Dear Members of the United States Congress and Executive Branch,
As health workers, we are writing to inform you of new research which demonstrates that a policy tool used extensively by the US government is causing half a million deaths around the world every year, including the deaths of over a quarter million children under the age of 5. The practice of imposing unilateral economic sanctions, such as those the US currently has in place against some 40 countries, must stop in light of this conclusive evidence.
We refer you to “Effects of international sanctions on age-specific mortality” published August 2025 in the prestigious, peer-reviewed medical journal The Lancet, examining increased mortality caused by economic sanctions in 152 countries from 1971 to 2021. This is the first study to determine causality between these variables, using multiple econometric methods and the largest database ever compiled on sanctions. It clearly demonstrates that some 564,000 people die annually from economic sanctions, comparable to the number of people who die from armed conflict. Perhaps the most disturbing fact is that a majority of the dead are children under 5 years of age. The researchers examined various kinds of sanctions and found the strongest negative impacts for US-imposed unilateral economic sanctions, while weapons embargoes and current UN sanctions did not significantly correlate with excess deaths.
Multiple sources, including numerous reports by the UN Special Rapporteur on unilateral coercive measures (also known as “sanctions,”) document how the trade and financial restrictions of sanctions cause significant declines in government services and increased poverty. Humanitarian exemptions, meanwhile, are undermined by overcompliance and offer little relief from sanctions’ overall impacts. The following are just a few of the many documented ways that unilateral economic sanctions kill children:
- Sanctions make it harder to import parts and chemicals to maintain drinking water systems, provoking a rise in water-borne illnesses and diarrheal diseases, which are particularly deadly for children under 5.
- Sanctions impact key health indicators. UNICEF reports that “A cross-country analysis of the impact of economic sanctions on babies in utero in 33 countries found that infants exposed for the duration of pregnancy to sanctions … were likely to be born at below average weight” because women and children are the most impacted when health services deteriorate due to sanctions.
- Sanctions disrupt the procurement of agricultural seeds, equipment, and fertilizers, causing spikes in food prices and hunger. A study of 66 countries from 1990 to 2014, found that sanctions exacerbated the incidence of hunger and malnutrition in children under 5 years.
- Sanctions deprive children of lifesaving medical care. Acute Lymphocytic Leukemia, the most common childhood cancer, is 98% curable with the appropriate medicine, including a reliable supply of chemotherapy for 2-3 years. Humanitarian exemptions in sanctions regimes routinely fail to facilitate access to such medicines, meaning “a child with cancer might die waiting for his turn to get treatment.”
- Children awaiting transplants are denied treatment and die because “third countries, regional groupings, banks and private companies are overly cautious” in dealing with sanctioned countries.
- Sanctioned countries have trouble importing antibiotics, antiepileptic drugs, insulin, immunosuppressants, and drugs for asthma, tuberculosis, HIV and malaria. Even the common antibiotic ceftriaxone is unobtainable in many of these countries, so common childhood injuries and fractures are likely to become seriously infected. In an atmosphere where children suffer more disease and undernourishment due to sanctions, they are more likely to perish from these untreated infections.
- Finally, sanctions not only can trigger acute economic crises and hinder development in the targeted countries, they also prevent those countries from receiving the international donations and assistance needed to save lives during natural disasters.
This is how children under 5 die from US economic sanctions. Nothing can justify this mass killing of innocents.
As The Lancet study documents, over the course of 50 years the percentage of the world’s economy subject to unilateral coercive measures increased from 5.4% to 24.7% — and these are primarily imposed by the US government. This study is not alone, but rather cements a clear consensus in the economic literature that broad unilateral economic sanctions have devastating health and humanitarian consequences for civilian populations.
This is a global public health crisis caused by US government policy. We implore you to fulfill your inescapable obligation to end it, as surely as you would prohibit the use of a defective medicine or faulty equipment causing comparable harm.
Imposing such collective punishment on the innocent is morally reprehensible. It must stop.
Sincerely,
- Margaret Flowers, MD (pediatrician), Maryland
- Amy Hagopian, PhD, professor emeritus, University of Washington, Washington
- Nidal Jboor, MD (internist), co-founder of Doctors Against Genocide, Michigan
- Ana Malinow, MD (pediatrician), National Single Payer
- Claudia Chaufan, MD, PhD; Professor, Health Policy, York University, Canada
- Claire M. Cohen, MD, Child and Adolescent Psychiatrist, National Single Payer, PNHP
- Kate Sugarman, MD, Family Medicine, Faculty Georgetown Law School and George Washington School of Medicine,
- Leni Villagomez-Reeves, MD (pediatrician), California
- Arnold Matlin, MD (pediatrician), New York
- William T. Whitney Jr, MD (pediatrician), Maine
- Michael Pappas, MD (family medicine), New York
- David Paul, Nurse Practitioner, California
- Feroze Sidhwa, MD, MPH, FACS (trauma surgeon), California
- Susan Rogers, MD (internal medicine), Illinois
- Jessica Ryan, LMT (licensed massage therapist), Washington
- Janys Murphy Rising Ph.D., LMHC, CMHS (licensed mental health counselor) Washington
- Elizabeth Baldo, RN, Family Practice Washington
- Emily Antoon-Walsh, MD, Pediatric Hospital Medicine, Washington
- Kim E. Koo MD, FACS, FAANS (retired, neurosurgery) North Carolina
If you are a health worker and would like to add your name to the letter, please fill out the form below:
Stop Killing Children with Sanctions!