Background The public health consequences of the
Iraq War (2003–2011) have remained difficult to
quantify, mainly due to a scarcity of adequate data. This
paper is the first to assess whether and to what extent
the war affected neonatal polio immunisation coverage.
Method The study relies on retrospective neonatal
polio vaccination histories from the 2000, 2006 and
2011 Iraq Multiple Indicator Cluster Surveys (N=64 141).
Pooling these surveys makes it possible to reconstruct
yearly trends in immunisation coverage from 1996 to
2010. The impact of the war is identified with a
difference-in-difference approach contrasting
immunisation trends in the autonomous Kurdish
provinces, which remained relatively safe during the war,
with trends in the central and southern provinces, where
violence and disruption were pervasive.
Results After controlling for individual and household
characteristics, year of birth and province of residence,
children exposed to the war were found to be 21.5
percentage points (95% CI −0.341 to −0.089) less
likely to have received neonatal polio immunisation
compared with non-exposed children.
Conclusions The decline in neonatal polio
immunisation coverage is part of a broader war-induced
deterioration of routine maternal and newborn health
services. Postwar strategies to promote institutional
deliveries and ensure adequate vaccine availability in
primary health facilities could increase dramatically the
percentage of newborns immunised.