The U.S. and 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 consequences 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 (Democratic Peoples’ Republic of the Congo) and Afghanistan and future demands in Iraq further darken the (humanitarian assistance) outlook for Africa”.

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 indices. 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. With such levels of dependency, can most African countries stand up to the implications of the Bush doctrine, which implicitly demands that nation 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 perceived enemies of the U.S. As a sampler, Nigeria’s military assistance pact with the US was reported suspended unilaterally by the Bush administration recently. The poor human rights records of Nigerian soldiers 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 support for a multi-lateral approach to the war against terrorism but not a unilateral American-led war against Iraq.

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 bilateral and multi-lateral donor funding for population, nutrition and health (PNH) activities, many may well kiss these activities goodbye unless they willfully undertake a 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.

3. Given American anxiety about rising costs of the war and with massive reconstruction estimates running from $20 billion per year for the first several years to $600 billion over a decade, 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 reconstruction.

4. Among the many specific consequences of adjustment policies, World Bank/IMF funds management duties and diversion of humanitarian assistance funds to rebuild Iraq, Africa should expect:
a) The prevalence of AIDS and AIDS-related diseases to increase as the poverty index worsens and the external funds which now drive prevention 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, resulting 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 poverty 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 delivery.

The litany of adverse consequences is long, but some challenging policy-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 with a forced opportunity to reform their high dependency on donor funds from the North. Such funds, rather than supporting sector-wide reforms, drive health and development assistance programs project-by-project. These projects are not always coordinated with national health plans and policies. 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 allocation process and look more inwards for their health and development solutions.

* What do you see as some of the impacts of the invasion of Iraq on Africa? Send your comments to

* 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 Independent, 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://heapol.oupjournals.org/cgi/reprint/16/1/74.pdf Accessed April 2, 2003

* ACKNOWLEDGEMENTS: This paper has benefited from valuable critiques from some public health scholars. To them, immense gratitude. Please share freely. Comments welcome.

* Akintola Odutola, Centre for Health Policy & Strategic Studies (CHPSS)
Lagos, Nigeria Tel. +234-1-470 1255 Fax. +234-1-2635285 Email: [email][email protected] Websites: http://www.datelinehealth-africa.net