The continuing public health emergency in Iraq is taking a higher toll in civilian lives than the coalition bombing last January and February. This emergency could have been over by now if the Bush administration and its allies at the United Nations had accepted recommendations on humanitarian needs and monitoring safeguards made by UN relief officials last July.

But the Security Council response to Iraqi needs, in Resolutions 706 and 712 of August and September, fell far short of UN staff recommendations. As a result of the Council’s actions -- and a predictable rejection of its conditions by the Iraqi regime -- civilians throughout the country continue to endure growing malnutrition, inadequate electricity, water, sanitation and health care services, and a fourfold increase in child mortality.

Acceptance of UN staff recommendations to alleviate civilian suffering, moreover, would not have cost the Security Council any effective leverage over the Iraqi regime, nor would the regime have been able to make any greater headway than it has in reestablishing its grip on power.

On July 15, 1991, a UN inter-agency humanitarian mission to Iraq led by Prince Sadruddin Aga Khan, the UN secretary-general’s executive delegate in charge of Iraq and Gulf relief, recommended that Iraq be permitted to resume limited oil sales to finance urgently needed humanitarian supplies. International relief efforts alone, the mission concluded, even government-funded programs run by UN agencies and the International Committee of the Red Cross, could not begin to meet humanitarian needs. (This was a conclusion obvious long before July to UN and private agency relief officials in Iraq.)

The Sadruddin report estimated that it would cost $22 billion to restore the power, oil, water, sanitation, food, agriculture and health sectors in Iraq to pre-war levels. Recognizing that it was both politically and practically impossible to generate this amount of revenue in the immediate future, the UN mission prepared a reduced estimate of essential needs requiring $6.9 billion over 12 months, to permit full restoration of the health sector, recovery of 50 percent of pre-war electrical capacity, 40 percent of water and sanitation production, enough food imports to supply subsistence rations to the entire population, some rehabilitation of domestic agriculture, and limited repair of damaged northern oil facilities (to permit sufficient oil production to sustain ongoing humanitarian needs). For the first four months of this 12-month program, the report recommended that the Security Council’s Sanctions Committee permit Iraq to sell $2.65 billion of oil (equal to a third of the annual figure plus a small sum for start-up costs).

Sadruddin’s office also addressed the issue of control and monitoring to prevent diversion of oil revenues for non-humanitarian purposes or inequitable distribution of relief supplies. On July 16, the executive delegate’s office prepared a memorandum entitled “Monitoring System for the Procurement of Humanitarian Needs in Iraq.” The memorandum set out what it termed “simple but effective” procedures to control and monitor Iraqi government actions at three key stages of the relief process: the sale of oil, the purchase of supplies and distribution within Iraq.

To control the sale of oil and the use of oil revenues, the memorandum proposed that the Iraqi State Oil Marketing Organization (SOMO) would contract to sell an approved quantity of oil to one of Iraq’s customary foreign buyers. The contract would require UN approval before it would become valid, and would permit the UN to check each shipment for appropriate price, quantity and quality. The foreign buyer would pay via a restricted letter of credit into a special account to be opened by SOMO at a leading international bank.

The Iraqi government would be able to use the funds in the special SOMO account to purchase only commodities and other relief supplies approved by the UN Sanctions Committee. UN permission would also be required for payments to be made out of the special account. The UN would monitor all oil sale and procurement transactions through a reputable commercial shipping inspection agent, chosen by the UN but paid for by Iraq, as a means to guarantee the integrity of the process. In Iraq, UN agencies such as the World Food Program and UNICEF would monitor the government’s distribution of food, medicine and other relief materials to insure that the distribution did not discriminate against any population group.

Under these proposed control and monitoring safeguards, Iraq would have had no more opportunity to divert or misuse relief supplies than under very similar arrangements eventually mandated by the Security Council in August and September. The principal difference was the Security Council’s provision for a UN escrow account, instead of the proposed special SOMO account. The escrow account afforded the UN no greater measure of security or control, but provocatively raised the issue of national sovereignty by taking direct possession of Iraqi national resources.

In July, Iraqi officials told UN humanitarian administrators in Baghdad that Iraq would accept the executive delegate’s recommendations. UN officials estimated then that it would take only two months to get supplies of food, medicine, replacement machinery and supplies flowing into Iraq. Had this happened, the public health emergency in Iraq would be almost over. Government rations would by now be able to provide enough low-cost food to meet all, instead of the current one third, of a family’s nutritional requirements. Most medical supplies, from basic antibiotics and vaccines to anesthesia and specialized drugs for chronic diseases, would be available again. Electricity, water and sewer systems would be gradually returning to normal. Infant and child mortality would be declining.

But this was not to be. In late July, after discussions with US and other coalition country representatives in Geneva and Washington, UN officials began speaking of the stringent political solution planned by the coalition and of humanitarian needs once again being held hostage to political objectives. UN officials were convinced then that the US intention was to present Saddam Hussein with so unattractive a package that Iraq would reject it and thus take on the blame, at least in Western eyes, for continued civilian suffering.

As UN officials foresaw in July, Iraq has so far refused to cooperate with Resolutions 706 and 712. At least two reasons are evident. Instead of the $2.65 billion over four months recommended by the Sadruddin report, Resolution 706 would allow Iraq to allot only $930 million to relief over six months. This shortfall -- only 23 percent per month of the recommended amount -- and the many conditions attached to the oil sales by the Security Council have prompted Baghdad to refuse to pump Iraqi oil.

By withholding the recommended amount of relief aid, the coalition has not yet and is not likely to weaken Saddam Hussein’s regime. The most powerless elements of Iraqi society, the poor and the lower middle class, suffer the worst impact of sanctions. Their suffering is not likely to trigger a revolution. Conversely, implementing the recommendations of the Sadruddin report is unlikely to lend much support to the regime’s effort to recoup and consolidate its hold on power. Business as usual will not resume in Iraq simply because there is once again enough food, medicine and clean water to go around. The coalition still retains the leverage afforded by continuing trade sanctions to keep much of the Iraqi economy frozen. And, of course, it still retains the leverage provided by the threat of renewed force that the Bush administration has employed several times to compel Iraqi compliance with UN weapons inspections. The deadlock on humanitarian aid can be broken by a new offer from the US and its coalition partners at the UN of a one-time sale of Iraqi oil exclusively for humanitarian purposes. The same controls and safeguards recommended by UN relief officials in July can be employed to prevent misuse. The same amount, $2.65 billion, would help civilians survive the winter and begin to alleviate the catastrophic public health emergency in Iraq.