Economic Sanctions as Human RightsViolations: Reconciling Political andPublic Health ImperativesStephen P. Marks

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In this commentary I consider the publichealth impacts of sanctions regimes in theirpolitical and legal context and examine sev-eral reform proposals designed to reduce theirharmful effects on civilians. The article byElizabeth Gibbons and Richard Garfield inthis issue ofthe Journal provides an excellentexample of the collection and presentation ofdata in support of their conclusion that eco-nomic sanctions in Haiti resulted in extensiveviolations of the rights of Haitian citizens.1My purpose is to raise some of the legal andmoral problems oftreating the civil impacts ofsanctions as human rights violations and tourge a collaborative effort ofpublic health andhuman rights professionals with policymakersto influence the way sanctions are applied.

The Legal and PoliticalFramework ofSanctions

Sanctions in intemational law and poli-tics are measures of coercion to induce arecalcitrant party to conform to a norm ofinternational behavior or to the will of the"sending" authority. Technically, the termapplies to both military and nonilitary mea-sures, although it is more commonly used formeasures short of force. In the United States,the term is used for the wide range of lawsthat deny aid and trade preferences, prohibitthe export and import ofweapons and goods,freeze assets abroad belonging to targetedcountries or their elites, and apply other mea-sures explicitly taken for purposes rangingfrom surrendering for trial persons accusedof participating in acts of terrorism (e.g.,Libya) to changing a country's basic politicaland economic system (e.g., Cuba).

According to an international financeand trade advising firm, as of July 1999 theUnited States was imposing sanctions on nofewer that 28 countries.2 From World War I to1990, the United States is reported to haveimposed sanctions 77 times.3 In the case ofLibya, the Security Council suspended sanc-tions on April 5, 1999, when Libya surren-dered for trial in the Hague the 2 suspects inthe downing ofPanAm Flight 103, renouncedterrorism, and promised to compensate vic-tims if the suspects are found guilty.4 In con-trast, sanctions applied to Cuba since 1960have not achieved their purpose of destabiiz-

ing the Castro regime and provoking its over-throw and have been overwhelmingly rejectedby the United Nations (UN) General Assem-bly, which "call[ed] on all States to refrainfrom promulgating and applying laws andmeasures" like the economic, commercial,and financial embargo against Cuba imposedby the United States.5 When the United Statesacts outside the enforcement mechanisms ofthe UN to impose sanctions, it may be usingits legitimate discretionary powers to grant orwithdraw aid or to grant or deny trade privi-leges. It may also be acting out ofsuperpowerarrogance (more euphemistically termed "USexceptionalism") with a dubious legal andpolitical basis (e.g., in the case ofthe Helms-Burton Act, which provides measures againstpersons from third countries who do businesswith Cuba).6

The UN has imposed economic sanc-tions in 13 cases, 9 of which are currentlyenforced.7 The legal grounding ofthese sanc-tions lies in the Security Council's power to"decide what measures not involving the useof armed force are to be employed to giveeffect to its decisions." Under this authority,the Council "may call upon the Members ofthe United Nations to apply such measures.These may include the complete or partialinterruption ofeconomic relations and of rail,sea, air, postal, telegraphic, radio, and othermeans of communications and the severanceof diplomatic relations."8

From this legal basis, which presup-poses a threat to or breach ofthe peace or actof aggression, 4 types of sanctions notinvolving military force are available.

Trade embargoes. Economic sanctionsare the most commonly applied form of sanc-tions and the one that has the most significantpublic health consequences, normally in theform of trade embargoes and cessation ofdevelopment assistance. Such sanctions wereused against Iraq in August and September1990 to induce withdrawal from Kuwait andafter April 1992 to induce compliance withSecurity Council Resolution 687, which setthe conditions Iraq must meet in the aftermath

Requests for reprints should be sent to Stephen P.Marks, Frangois-Xavier Bagnoud Professor ofHealth and Human Rights, Harvard School of Pub-lic Health, 651 Huntington Ave, 7th Floor, Boston,MA 02115 (e-mail: smarks@hsph.harvard.edu).

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of Operation Desert Storm. They were alsoused against Yugoslavia (1991-1996) andSerbia and Montenegro (1992-1996), thesocial consequences of which were surveyedin 1994.9 In the case of Haiti, the OrganizationofAmerican States (OAS) called for sanctionsin 1991, but the Security Council did notimpose binding sanctions until June 1993.10

Arms embargoes. Typically, the firstresponse to military aggression or otherthreats to international peace and security is tolimit the target country's access to weaponsby means of an arms embargo and by curtail-ing military assistance. Iraq's invasion ofKuwait was the only case of a UN-mandatedmultilateral arms embargo following a trans-boundary attack." Arms embargoes have alsobeen imposed on Yugoslavia, 12 Somalia,'3Liberia,'4 and Haiti.'5 The direct public healthimplications of such sanctions are negligible,except for the general impact on civilian pop-ulations of prolonging the conflict, a possibleconsequence if the embargo prevents one sidefrom achieving a decisive military victory.

Severing ofcommunications. Preventingtelephone and telegraph communication,delivery of mail, Internet access, and air, sea,and river travel is a means of focusing sanc-tions on the ruling elite of a recalcitrantregime. By their nature, such sanctions aremore suitable for targeting those responsiblefor wrongdoing and avoiding harm to inno-cent civilians than is the prohibition of allforms of trade. Related to these measures arediplomatic isolation-withdrawing diplo-matic personnel and refusing visas-and cul-tural and sports boycotts.

International criminal prosecution. In1993, the Security Council invented an auda-cious form of sanction by establishing an inter-national penal court to try individuals responsi-ble for war crimes (serious violations ofintemational humanitarian law) in the formerYugoslavia'6; its jurisdiction was expanded in1994 to include genocide and crimes againsthumanity in Rwanda.'7 Because the SecurityCouncil acted under Article 41 of the UNCharter, the tribunal is a form of sanction,although it is not often referred to as such in theliterature. Like the severing of communica-tions, penal sanctions against individuals arelikely to have a deterrent and retributive effectwithout endangering the health and well-beingofthe civilian population.

Effectiveness ofSanctions andTheirAlternatives

The principal argument in favor of sanc-tions is that, in the case of a recalcitrant dicta-tor, the preferable coercive measure is toblock access to weapons, resources, and trade

advantages rather than resort to armed force.Whether such sanctions are effective is dis-puted in the literature.'8 The claim in a classicstudy that economic sanctions have an overallsuccess rate of 34%19 has been challenged,20and a theoretical model (spatial theory of cri-sis bargaining) was applied to the same dataset in a study that found sanctions to haveinfrequent and modest impact.2 "In mostcases," the latter study concluded, "a stateimposing sanctions on its opponent canexpect an outcome that is just about the sameas would be obtained without sanctions."22

The utilitarian assumption underlyingthe decision to impose sanctions is that thepolitical gain will outweigh the human pain.In other words, there is a higher purpose thatjustifies the regrettable but unavoidablecivilian suffering. This assumption oftenproves ill founded in practice; the greatergood is rarely achieved and is morally unsus-tainable in terms of its costs.23 If the aim ofsanctions is to communicate a message orpunish wrongdoing, then sanctions are onweak ethical ground because they create sit-uations in which "human suffering becomesmerely a device of communication" and "awrongdoer remains untouched and an inno-cent person is gratuitously harmed."24 It isequally hazardous to assume that bombingsand deployment of troops will succeed, shortof the overwhelming force used to dislodgethe Iraqi military from Kuwait. An alterna-tive to both war and sanctions is the neglectedrealm of "positive sanctions" in the form ofrewards, inducements, and incentives,25 asis proposed in the case of Iraq.26 In otherwords, more carrots and fewer sticks maybe required. When sticks are necessary, thesending states must confront the risk of civil-ian harm.

Collateral Harm and HumanRights Accountability

The issue of harmful impact on civilianpopulations was brought to public attentionin a significant way as early as 1991 by thestudy ofthe impact of the GulfWar and tradesanctions on epidemics and child mortality inselected Iraqi hospitals. This study wasexpanded to a nationwide survey of infantand child mortality, conducted by a team of11 public health and medical professionals.27More than 30 major studies have been identi-fied as dealing with the civilian impact of thewar and sanctions against Iraq.28 In 1996, theCenter for Economic and Social Rights(CESR) sent a mission of 24 researchers,over half of whom were from the fields ofpublic health and medicine, to review theimpact ofUN sanctions on Iraq in order to

assess whether the sanctions violated humanrights. After considering the ethical and legalquestions regarding UN sanctions againstIraq in the light of available data concerningeconomic conditions, health facilities, andhealth infrastructure, the CESR concludedthat the "case ofIraq illustrates why sanctionsare not always a humane alternative to war."29The CESR argued that the UN SecurityCouncil should "hold itself accountable to itshuman rights obligations" and recommendedthat the Council "take less drastic means ...to constrain the Iraqi regime without impos-ing the costs on the most vulnerable sectorsof society." Like Gibbons and Garfield, theCESR study raises the complex issue of therelationship between economic sanctions andhuman rights accountability.

It is tempting to consider that because(a) the rights to an adequate standard of liv-ing, to physical and mental health, to justremuneration, to education, to family life,and to other related rights are universally rec-ognized and (b) serious studies by publichealth experts substantiate the claim thatthese rights have been violated as a result ofeconomic sanctions, then (c) the "senders" ofsanctions regimes-that is, the governmentaland intergovernmental decision makers inCongress, the White House, the UN SecurityCouncil and the OAS-are perpetrators ofhuman rights violations. The CESR and Gib-bons in her book on sanctions in Haiti comeclose to succumbing to that temptation, theformer stressing that "the [Security] Councilremains accountable to human rights princi-ples regardless of the conduct of the Iraqigovernment"30 and the latter claiming thatstates that enforce sanctions in Haiti "inad-vertently participated in violating the rightsof Haitian citizens."31

The identification of senders of sanc-tions with perpetrators ofhuman rights viola-tions is not so simple, for 2 reasons. First, as amatter of law, responsibility for a violationcan only be attributed to a duty holder, in mostcases a state that has ratified a treaty establish-ing the obligation in question, and neither theSecurity Council nor the UN in general is aparty to the International Covenant on Eco-nomic, Social and Cultural Rights (ICESCR),the Convention on the Rights of the Child(CRC), or any other relevant convention.Moreover, treaties impose obligations onstates to take measures within their jurisdic-tion-that is, within the national territoryand, for a limited range of matters, for itsnationals outside the territory-but not forforeigners in their own countries. Thus, themembers of the Security Council have no

treaty-based duty to ensure treaty rights forthe citizens of Haiti, Iraq, Serbia, or other tar-

geted countries.

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One can hold states accountable, how-ever, for actions that defeat the object andpurpose of a treaty to which they are a party(or even that they have signed and not yet rat-ified, as is the case with the United Stateswith respect to the ICESCR), and the aim ofprotecting the human rights set out in theICESCR is part of that object and purpose.Such is the intention of the following provi-sion of the Maastricht guidelines, adopted bya group of 30 human rights experts in Janu-ary 1997:

19. The obligations of States to protecteconomic, social and cultural rights extendalso to their participation in internationalorganizations, where they act collectively.It is particularly important for States touse their influence to ensure that violationsdo not result from the programmes andpolicies of the organizations of which theyare members.32

The language is not that of firm obliga-tion, but it is designed to acknowledge theimportance of states' using their influence toprevent violations-for example, throughdecisions of the Security Council or theOAS to impose sanctions. There is, more-over, a duty upon the Security Council to"act in accordance with the purposes andprinciples of the United Nations,"33 amongwhich is the purpose of "promoting andencouraging respect for human rights andfundamental freedoms for all."34 Signifi-cantly, the Committee on Economic, Socialand Cultural Rights, which monitors theapplication of the ICESCR, requires thestate or entity imposing sanctions to takethese rights "fully into account" whendesigning the sanctions regime, to monitoreffectively the situation in the targeted coun-try with respect to these rights, and to takesteps "to respond to any disproportionatesuffering experienced by vulnerable groupswithin the targeted country."35 In the caseof Haiti, the UN and the OAS did takehuman rights into account by creating theHuman Rights Civilian Observation Mis-sion (MICIVIH), which Gibbons describesas "a positive action ... that was quite dif-ferent in nature from the negative action ofsanctions."36 However, she also notes that itsmandate excluded economic, social, andcultural rights, as a result of "pragmaticdecisions" that "respect for Haitians' eco-nomic and social rights would be sacrificedfor the sake of advancing their political andcivil rights." This dilemma emerged in thefunctioning of MICIVIH's Medical Unit, anunprecedented addition to a human rightscomponent of a peace operation, which raninto difficulty in trying to reconcile missionheadquarters' efforts to restrict its role todocumenting abuse of civil and politicalrights with the participating medical practi-

tioners' duty to provide care when the situa-tion called for medical assistance.37

The second problem with the senders-as-perpetrators argument is both moral andlegal: Senders of sanctions cannot be heldresponsible unless they intentionally seekto violate the rights in question or pursuepolicies that are so blatantly harmful to thoserights that they fail to meet a minimumstandard of compliance. The humanitarianexemptions that have been voted with sanc-tions in almost every case, and the supple-mental humanitarian assistance programsfunded by the "senders," as well as their pub-lic statements of concern for the plight ofcivilian populations, make it difficult to findwillful intent on the senders' part. Gibbons'reference to states "inadvertently" partici-pating in violations,38 and the use she andGarfield make of "unintentionally" in theirarticle in this issue of the Journal, are indica-tive ofthe problems of accountability.

Nevertheless, the moral outrage of thosewho would like to hold senders of sanctionsaccountable as perpetrators of violations isjustified, and passing blame to Saddam Hus-sein, Lt Gen Cedras, or Slobodan Milosevicis not enough. As a study commissioned bythe UN concluded, "the amount of infor-mation available today on the devastatingeconomic, social, and humanitarian impactof sanctions no longer permits [policymak-ers] to entertain the notion of 'unintendedeffects."'39A member ofthe Security Councilhas declared that "it is disingenuous to talk of'unintended side effects' when everybodyknows that the sector most affected by sanc-tions, as presently applied, are precisely civil-ian populations. There is nothing surprisingor unintended about it."40 His statement wasin reaction to a "non-paper" (an informal doc-ument used as a flexible tool for negotiation)by the 5 permanent members of the SecurityCouncil (P-5) that insisted that sanctionsregimes should "minimize unintended adverseside-effects of sanctions on the most vulnera-ble segments oftargeted countries."4l

This tension between the sound conclu-sions of public health surveys of countriestargeted by sanctions and the uncertain attri-bution ofresponsibility for human rights vio-lations underscores the need for more reflec-tion on the relationship between health andhuman rights. There can be no doubt that thecivilian populations in targeted countries arevictims ofhuman rights violations. The Com-mittee on Economic, Social and CulturalRights authoritatively declared that "theinhabitants of a given country do not forfeittheir basic economic, social and culturalrights by virtue of any determination thattheir leaders have violated norms relating tointernational peace and security."42 While it is

necessarily true that violations are committedby perpetrators, the principles ofaccountabil-ity for the human rights violations resultingfrom sanctions do not clearly identify the per-petrators or the consequences they shouldbear. Therefore, a more fruitful avenue isreform of sanctions to avoid such violations.

Rethinking Economic Sanctions

The policy community has been grap-pling with the dilemmas of sanctions, andnumerous solutions have been proposed. In awidely quoted study for the Council on For-eign Relations, international lawyer LoriDamrosch proposed criteria for evaluatingcollective sanctions that address internal con-flicts. She posits a "conflict containment cri-terion'" by which sanctions are assessed fortheir capacity to reduce or end conflict, and a"differentiation criterion" that rates higherthose collective responses that "target theperpetrators of violence or other wrongdoingand minimize severe adverse consequenceson civilians who are not in a position to bringabout cessation of wrongful conduct." Shefurther distinguishes, within the differentia-tion criterion, the civilian impact, the wrong-doer impact, and the relationship betweenthe two ("To the maximum feasible extent,a program of economic sanctions should bedesigned and implemented so as to avoidenriching the perpetrators of wrongdoing atthe expense oftheir victims").43

More recent studies on sanctions in Iraqby David Cortright and George A. Lopez,in 199844 and 1999,45 concluded that sanc-tions inflict "unacceptably high humanitar-ian costs."46 Applying criteria of legitimacy,effectiveness, and morality, they recom-mended restructuring sanctions to allow Iraqto purchase civilian goods, food and medi-cine, spare parts, and manufactured goods,while maintaining the arms embargo. Theyfavor the use of "smart sanctions strategiesthat focus more on the wrongdoer than onthe general population and economy." TheGlobal Policy Forum,47 Gibson,48 Gibbons,49and others have made additional policyrecommendations.

One of the most systematic sets of rec-ommendations was compiled in TowardMoreHumane and Effective Sanctions Manage-ment: Enhancing the Capacity ofthe UnitedNations System, a joint project of 3 institu-tions, which proposes a useful methodologyfor anticipating and tracking the impact ofsanctions in public health, economics, popu-lation displacement, governance and civilsociety, and humanitarian activities.50 Thesame 3 sponsors, along with 5 others, metwith the chairpersons ofthe various sanctions

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committees, senior diplomats, and nongovern-mental organization and private sector repre-sentatives during the Symposium on SecurityCouncil Targeted Sanctions in New York inDecember 1998. Drawing on the work of theInterlaken Seminar convened by the Swissgovernment in March 1998, the New Yorksymposium distinguished between efforts tobreak the target's "power to resist" (which canhave "devastating humanitarian conse-quences") and efforts to break its "will toresist" (which require "the use of sanctions astools of inducement rather than punish-ment.").5' The symposium recommendedimpact preassessments, fine tuning of sanc-tions to reduce unintended consequences, tech-nically competent monitoring, more effectiveadministration of humanitarian exemptions,model legislation, and special measures for tar-geted financial sanctions, arms embargoes, andtravel bans. The symposium concluded that "astrategy for more effective sanctions should tar-get pressure on decision-making elites, whileavoiding to the greatest extent possible adversehumanitarian consequences."52

Reconciling Political ImperativesWith Human Rights and PublicHealth

This reflection leads to several conclu-sions concerning the legitimate reasons forthe preferred types of sanctions, as well as thevaluable role human rights and health profes-sionals might play in their implementation.

Legitimacy ofsanctions. Unilateral mea-sures for narrow national interests or ideologi-cal fervor are dangerous to world order andare usually unjustifiable on legal and moralgrounds. Sanctions decided collectively inaccordance with Chapter VII ofthe UN Char-ter are based on the valid grounds of a collec-tive effort by the international community topreserve international peace and security.

Types ofsanctions. It is true, as Minearcontends, that "sanctions are not entirely orinherently hostile to humanitarian interests."53Economic sanctions are more likely to be hos-tile to those interests than the other 3 types ofsanctions enumerated at the beginning of thiscommentary. Indeed, arms embargoes, sever-ing of communication, and criminal prosecu-tions merit more systematic use by govern-ments and offer greater chances of influencingthe political decision makers in the target statethan do economic sanctions. The latter placethe human rights and public health ofthe civil-ian population at considerable risk and mustbe reformed along the lines proposed in thevarious studies cited.

The political climate is increasinglyfavorable to the restructuring of sanctions in

ways that are responsive to human rights andpublic health concerns. In the 1995 UN "non-paper" quoted earlier, the P-5 had alreadycalled for 'unimpeded access to humanitarianaid," assessment of "the short- and long-termhumanitarian consequences of sanctions,"review of sanctions "to give due regard to thehumanitarian situation," and expeditious con-sideration of humanitarian applications bysanctions committees. More recently, the UNSecretary General said he wanted to render"sanctions a less blunt and more effectiveinstrument" by using "smart sanctions,"which seek, in his words, "to pressure regimesrather than peoples and thus reduce humani-tarian costs."54 He favors sanctions that, inaddition to the normal exemptions, includespecific measures to protect the human rightsof vulnerable groups, as recommended by theCommittee on Economic, Social and CulturalRights and the Committee on the Rights ofthe Child, which monitor the ICESCR and theCRC respectively.55 He warns, however, that"these humanitarian and human rights policygoals cannot easily be reconciled with thoseof ... sanctions"56 that, as tools of enforce-ment, are expected to do harm.

The role of health and human rightsprofessionals. Independent teams of investi-gators from the fields of human rights andhealth, using their own assumptions, meth-ods, and professional standards, are justifiedin publicizing the unacceptable suffering thatsanctions impose on civilians. In doing so,they are likely to cause more "tornadoes" ofcontroversy, as Gibbons described the reac-tion to the November 1993 release of theHarvard School of Public Health's reportSanctions in Haiti: Crisis in HumanitarianAction.s7

Such tensions would be obviated if therewere effective cooperation among publichealth, human rights, and peacekeeping pro-fessionals in implementing the recommenda-tions of the recent studies. Health and humanrights professionals are needed to seriouslyand systematically monitor, applying the care-fully considered methodology and indicatorsthat have been proposed,58 the civil conse-quences of sanctions. Such individuals areinvaluable in drawing attention to such conse-quences and urging funding of humanitarianassistance under sanctions regimes. They arevital to preassessment missions prior to theimposition of sanctions, as occurred withrespect to Sudan in 1997.59 They can make thecase that economic, social, and cultural rightsshould be given as much importance as civiland political rights in monitoring and policy.In sum, they can provide the empirical andanalytic basis for the argument that the"smartest" sanctions are those that do not sac-rifice the health and human rights of the pop-

ulation of targeted countries for an uncertainpolitical outcome. DG

References1. E. Gibbons and R. Garfield, "The Impact of

Economic Sanctions on Health and HumanRights in Haiti, 1991 to 1994," American Jour-nal ofPublic Health 89 (1999):1499-1504.

2. Sanctions.Net, a Web site created by James OrrAssociations, International Finance and TradeAdvisors, Washington, DC. The countries listedby Sanctions.Net as under a sanctions regime asof July 9, 1999, are Afghanistan, Angola, Azer-baijan, Burma, Burundi, Cambodia, China,Congo, Cuba, Gambia, Guatemala, Haiti, India,Indonesia, Iran, Iraq, Liberia, Libya, Maurita-nia, Nigeria, North Korea, Pakistan, Sudan,Syria, Turkey, Ukraine, Vietnam, and the Fed-eral Republic of Yugoslavia, Serbia and Mon-tenegro. Available at http://www.sanctions.net(accessed July 15, 1999).

3. G. C. Hufbauer, J. J. Schott, and K. A. Elliott,Economic Sanctions Reconsidered, History andCurrent Policy, 2d ed. (Washington, DC: Insti-tute for International Economics, 1990), 9.

4. In July, the council reaffirmed its intention tolift sanctions "as soon as possible." PresidentialStatement S/PRST/1999/22 of July 9, 1999.

5. General Assembly Resolution 53/4, adopted onOctober 14, 1998. The vote was 157 in favor to2 against (United States and Israel), with 12abstentions.

6. Cuban Liberty and Democratic Solidarity (LIB-ERTAD) Act of 1996, Pub. L. No. 104-114,1 10 Stat. 785 (Mar. 12, 1996), 22 U.S.C.6021-6091. A. F. Lowenfeld, "Agora: TheCuban Liberty And Democratic Solidarity (Lib-ertad) Act: Congress And Cuba: The Helms-Burton Act," American Journal ofInternationalLaw 90 (1996): 419-434; J. B. Busby, "Jurisdic-tion to Limit Third-Country Interaction WithSanctioned States: The Iran and Libya Sanc-tions and Helms-Burton Acts," Columbia Jour-nal ofTransnational Law 36 (1998): 621-658.

7. Sanctions regimes have existed with respect toSouthern Rhodesia, South Africa, Serbia-Mon-tenegro, and Sudan and are currently enforcedwith respect to Iraq, Federal Republic ofYugoslavia, Somalia, Libya, Liberia, Haiti,Angola, Rwanda, and Sierra Leone.

8. UN Charter, Article 41.9. Social Conditions for Health in Serbia and

Montenegro (New York, NY: CIET Interna-tional, 1994). M. P. Doxey, United NationsSanctions: Current Policy Issues (Halifax, NovaScotia: Center for Foreign Policy Studies, Dal-housie University, 1997), 17.

10. Security Council Resolution 841 of June 16,1993.

11. Security Council Resolutions 661 of August 6,1991, and 687 ofApril 3, 1992.

12. Security Council Resolutions 713 of September25, 1991, 724 of December 15, 1991, and 727of January 8, 1992. When the former Yugoslavrepublics were recognized as new states on or

after January 15, 1992, sanctions were appliedto all by Resolution 762 of June 30, 1962, andspecial economic sanctions were applied to Ser-bia and Montenegro by Resolution 757 of May30, 1992.

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13. Security Council Resolution 733 of January 23,1992.

14. Security Council Resolution 788 of November19, 1992 (with an exemption for ECOWAS, theEconomic Community of West African States,which provided the peacekeeping forces).

15. OAS MRE/RES/1/91 and MRE/RES/2/91 ofOctober 3, 1991.

16. Security Council Resolution 827 of May 25,1993.

17. Security Council Resolution 955 of November8, 1994.

18. Extensively reviewed in S. S. Gibson, "Interna-tional Economic Sanctions: The Importance ofGovernment Structures," Emory InternationalLaw Review 13 (1999): 161-245.

19. Hufbauer, Schott, and Elliott, Economic Sanc-tions Reconsidered, 93.

20. R. A. Pape, "Why Economic Sanctions Do NotWork," International Security 22 (1997): 90-136.

21. T. C. Morgan and V L. Schwebach, "Fools Suf-fer Gladly: The Use of Economic Sanctions inInternational Crises," International StudiesQuarterly 41 (1997): 27-50.

22. Ibid., 46.23. J. A. Gordon, "A Peaceful, Silent, Deadly Rem-

edy: The Ethics ofEconomic Sanctions," Ethics& International Affairs 13 (1999): 128-133.

24. Ibid., 139-140.25. E. A. Amley, "Peace by Other Means: Using

Rewards in UN Efforts to End Conflicts," Den-ver Journal ofInternational Law and Policy 26(1998): 235.

26. F. G. Gause III, "Getting It Backward on Iraq,"Foreign Affairs 78 (1999): 54-65.

27. Harvard Study Team, "The Effect of the GulfCrisis on the Children of Iraq," New EnglandJournal ofMedicine 325 (1991): 977-980.

28. A. Ascherio, R. Chase, T. Cote, et al., "Effect ofthe GulfWar on Infant and Child Mortality inIraq," New England Journal ofMedicine 327(1992): 931-936.

29. D. Cortright and G. A. Lopez, "Are SanctionsJust? The Problematic Case of Iraq," Journal ofInternational Affairs 52 (1999): 741, note 18.

30. Center for Economic and Social Rights, UNSanctioned Suffering: A Human Rights Assess-ment ofUnited Nations Sanctions on Iraq (NewYork: Center for Economic and Social Rights,May 1996), 42.

31. Ibid., 36.32. E. D. Gibbons, Sanctions in Haiti: Human Rights

andDemocracy UnderAssault (West Port, Conn,and London, England: Praeger, 1999), 97.

33. "The Maastricht Guidelines on Violations ofEconomic, Social and Cultural rights," HumanRights Quarterly 20 (1998): 698.

34. UN Charter, Article 24, paragraph 2.35. Ibid., Article 1, paragraph 3.36. Committee on Economic, Social and Cultural

Rights, General Comment No. 8 (1997), TheRelationship Between Economic Sanctions andRespect for Economic, Social and CulturalRights, UN document E/C.12/1997/8, para-graphs 11-14.

37. Gibbons, Sanctions in Haiti, 98.38. C. Marotte and H. R. Razafimbahiny, "Haiti

1991-1994: The International Civilian Mis-sion's Medical Unit," in Health and HumanRights: A Reader, ed. J. M. Mann, S. Gruskin,M. A. Grodin, and G. J. Annas (NewYork: Rout-ledge, 1999), 106-112.

39. Gibbons, Sanctions in Haiti, 97.40. C. von Braunmihl and M. Kulessa, The Impact

of UN. Sanctions on Humanitarian AssistanceActivities (Berlin: Gesellschaft fuir Communica-tion Management Interkultur Training, 1995),iii; cited by L. Minear, "The Morality of Sanc-tions," in Hard Choices: Moral Dilemmas inHumanitarian Intervention, ed. J. Moore (Lan-ham, Md: Rowman & Littlefield, 1998), 236.

41. Juan Somavia, Permanent Representative ofChile to the UN, The Humanitarian Responsi-bility of the United Nations Security Council,Gilbert Murray Memorial Lecture, Oxford,June26, 1996; p. 18ofmanuscript.

42. "Humanitarian Impact of Sanctions," annex toletter of April 13, 1995, to the president of theSecurity Council, UN document S/1995/300.

43. Committee on Economic, Social and CulturalRights, General Comment No. 8, paragraph 16.

44. L. F. Damrosch, "The Civilian Impact of Eco-nomic Sanctions," in Enforcing Restraint: Col-lective Intervention in Internal Conflicts, ed.L. F. Damrosch (New York: Council on ForeignRelations Press, 1993), 283.

45. G. A. Lopez and D. Cortright, "Economic Sanc-tions and Human Rights: Part of the Problem,or Part of the Solution?" International JournalofHuman Rights 1(1998): 1-25.

46. G. A. Lopez and D. Cortright, "Are SanctionsJust? The Problematic Case of Iraq," Journal ofInternational Affairs 52 (1999), 735-755. Abook by the same authors entitled The Sanc-tions Decade is scheduled for publication in late1999.

47. G. A. Lopez and D. Cortright, "Are SanctionsJust?", 750.

48. J. A. Paul, Sixteen Policy Recommendations onSanctions. Proposed at a forum of German par-liamentarians in Bonn, March 31, 1998. Avail-able on-line at http://www.globalpolicy.org/security/sanctions/jpreccs.htm (accessed onJuly 22, 1999).

49. Gibson, "International Economic Sanctions,"229-235.

50. Gibbons, Sanctions in Haiti, 100-110.51. L. Minear, D. Cortright, J. Wagler, G. A.

Lopez, and T. G. Weiss, Toward More Humaneand Effective Sanctions Management: Enhanc-ing the Capacity of the United Nations Sys-tem, Occasional Paper no. 31 (Providence, RI:Thomas J. Watson Jr Institute for InternationalStudies, 1998). The sponsoring institutionsare the Humanitarianism and War Project atBrown University, the Joan B. Kroc Institutefor International Peace Studies at NotreDame, and the Fourth Freedom Forum ofGoshen, Ind.

52. Toward Smarter, More Effective United NationsSanctions (Goshen, Ind: Fourth FreedomForum, 1998), 2. The new cosponsors were theCarnegie Commission on Preventing DeadlyConflict, the Carter Center, the Center for theStudy of International Organizations at NewYork University Law School, the Institute ofInternational Economics, and the UnitedNations Association ofthe USA.

53. Ibid., 8.54. Minear, "The Morality of Sanctions," 246.55. Annual Report ofthe Secretary-General on the

Work ofthe Organization, UN document A/53/1ofAugust 27, 1998, paragraph 62.

56. Ibid., paragraph 63.57. Ibid., paragraph 64.58. Gibbons, Sanctions in Haiti, 59-62.59. Minear et al., Toward More Humane and Effec-

tive Sanctions Management, 23-54.60. Ibid., 11-13.

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