Table 3

Elements in the 12-D framework covered in the review of systematic reviews

The 12-D frameworkImpacts on public health concluded from the review of systematic reviews on Iraq
DeathAverage deaths per day ranged from 48 to 759. The cause-specific mortality rates attributable to violence ranged from 0.64 to 10.25 per 1000 per year. There was also higher rates of childhood mortality.40
Diseases and disordersMultisymptom illness (MSI): Higher prevalence among Gulf War veterans.41
Mental illness
Prevalence of post-traumatic stress disorder in children and adolescents is estimated to be 10%–30% in Iraq. Other illnesses noted: major depression, attention-deficit hyperactivity disorder, specific phobia, oppositional defiant disorder, generalised anxiety disorder and obsessive-compulsive disorder. More than 80% of 2-year-olds to 7-year-olds had separation fears, >60% had strong reactions to noise, anxiety, fears and nervousness, agitation or aggressiveness, high-risk behaviours in adolescents.42 However, the Post-Traumatic Growth Inventory found moderate growth.43
DependencyAlcohol and substance use: Pooled analysis based on a random-effects model yielded higher risk for alcohol and substance use disorders among Iraq/Afghanistan veterans.44
DeformitiesCongenital birth defects
Thirty studies (83%) reported a positive association between uranium exposure and adverse birth outcomes, though they suffer from a high risk of bias.45
Pregnancy outcomes
Higher risk of small for gestational age and a lower 5 min Apgar score.46
Destruction to infrastructureHealth infrastructure
Maternal and neonatal health services adversely affected during recurrent crises.47