News
War on Iraq could produce a
humanitarian disaster, health
professionals warn
Jocalyn Clark BMJ
141
A report from Medact—a UK
based organisation of health
professionals that was set up to
highlight the health conse-
quences of war—warns that a
new war on Iraq would produce
a humanitarian disaster.
A war would lead to wide-
spread damage to the environ-
ment, including oil spills, toxic
smoke, and chemical, biological,
and possibly radiological pollu-
tion. Emergency relief for dis-
placed and sick civilians would
cost billions of pounds. Existing
relief programmes, such as the
oil for food programme, have
institutionalised a state of crisis
and have failed to provide prop-
er access to food, education,
employment or health care.
The authors contend that a
new war on Iraq would further
destabilise the Middle East and
the global economy.
The report was launched this
week simultaneously by the
International Physicians for the
Prevention of Nuclear War, to
MMR vaccine is
not linked with
autism, says
Danish study
Janice Hopkins Tanne New York
198, 154
A Danish study of more than
half a million children showed
no link between measles,
mumps, and rubella (MMR) vac-
cination and autism.
In a commentary accompany-
ing the study, which was pub-
lished in the New England Journal
of Medicine (2002;347:1477-82), Dr
Edward Campion, senior deputy
editor, wrote, “This careful and
convincing study shows that there
is no association between autism
and MMR vaccination.”
Lead author Dr Kreesten
Meldgaard Madsen, an epidemi-
ologist and expert on infectious
diseases at the Danish Epidemi-
ology Science Centre in Aarhus,
told the BMJ that the study
showed that the risk of autism
1134
which Medact is affiliated, and
by organisations in the United
States, Australia, Canada, Ger-
many, Guatemala, India, Japan,
the Netherlands, and the Philip-
pines.
Drawing on evidence from
international organisations, the
report states that the 1990-1 war
was responsible for 200 000
deaths among military person-
nel, civilians, and refugees in
Iraq. Up to 300 000 Iraqi sol-
diers were wounded, some of
whom later died or had long
term disability.
Air attacks and sanctions tar-
geted Iraq’s oil industry, crip-
pling the country’s economy,
which had been growing in the
previous decades. Roads, com-
munications, electricity, water
supply, sewage systems, and
healthcare facilities were severe-
ly damaged.
This damage severely limited
water, food, and other resources.
An estimated 1.8 million
refugees fled to the borders, with
was similar in children who were
vaccinated and children who
were not.
The study reviewed records
of 537 303 children born in
Denmark between January 1991
and December 1998, represent-
ing almost 100% of children
born in that period. Of these
children 440 655 had been vac-
cinated. Records were retrieved
from three sources: the unique
identification number assigned
to each child at birth; MMR vac-
cination data reported to the
National Board of Health by
general practitioners, who give
all MMR vaccinations and are
reimbursed for their reports;
and diagnoses of autism record-
ed in the Danish Psychiatric
Central Registry. Only specialists
in child psychiatry diagnose
autism and related conditions.
The study considered the
children’s sex, weight and gesta-
tional age at birth, and age at
diagnosis of autism or of a relat-
ed disorder; the socioeconomic
status of the parents; and the
mother’s education.
Neighbours search for a family buried in rubble after a 1999 attack
on Jesan, near Baghdad, by US planes
disease and malnutrition. The
report states that women, chil-
dren, and elderly people were
affected the worst. Some 47 000
excess deaths in children aged
under 5 years occurred in Janu-
ary to August 1991 alone.
Medact proposes alternative
strategies to war, including tar-
geted sanctions against the Iraqi
elite, creation of a visible and
accountable containment system
to restrict the arms trade, estab-
The authors found that
“There was no increase in the risk
of autistic disorder or other autis-
tic-spectrum disorders among
vaccinated children as compared
with unvaccinated children
(adjusted relative risk of autistic
disorder, 0.92; 95% confidence
interval, 0.68 to 1.24; adjusted rel-
ative risk of other autistic-spec-
trum disorders, 0.83; 95%
confidence interval, 0.65 to 1.07).”
In addition, the authors
found no association between
the development of autistic dis-
order and the age at vaccination,
the interval since vaccination, or
the calendar period at the time
of vaccination.
Children were vaccinated at
15 to 17 months, and catch up
vaccination was given to older
children when the vaccine was
introduced in 1987. Almost all
children were vaccinated before
the age of 3 years. The mean
age at diagnosis for autism was
4 years, 3 months, and for
autistic spectrum disorders 5
years, 3 months.
Although MMR vaccination
BMJ VOLUME 325 16 NOVEMBER 2002 bmj.com
AP PHOTO/JASSIM MOHAMMED
lishment of a longer term and
sustainable development plan,
and an international effort to
foster democratic political
processes in Iraq.
It recommends an allowance
of time for Iraq to comply
with international pressure for
disarmament.
Collateral Damage: The Health and
Environmental Costs of War on Iraq is
available at www.medact.org
was introduced in Denmark in
1987, the rise in autism began
only in the mid-1990s. “If it
[MMR vaccination] caused
autism, we would see a greater
risk [soon] after its introduc-
tion,” Dr Madsen said, but the
study did not show that. Autism
is increasing, perhaps because of
better diagnosis, but there is no
link to MMR vaccination, he
said.
The retrospective nature of
the study may be its strength, Dr
Madsen told the BMJ. Recall
bias, such as when parents
whose children are given a diag-
nosis of autism recall events that
occurred around the time of the
diagnosis, was absent. In this
study, data on vaccination were
recorded separately from data
on diagnosis.
MMR vaccination protects
children against disease, Dr
Madsen said. “Measles kills one
in 3000 children, even in devel-
oped countries. It causes
encephalitis in one in 2000 and
pneumonia in one in 20. People
tend to forget.”