The Quiet War: How American Sanctions Have Killed 38 Million People and Almost Never Worked

Political Analysis

A landmark study in The Lancet finally puts a number on what we’ve always been too polite to calculate

There’s a study that’s been making rounds since it was published in The Lancet Global Health last year, and if you read it, it’s genuinely hard to sit with.

Researchers from the Center for Economic and Policy Research looked at mortality data and sanctions events across 152 countries from 1971 to 2021, and what they found is that US and EU unilateral sanctions over that 50-year period are associated with 38 million deaths.

In some years during the 1990s, over a million people died annually. By 2021, the most recent year of data, sanctions were causing over 800,000 deaths per year, several times more than the number killed as direct casualties of war.

The figure that should really stop you is who’s dying.

Children under five made up 51 percent of total deaths caused by sanctions over the study period. Most deaths, 77 percent, were in the 0-15 and 60-80 age groups.

These are not the government officials we’re mad at. These are not the military. These are children and grandparents who have the profound misfortune of living in a country that Washington has decided to punish.

The study found that the annual toll of US and EU economic sanctions, roughly 564,000 deaths per year, is higher than the annual number of battle-related casualties, around 106,000 deaths.

We talk about war constantly. We have museums, memorials, national holidays. We do not talk about this. There is no memorial for the Iraqi children who died in the 1990s under sanctions, even though the former UN Secretary-General estimated that sanctions killed half a million of them. When Madeleine Albright was asked about that number on 60 Minutes in 1996, she said the price was worth it. That quote has never fully left me.

The stated logic of sanctions is always the same: apply economic pressure until the population suffers enough that they rise up and overthrow their government, or until the government caves. It sounds reasonable until you look at the actual track record.

Since 1970, unilateral US sanctions have achieved their foreign policy goals in only 13 percent of cases. Thirteen percent.

Cuba remains a dictatorship, and the failure of sanctions on Venezuela is probably the most egregious recent example, where they failed to remove the Maduro regime from power, deepened a humanitarian crisis, and led to a mass exodus.

Cuba has been under embargo since 1960. That’s 65 years of punishing ordinary Cubans for having a government we don’t like, with nothing to show for it except suffering and, as a side effect, a captive market for US sugar manufacturers who benefit from keeping Cuban competition out.

The reason sanctions don’t work on authoritarian governments is pretty obvious once you think about it for five seconds. Authoritarian regimes can stifle internal debate, present elite consensus on a tough response, and use foreign pressure to produce rally-’round-the-flag effects that consolidate support and strengthen rather than weaken the regime. Autocrats don’t get voted out by hungry people. They have guns. So the people who starve are just the people who starve, and the regime stays in power and gets to blame America for everything, which, to be fair, is not an entirely unfair argument when the death count looks like this.

There’s also the matter of how explicit we’ve been about this strategy.

A State Department memo from April 1960 regarding Cuba called for denying money and supplies to the country, decreasing wages, and bringing about what the memo described as hunger, desperation, and overthrow of government. That’s not a quote from a critic. That’s the policy document.

The architects of American foreign policy have, in writing, outlined a strategy of deliberately starving civilian populations into political compliance, and we’ve been running that strategy for over six decades while talking about ourselves as the good guys.

The standard rebuttal is that we need some tool between diplomacy and war, and sanctions fill that gap. That’s not wrong as an observation. But the current approach takes a tool that works about 13 percent of the time for modest goals and uses it almost exclusively for the hardest possible goal, which is toppling authoritarian governments.

Sanctions that demanded modest policy changes tended to be more successful than those aiming at regime change or military impairment. We keep doing the thing that doesn’t work, killing hundreds of thousands of people in the process, and calling it foreign policy.

None of this means there’s a clean alternative. Diplomacy with dictators is messy and gets you accused of legitimizing them. War has its own body count and its own catastrophic unintended consequences, as Iraq demonstrated. The question isn’t whether there’s a perfect option, because there isn’t. The question is whether we’re being honest with ourselves about what we’re actually doing when we issue a sanctions order.

We’re not pressuring a government. We’re choosing to slowly kill civilians, mostly children and elderly people, on the calculated bet that their deaths will eventually destabilize the regime. And based on the data, that bet loses about 87 percent of the time.

The 38 million figure deserves the same kind of moral reckoning we give to anything else with a death count that large. The cognitive dissonance required to hold “America is a noble force for good in the world” alongside that number is considerable.

You don’t have to hate your own country to look at the evidence and conclude that we have been doing something genuinely horrific, largely in the dark, for 50 years.

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