & British led war in Iraq is now a significant chapter in 
world history. It adds to the conflict level in the Middle East. The 
short and long-term triggers to the war may be debatable; the conse-
quences on health and development issues in Africa are not. Support 
for this view is widely shared in development circles. For example, 
James T. Morris, Executive Director, World Food Programme said in an 
April 7 speech to the United Nations Security Council in New York: 
"Continuing funding shortfalls for food emergencies in the DPRK (De-
mocratic Peoples' Republic of the Congo) and Afghanistan and future 
demands in Iraq further darken the [humanitarian assistance] outlook 
for Africa".(1)

Africa is known for many good things; clearly defined and publicly 
reinforced geo-strategic interests are not among these. Many African 
countries are plagued with internal strife, famine, high external and 
internal debts, weak economies as well as poor human development in-
dices. Many depend, perhaps too willingly, on foreign aid for basic 
survival. The World Bank estimates for example that African countries 
on average receive three dollars per capita from donors for every 
dollar of GDP expenditure on health and social development.(2) With 
such level of dependency, can most African countries stand up to the 
implications of the Bush doctrine, which implicitly demands that na-
tion states choose sides in the conflict? 

Americans like all humans can be friendly and supportive as well as 
singularly vindictive. Post 9/11, the present Bush administration is 
the face of American friendship or enmity that the world sees. For 
now, that face seems stone-hard in the relentless pursuit of per-
ceived enemies of the US. As a sampler, Nigeria's military assistance 
pact with the US was reported suspended unilaterally by the Bush ad-
ministration recently. The poor human rights records of Nigerian sol-
diers sent to quell internal civil unrests were the official American 
reason offered for the suspension. The timing however has raised the 
allegation, that the suspension was provoked by Nigeria's stated sup-
port for a multi-lateral approach to the war against terrorism but 
not a unilateral American-led war against Iraq.(3) 

As the US understandably diverts more of its resources to war efforts 
and seeks to fund rising budget deficits at home, it is conceivable 
that development assistance funding cuts would be implemented against 
'unsupportive' nations and multi-lateral development institutions.

So, at the risk of clairvoyance, here are some predictions for health 
and development in many African countries as war in the Middle East 
progresses and the Iraq post-war period unfolds:

1. Given the present high dependency of most Africa countries on bi-
lateral and multi-lateral donor funding for population, nutrition and 
health (PNH) activities, many may well kiss these activities goodbye 
unless they wilfully undertake major paradigm shift and target more 
internal resources towards the promotion of their PNH activities. The 
alternative saving grace (assuming external dependency is considered 
inevitable) would be for the EU, Japan and other non-U.S donors to 
step in and fill inevitable funding shortfalls.

2. In the ensuing five or more years, African countries should expect 
more pressure to remove subsidies on social goods, devalue national 
currencies and promote more privatization of water, power, education 
and health. These standard structural adjustment policies recently 
repackaged as Poverty Reduction Strategy Programmes (PRSP), have been 
shown to worsen rather than uplift health, education and development 
indices generally in Africa.(4)

3. Given American anxiety about rising costs of the war and with mas-
sive reconstruction estimates running from $20 billion per year for 
the first several years to $600 billion over a decade,(5) it is no 
surprise that the World Bank and the IMF have been conveniently 
charged with managing war and rebuilding funds. African countries 
should (regardless of their economic problems) expect to contribute 
willy-nilly in paying for the Iraq war and for post-war reconstruc-
tion. 

4. Among the many specific consequences of adjustment policies, World 
Bank/IMF funds management duties and diversion of humanitarian assis-
tance funds to rebuild Iraq, Africa should expect: 

a) The prevalence of AIDS and AIDS-related diseases to increase as 
poverty index worsens and the external funds which now drive preven-
tion activities and access to anti-retroviral treatment declines.

b) Subsidy on socially-marketed condoms to be removed at source or 
its level reduced and free condom distribution to be constrained, re-
sulting in condom scarcity and increase in open market pricing beyond 
the reach of the "common man". Prior gains in family planning and 
control of sexually transmitted diseases including HIV/AIDS would 
suffer setbacks.

c) Further drop in immunization coverage with worsening infant and 
childhood mortality/morbidity as donor funding for free or subsidized 
distribution of childhood vaccines reduces.

d) Poverty-induced girl trafficking and prostitution to rise as pov-
erty worsens locally and the externally-funded micro-credit and other 
women empowerment projects get less funding. Mainstreaming women into 
the development agenda of most African countries will likely suffer 
setbacks.

e) Worsening unemployment rate especially in the pool of non-
governmental organisations in health, development and human rights 
activities as most of these organisations and their projects are 
largely dependent on external donor funding.

f) More aggravated drain in health manpower to developed nations with 
consequential reduction in the local manpower pool for services de-
livery.(6) 

The litany of adverse consequences is long, but some challenging pol-
icy-related questions beg to be asked.

Must health and development in Africa be inevitably worse off in the 
ensuing years as a result of conflict in the Middle East? Is there a 
silver-lining for Africa in the conflict? 

Necessity is said to be the mother of invention and the war may well 
present African countries a forced opportunity to reform their high 
dependency on donor funds from the North. Such funds, rather than 
support sector-wide reforms, drive health and development assistance 
programs project-by-project. These projects are not always coordi-
nated with national health plans and policies.(7)

African countries would do well to seize the opportunity to re-
examine and publicly redefine their respective national and geo-
strategic interests, restructure their resource mobilization and al-
location process and look more inwards for their health and develop-
ment solutions. 

References

1. Morris, J.T. Iraq - Africa: Double standards? World Food Programme 
2003; 7 April 
http://www.wfp.org/aboutwfp/how_run/ED/speeches/030407.pdf Accessed 
April 11, 2003 
2. Better Health in Africa. World Bank. Washington DC; 1999. 
3. Oloruntola, T. Military reform in troubled waters. Daily Independ-
ent, Lagos. 2003; 28 March 
http://odili.net/news/source/2003/mar/28/303.html. Accessed March 30, 
2003	 
4. Colgan, A. Hazardous to Health: The World Bank and IMF in Africa. 
Africa Action 2002; 18 April 
http://www.africaaction.org/action/sap0204.htm Accessed April 11, 
2003 
5. Dunphy, H. Finance Leaders Back U.N. Postwar Plan. Associated 
Press 2003; 12 April 
http://story.news.yahoo.com/news?tmpl=story2&cid=530&ncid=530&e=3&u=/
ap/20030412/ap_on_re_mi_ea/war_iraq_aid Accessed April 13, 2003 
6. Thom, A. Rich countries deplete Africa's medical resources. 
Health-e News, South Africa 2003; 10 April 
http://news.hst.org.za/view.php3?id=20030411 Accessed April 10, 2003 
7. Bodart, C. et al. The influence of health sector reform and exter-
nal assistance in Burkina Faso. Health Policy & Planning, 2001; 16(1) 
74 -86 http://heapol.oupjournals.org/cgi/reprint/16/1/74.pdf Accessed 
April 2, 2003

--
A. Odutola 
Centre for Health Policy & Strategic Studies (CHPSS)* 
Lagos, Nigeria 
Tel. +234-1-470-1255 
Fax: +234-1-263-5285 
mailto:chpss_abo@yahoo.com 
http://www.expage.com/chpss 
http://www.datelinehealth-africa.net

Please share freely. Comments welcome.

ACKNOWLEDGEMENTS: 
This paper has benefited from valuable critiques from some public 
health scholars. To them, immense gratitude. 

--
*CHPSS works to promote better health for all in Nigeria and the rest 
of Africa through research, policy advocacy and information dissemi-
nation.
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