Inhumane diplomacy: A systematic review on the effects of international sanctions on poverty

Koehler, Anna Franziska Article Inhumane diplomacy: A systematic review on the effects of international sanctions on poverty International Trade, Politics and Development (ITPD) Provided in Cooperation with: Department of International Commerce, Finance, and Investment, Kyung Hee University Suggested Citation: Koehler, Anna Franziska (2024) : Inhumane diplomacy: A systematic review on the effects of international sanctions on poverty, International Trade, Politics and Development (ITPD), ISSN 2632-122X, Emerald, Leeds, Vol. 8, Iss. 3, pp. 118-143, https://doi.org/10.1108/ITPD-02-2024-0008 This Version is available at: https://hdl.handle.net/10419/319593 Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. 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If the documents have been made available under an Open Content Licence (especially Creative Commons Licences), you may exercise further usage rights as specified in the indicated licence. https://creativecommons.org/licenses/by/4.0/ Inhumane diplomacy: a systematic review on the effects of international sanctions on poverty Anna Franziska Koehler Fakult€ at f€ ur Wirtschaftsund Organisationswissenschaften, Chair of Economics, in Particular Microeconomics and Competition Policy, Universit€ at der Bundeswehr M€ unchen, Munich, Germany Abstract Purpose –This paper addresses the under-explored collateral damage of economic sanctions, shedding light on the disproportionate harm endured by the most vulnerable segments of societies, which at the same time lack political influence to effect the ruling government into change. The primary objective is to review the literature on humanitarian repercussions associated with sanctions, concluding if they really are a comparably human way of international interference. Design/methodology/approach –Employing a systematic literature review, adhering to the PRISMA approach, and incorporating key term definitions and clear selection criteria, this review analyses 52 studies sourced from Scopus and EconBiz. Findings –The surveyed literature reveals profound adverse impacts of sanctions on health, economic wellbeing, inequality, and education. Critical gaps in the literature such as disproportional focus on extreme cases like Iran and Iraq, scarce literature on effects on education and inequality, and predominantly inadequate control groups are identified, limiting the generalizability of existing findings. Originality/value –This paper is the first systematic and replicable review of the literature on the effects of sanctions using a capabilistic approach to define poverty. Highlighting gaps in the current research landscape underscores the limited generalizability of reviewed results. Providing a well-structured summary of existing literature, this work serves as a foundation for future research. Keywords Economic sanctions, Poverty, Health, Education, Inequality, Systematic review Paper type Literature review 1. Introduction I must call upon the consciousness of those who, in Iraq and elsewhere, put political, economic or strategic considerations before the fundamental good of the people, and I ask them to show compassion. The weak and innocent cannot pay for mistakes for which they are not responsible. - Pope John Paul II [1] Sanctions have demonstrated significant adverse effects, including a notable decline in GDP per capita (Neuenkirch and Neumeier, 2015), elevated inflation rates (Heine-Ellison, 2001; Hufbauer et al., 2009), withdrawal of foreign direct investment, foreign aid, and financial grants (Evenett, 2002), coupled with an increase in income inequality (Afesorgbor and Mahadevan, 2016). This economic strain, particularly on fragile economies, increases the risk of economic collapse and exacerbates poverty (Neuenkirch and Neumeier, 2016). Sanctions disproportionately impact the weakest members of the targeted state, with limited influence on the political decision-making of sanctioned regimes. ITPD 8,3 118 © Anna Franziska Koehler. Published in International Trade, Politics and Development. Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY4.0) license. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this license may be seen at http://creativecommons.org/licences/by/4.0/ legalcode The current issue and full text archive of this journal is available on Emerald Insight at: https://www.emerald.com/insight/2586-3932.htm Received 17 February 2024 Revised 11 April 2024 Accepted 22 July 2024 International Trade, Politics and Development Vol. 8 No. 3, 2024 pp. 118-143 Emerald Publishing Limited e-ISSN: 2632-122X p-ISSN: 2586-3932 DOI 10.1108/ITPD-02-2024-0008 A substantial body of economic and political literature has explored the impact of economic sanctions on the civilian population of target countries. Findings suggest that such sanctions can inflict significant harm, especially in cases where the targeted regimes lack democratic legitimacy (Neuenkirch and Neumeier, 2015,2016;Peksen, 2011;Peksen and Son, 2015). Studies primarily concentrate on economic indicators such as economic growth (Neuenkirch and Neumeier, 2015), and financial poverty (Neuenkirch and Neumeier, 2016). The unintended adverse consequences on human well-being, health, morbidity, and mortality are highlighted (Ali and Shah, 2000;Garfield and Santana, 1997;Gibbons and Garfield, 1999). While some researchers, politicians and officials may consider those effects as inevitable collateral damage (Hufbauer, 1998), it is important to acknowledge that innocent civilians may bear the primary burden of sanctions while having limited possibility to channel it into political change as intended by the sanctions (Gutmann et al., 2023). At the same time, studies indicate that sanctions frequently fall short of achieving their intended objectives in altering a target’s political behavior (Allen and Lektzian, 2013;Naylor, 2001). As a result, the question arises, whether the wrong people bear the burden of sanctions. Scholars demand a more thorough a priori assessment and ongoing monitoring of unintended consequences (Sponeck, 2022, p. 272f), arguing that despite their apparent non-violent nature, sanctions can be as deadly as armed warfare, essentially representing a form of war by other means (Schwab, 1999, p. 54). Despite the relevance and far reaching consequences of the topic, a systematic literature review on the impact of economic sanctions on poverty in sanctioned countries, integrating a comprehensive definition of poverty and considering possible mitigation strategies, without temporal and geographical constraints, is missing. The focus on extreme cases neglects nuanced variations in the effects of different types and intensities of sanctions. Additionally, the literature tends to emphasize single effects, particularly medical consequences, overlooking broader economic aspects, such as perceived poverty, food security, and access to education. This emphasizes the need for a more multidimensional approach in a systematic review to inform policy decisions. 1.1 Defining economic sanctions When discussing economic sanctions it is important to differentiate three principal strategies of international economic pressure: economic sanctions, trade wars, and economic warfare. Economic sanctions are designed to diminish the overall economic wellbeing of a target state, using measures like trade restrictions, to coerce the target government into altering its political behavior (Pape, 1997). The primary motives behind imposing sanctions are: (1) compelling target states to cease threats or violations against another state’s sovereignty, including violence or destabilization of its government; (2) promoting democratic change, protecting democracy, or destabilizing autocratic regimes; and (3) safeguarding the citizens of a target state from political repression and upholding human rights (Hufbauer et al., 2009). This coercion can occur either directly, by convincing the target government that the issues at stake aren’t worth the economic cost, or indirectly, by generating popular pressure that forces concessions or inciting a popular revolt leading to a new government. Economic sanctions encompass various forms, with financial sanctions, trade sanctions, and travel sanctions being the most relevant (Gutmann et al., 2023). Financial sanctions involve restrictions on international financial markets and freezing foreign assets, trade sanctions rangefromspecificgoodsbanstocompletetrade embargoes, and travel sanctions prevent the target country’s elite from visiting imposing nations. Notably, Western democracies, particularly the United States and the European Union, are frequent issuers of economic sanctions, while African countries are often the targets (Felbermayr et al., 2020). International Trade, Politics and Development 119 In contrast, trade wars involve a state causing economic harm to persuade the target to agree to more favorable trade terms. Unlike sanctions, trade wars focus on international economic policies rather than the target’s political behavior. The primary measure is the change in the price of affected goods or services. Economic warfare seeks to weaken an adversary’s overall economic potential to undermine its military capabilities. Unlike sanctions and trade wars, it does not inflict economic pain but aims to reduce military production to make certain political objectives unattainable (Pape, 1997). 1.2 Multi-dimensional definition of poverty This literature review adopts a multidimensional approach to define poverty, drawing from the concept of capability poverty (Sen and Sen, 1987;Sen, 2014;Sen, 1995) and operationalized for example by the World Bank’s Multidimensional Poverty Measure (MPM). Unlike traditional measures such as income, consumption, and welfare, this definition considers factors like unemployment, education and health, offering a more comprehensive understanding of poverty. Those factors significantly influence overall well-being, impacting income generation and consumption. Sanctions can lead to shortages in essential goods, affecting living conditions beyond what monetary poverty metrics capture. For example, low income’s effects are not as pervasive as those of factors like unemployment, which induces psychological stress, motivation and skill deficits, selfconfidence issues, increased morbidity, and disruptions to family and social life (Sen, 2014). Comparing income with health or nutritional status reveals the latter’s broader and more profound effects on well-being, influencing income-earning capacity. Morbidity and life expectancy rates, key indicators of well-being or deprivation, underscore the intricate relationship between health and poverty (Sen, 2014). Therefore, the capabilistic notion of poverty in this review offers a much needed comprehensive understanding of the consequences for sanctioned populations. 2. Methods 2.1 Approach This systematic literature review is a foundational step in grasping the effects of sanctions on poverty in targeted countries. It involves a comprehensive search of academic articles and publications, and identifies gaps and areas where further research is needed. I adhere to established systematic review guidelines, including the formulation of the research question, the definition of inclusion and exclusion criteria, and a structured search strategy. The systematic review aligns with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) concept to minimize bias in the process and ensure replicability. 2.2 Research question and search strategy The main research question identified and addressed in my research is: What effects do international sanctions have on the poverty in the targeted country?, hypothesizing that economic sanctions significantly affect poverty levels, leading to increased economic hardship for vulnerable populations. To examine this, I specified the following ancillary question: What and how reports existing literature on those effects?. I employ an extensive view on poverty based on extensive search terms searching the databases Scopus and EconBiz on 27th Sept. 2023 [2]. 2.3 Selection criteria and screening From each selected article relevant data, including study objectives, methodologies, findings, and conclusions, was extracted. The systematic review encompasses a synthesis of the ITPD 8,3 120 chosen studies, involving categorization and analysis of their findings, while identifying recurring themes and trends. The formulation of clear inclusion and exclusion criteria ensures a replicable selection process: (1) Only inclusion of primary research reporting of direct and/or indirect measures of impact on poverty consisting of: •Economic poverty •Food security or prices •Access to education •Effects on inequality (regarding income and gender) •Health care outcomes: individual (death rates, malnutrition, increase in illnesses) and institutional (government spending on health care system, availability of medication and access to health care equipment) (2) Solely inclusion of papers published in English (3) Exclusion of reviews, letters to the editor, commentaries and (4) Exclusion of sanctions which are not international/inter-state Even though each included study underwent an assessment of its quality. Taking into account established criteria that consider factors such as study design, methodology, and data source reliability–the selection of articles is based on its relevance for answering the research question rather than any primary assessment of scientific quality and risk of bias. 2.4 Data extraction To minimize type I error, the selection process and data extraction is based on human analysis of the title, abstract and full text regarding the range of data collection periods, sample size, research methods, sanctioned and sanctioning agents, availability of reporting on the effectiveness of targeted sanctions and/or mitigation strategies and the used comparison/control group. The literature is additionally clustered by the investigated dimension(s) of poverty followed by a cluster definition based on further sub-groups of dependent variables. Supersets include (1) economic poverty (e.g. food security, employment, prices, household consumption/spending, household income), (2) inequality (e.g. by income or gender), (3) health-care (e.g. life expectancy, malnutrition, mortality, single disease level, disease spreading, availability of medication, availability of medical services, government budget), and (4) access to education (e.g. enrollment rates, average years of schooling). Furthermore, the findings from the studies are extracted and again categorized into clusters based on whether a significant direct link between sanctions and relevant independent variables was identified and, if so, the specific results. 3. Results 3.1 Included studies Initially, the search yielded 1953 articles, with 1,233 retrieved from Scopus and 720 from EconBiz. To streamline the dataset, 1,258 duplicates and non-English articles were removed, resulting in 695 articles for primary screening based on title and abstract. Through an indepth review of titles, abstracts, and full texts, results a final set of 52 articles [3]. International Trade, Politics and Development 121 3.2 Study characteristics The systematic review encompasses studies conducted between 1950 and 2021, with a record range spanning from 1 to 70 years and an average range of 14.67 years 31% (16/52) of the included studies employ qualitative approaches, 73% (38/52) utilizing quantitative methods [4]. The studies’samplesizes range from 1 to 1999 sanctioned countries, predominantly focusing on Iran and Iraq. Notably, 75% of the analyzed papers are single-case studies, with 25 papers (48%) studying Iran and 14 papers (27%) studying Iraq. Only 19% of the studies (10/52) are dedicated to single-case analyses of countries other than Iran and Iraq. Additionally, 23% of the studies (12/52) involve comparisons between multiple countries instead of single case studies. There is a major emphasis on the United States (US) and the United Nations (UN) as sanctioning agents, with 52% of the studies exclusively considering UN and/or US sanctions. In contrast, 12% of the studies include other sanctioning agents, and 25% do not specify the sanctioning countries. As control or comparison groups, 34 studies (65%) primarily use the prior or past situations within the same country. Moreover, two studies (4%) compare the sanctioned country to comparable, non-sanctioned countries, while seven studies (13%) incorporate both types of comparison. The majority of included studies (67%) focus on the effects of sanctions on healthcare followed by 48% considering the impact on economic poverty. Beyond humanitarian impacts, 12% of the studies also consider the effectiveness of sanctions, and five papers discuss whether sanctions were targeted or not. A further break down is provided in Table 1. Furthermore, 27% of the papers (14/52) analyze mitigation strategies, with ten of the 52 exploring national strategies and eight international approaches. The analyzed literature did focus little on smart sanctions–only four papers explicitly discuss consequences of those targeted measures. 3.3 Impact of sanctions on poverty in targeted countries Impact on economic poverty Multiple resources report an increase in unemployment, increase in prices, and food scarcity. This results in an increase in poverty, decline in household spending and decrease in household income. Work by Williams (2021) shows a significant Dependent variable Absolute frequency Percentage Health 35 67% Malnutrition 12 23% Life expectancy 5 10% Mortality 18 35% Disease level(s) 10 19% Availability of medication or medical services 18 35% Government budget 2 4% Economic poverty 25 48% Employment 10 19% Prices 12 23% Income 9 17% Spending/consumption 6 12% Food availability 6 12% Access to education 10 19% Gender differences 4 8% Inequality 13 25% by Gender 10 19% Income inequality 3 6% Source(s): Table by author Table 1. Frequency of dependent variables in 52 reviewed studies ITPD 8,3 122 negative response of household consumption to sanctions, and government consumption is adversely associated with the intensity of sanctions. Additionally, in Iran the real expenditure of households has been declining, particularly in urban areas, partially caused by adverse effects on employment and labor force participation (Laudati and Pesaran, 2023). Kelishomi and Nistic o (2022) find a significant decline of 16.4 percentage points in the employment growth rate in the manufacturing sector in Iran between 2012 and 2014 and women were disproportionately affected by the decrease in employment rates (Laudati, 2023). However, other authors report less clearly directed dynamics. For example, Nosratabadi (2019) finds that the demand for skilled production workers even increases during sanction years, resulting in a rise in the real average wage, but on the other hand the demand for nonproduction workers decreases, leading to a fall in the real average wage. Furthermore, examined papers investigating the influence of sanctions on food availability document adverse effects: sanctions contribute to hunger and starvation, affecting food distribution, availability, and stability in domestic markets (Allen and Lektzian, 2013;Afesorgbor, 2021; Hejazi and Emamgholipour, 2022). However, investigating 199 countries, a study by Allen and Lektzian (2013) concludes, that this impact on food supplies is rather limited, possibly due to humanitarian exemptions and the inclusion of less drastically sanctioned countries. Additionally, it’s crucial to consider that socio-economic indicators in sanctioned countries may be influenced by factors predating specific sanctions. For example, Bahar et al. (2021) argue that insufficient evidence exists to attribute the worsening socio-economic crisis in Venezuela to sanctions. Impact on inequality The examined differentiates between income and gender inequality. Studies examining effects of sanctions on income inequality are scarce; the consequences of sanctions on gender inequality have received more extensive research. Income Inequality: Laudati and Pesaran (2023) analyzed effects of the UN and US sanctions on Iran, reporting a rise in the Gini coefficient, indicating increasing income inequality [5]. Even though mobility, financial, and trade sanctions have the most substantial negative effects on economic growth in general, military and arms sanctions are the only sanctions where Gonz alez (2022) was able to report a significant negative impact on income inequality. Gender Inequality: Sanctions significantly restrict women’s rights in the target state, marked by a substantial loss of government spending on education. Studying 84 sanctioned countries, Perry (2022) finds that cuts in government education spending due to sanctions disproportionally affect women by reducing literacy parity between men and women and as a consequence decreasing women’s participation in the labor force. Studying the adverse effects of sanctions on secondary school education in Iran, gender disparities are notable and women also have paid the higher price of the systematic decrease of the employment rate in Iran, with significant declines in female labor force participation after sanctions were imposed (Laudati, 2023)[6]. Additionally, studying multiple sanctioned countries, Gutmann et al. (2021) finds a disproportional effect on the life expectancy of women. This goes hand in hand with the finding, that the imposition of sanctions leads to a significant increase in women’s mortality rates from HIV/AIDS infections, doubling the rates, and an average mortality rate increase of 12%, unlike men who do not experience such negative effects (Miromanova, 2023). Contrarily, Al-Ani et al. (2011) find that in Iran, the gender disparities go in the different direction, sanctions causing a higher infant mortality rate for males than females [7]. Impact on the Health Sector Economic sanctions can exert profound and diverse effects on the healthcare systems of targeted nations, even when they do not explicitly encompass pharmaceuticals or medical equipment. The examined research encompasses heterogeneous findings. Following a study of 30 countries subjected to sanctions, Williams (2021) contends that there is no conclusive evidence establishing a significant link between sanctions and life expectancy or infant mortality. Complementary, Allen and Lektzian (2013) posit that even International Trade, Politics and Development 123 though sanctions can significantly reduce immunization rates and government spending on healthcare, this effect is mainly pronounced when imposed on nations involved in military conflicts, and despite their impact on healthcare resources, sanctions do not exhibit a significant effect on life expectancies [8]. However, the majority of researcher presents a contrasting view, stating that the sanctions had a severe impact on the healthcare sector. For the example of Iraq Gutmann et al. (2021) finds that an average episode of UN sanctions reduced life expectancy by about 1.2–1.4 years, with corresponding but milder effects under US sanctions (0.4–0.5 years). Transmission channels include an increase in child mortality and cholera deaths, coupled with a decrease in public spending on healthcare and a lack of drug availability (Asadi-Pooya et al., 2016). Inadequate funding, rising inflation, extreme increase in costs, and medical shortages contribute to the impediments faced by the rehabilitation sector. Even when medication and medical equipment are available, there often is no budget for transportation, cooling, management tools, or training of the medical staff to use the equipment, leading to an inefficient distribution and delay until the equipment can be used (Shahabi et al., 2020)[9]. Despite the wide range of literature available, the accuracy of healthrelated statistics during sanction periods in Iraq should be questioned due to survey data manipulation, as observed by Dyson and Cetorelli (2017). Also in Iran economic sanctions manifest through tangible economic indicators, such as a significant increase in cost of a healthy diet, contributing to increased food insecurity and malnutrition among children (Hejazi and Emamgholipour, 2022;Afesorgbor, 2021). They have an adverse effect on life expectancy, with financial market development and institutional quality playing pivotal roles (Ha and Nam, 2022). A reduction in the GDP growth rate, triggered by sanctions, leads to a subsequent cut in healthcare spending in the targeted countries. The pharmaceutical supply chain faces substantial challenges under sanctions (Bastani et al., 2022), due to hindered financing, purchasing, importing, and manufacturing of pharmaceuticals, as can be seen on the example of Iran (Karami Matin et al., 2022;Kheirandish et al., 2018). So far, Cuba is the only nation in the world that was denied medicine as part of a US embargo (Schwab, 1999, p. 54). Since most pharmaceutical drugs are at least partially developed by US companies, the field of health care dramatically crippled. It serves as a poignant case study, illustrating the limitations of national mitigation strategies, not being able to impede declining nutritional levels, increased infectious diseases, and challenges in healthcare access (Garfield and Santana, 1997). An increase in diseases is caused by a lack of vaccination and medication (e.g. HIV/AIDS) as well as due to severe malnutrition (e.g. malnutrition-induced optic and peripheral neuropathy). High gasoline and fuel prices lead to an inability of patients to travel to hospitals and disrupt refrigeration of medication (Schwab, 1999, p. 73ff). Similar effects can be observed in Haiti, where malnutrition in young children more than doubled, child mortality increased and treatment as well as medicine shortages occurred (Gibbons and Garfield, 1999). Sanctions contribute to heightened mental health issues due to uncertainty, stress, malnutrition, and restricted access to psychiatric medication (Schwab, 1999). Furthermore, denied access to medical journals limits knowledge dissemination and modern treatment methods (Sponeck, 2022, p. 44; Schwab, 1999, p. 73f). In summary, economic sanctions pose intricate challenges, affecting immunization rates, government spending, nutrition, healthcare access, and pharmaceutical supply chains in Iraq, Iran, and Cuba. Although less likely to cause immediate deaths than military intervention, sanctions’resource reduction has comparable humanitarian implications (Allen and Lektzian, 2013). Impact on access to education Economic sanctions profoundly affect educational enrollment, seen notably in Iraq and Iran. Resources are diverted from education to pressing needs, and children are forced into income-contributing activities (Laudati and Pesaran, 2023;Sponeck, 2022, p. 56). Iran’s education expenditure declined by 58% from 2007 ITPD 8,3 124 to 2013, resulting in a 0.1-year decrease in children’s schooling and a 4.8% point drop in college attendance likelihood (Moeeni, 2022). While Laudati (2023) reports adverse impact on secondary and high-school education in Iran, Moeeni (2022) contrasts stable primary and secondary enrollment rates with a decline in undergraduate programs and an 11.5% decrease in first-year college students. Consequences intensify for females (Laudati, 2023) and those exposed longer to sanctions (Moeeni, 2022). In Haiti, sanctions caused a significant decrease in gross school enrollment, rotating attendance among siblings, increased child labor, and a rise in street children (Gibbons and Garfield, 1999). Sanctions impede academic mobility, affecting both incoming and outgoing students, and influences foundations and funds (Golovina et al., 2021)[10]. In conclusion, economic sanctions disrupt education access, impacting students at various levels, creating long-term challenges for future generations in sanctioned countries (Laudati, 2023;Sponeck, 2022; Moeeni, 2022;Gibbons and Garfield, 1999). 3.4 Mitigation strategies, targeted sanctions and their effectiveness Broadly speaking, the investigated literature identified three channels to counteract adverse effects: (1) Household-level coping strategies, such as modifying dietary practices and reducing expenses like enrollment fees; (2) Nation-level mitigation strategies, which involve rationing programs or reallocating government budgets in the sanctioned country; (3) International mitigation strategies implemented by the sanctioning countries, other international organizations, or nations, encompassing measures like exempting pharmaceutical products, implementing programs like the Oil for Food Program, or establishing dedicated aid initiatives; and (4) so called smart sanctions [11]. Mitigation strategies on a household level include altering dietary habits, engaging in informal economic activities, relocating to relatives’homes, selling possessions, forming informal unions, reducing school attendance, and resorting to child indentured servitude (Gibbons and Garfield, 1999). Additional or alternative sources of income maybe pursued such as begging for children as well as prostitution for women, while costly events such as marriages are postponed (Schwab, 1999;Sponeck, 2022). Needless to say, that such counterstrategies often have severe negative effects on nutrition, well-being and education. Supplementary national mitigation strategies discussed by the literature include modified policies (Gibbons and Garfield, 1999), and the implementation of rationing (Garfield and Santana, 1997). Cuba serves as a positive example. Due to universal access to primary health services, food rationing systems and a highly educated population, the medical system remained for a remarkable long time resilient, maintaining comparably low mortality rates (Schwab, 1999). When goods could no longer be stretched to meet the needs of the entire population, preferential access to essential goods for women and children has emerged (Garfield and Santana, 1997). Nevertheless, national strategies to counteract the adverse effects of economic sanctions are limited. Rationing and preferential access for certain subgroups may create new vulnerable groups (e.g. adult men and the elderly) and it is rarely possible to fully counteract a rise in mortality (Garfield and Santana, 1997;Reid et al., 2007). Additionally, national mitigation strategies mostly include the reallocation of government spending to fulfill basic needs–causing other long-term effects for example trough a substantial decrease of government spending on education (Perry, 2022). The implementation of international assistance is difficult and often fails to achieve intended outcomes. Challenges include a lack of financing, inefficient implementation or even resentment by the local population and/or political groups, viewing aid as a way to assuage the guilt of sanctioning powers (Gibbons and Garfield, 1999). One of the largest humanitarian programs in combination with sanctions was the Oil-for-Food program implemented in Iraq from 1996 until 2003. Even though it partially prevented a food-crisis, it had major International Trade, Politics and Development 125 Shahabi, S., Teymourlouy, A.A., Shabaninejad, H., Kamali, M., Lankarani, K.B. and Mojgani, P. (2020), “Physical rehabilitation in Iran after international sanctions: explored findings from a qualitative study”,Globalization and Health, Vol. 16 No. 1, pp. 1-10, doi: 10.1186/s12992-02000618-8. Sponeck, H.V. (2022), A Different Kind of War: The UN Sanctions Regime in Iraq, Berghahn Books, New York. Taheri, E. and Guven-Lisaniler, F. (2018), “Gender aspect of economic sanctions: case study of women’s economic rights in Iran”, Gender Aspect of Economic Sanctions: Case Study of Women’s Economic Rights in Iran (December 19, 2018). Williams, K. (2021), “Do international sanctions reduce household and government consumption in developing countries?”,South African Journal of Economics, Vol. 89 No. 2, pp. 196-217, doi: 10. 1111/saje.12281. Yousefzadeh, S. and Gassmann, F. (2012), “Children of Iran: born into a middle-income state, caught between war, embargo and rising social indicators”, (tech. rep.). Further reading Ali, H. (2004), “Hepatitis B infection among Iraqi children: the impact of sanctions”,EMHJ-eastern Mediterranean Health Journal, Vol. 10 Nos 1-2, pp. 6-11, doi: 10.26719/2004.10.1-2.6. Smeets, M. (2018), “Can economic sanctions be effective?”,WTO Staff Working Paper, No. ERSD2018-03, World Trade Organization (WTO), doi: 10.30875/0b967ac6-en. Wagle, U. (2002), “Rethinking poverty: definition and measurement”,International Social Science Journal, Vol. 54 No. 171, pp. 155-165, doi: 10.1111/1468-2451.00366. Corresponding author Anna Franziska Koehler can be contacted at: anna.k[email protected] ITPD 8,3 132 Appendix # Variable Key words 1 Sanctions TITLE(sanction* OR embargo* OR conditional welfare OR welfare conditionality OR economic sanction* OR monetary sanction* OR financial sanction* OR smart sanction*) 2 Economic Poverty TITLE-ABS-KEY((economic well*being OR human* cost OR poverty OR deprevation OR impoverishment OR financial aid OR poor OR financial development OR distributional effect* OR development aid OR (economic resource* AND access) OR Income OR earning* OR wage* OR salar* OR asset* OR expenditure* per capita OR personal expenditure* OR household expenditure* OR consumption per capita OR household consumption OR financial status* OR wealth* OR socio*economic status OR social class* OR social rank* OR social environment OR *employment OR socioeconomic factor*) OR (starvation OR malnourish* OR malnutrition OR undernourish* OR undernutrition OR food *security OR food scarcity OR hidden hunger OR (food market AND (restriction OR tariff OR access OR development governance)) OR food supply chain OR food value chain OR food commodity market AND NOT disease)) 3 Health TITLE-ABS-KEY(health* OR disease* OR illness* OR mortality OR well*being index OR quality adjusted life year OR preventable death* OR suicid* OR life expectanc* OR ((health system OR treatment OR medicine*) AND (access OR accessible)) OR health risk* OR psychological harm OR psychological well*being OR public health) 4 Income Inequality TITLE-ABS-KEY((*equality AND (economic OR financial OR socioeconomic)) OR development gap* OR social exclusion OR income*distribution OR economic marginali*ation OR income *equality OR income disparity OR Gini*Coefficient OR Robin*Hood*Index) 5 Education TITLE-ABS-KEY((school OR education* OR school attendance OR school enrol*ment OR educational enrol*ment OR adult literacy OR literacy rate OR numeracy rate OR educational access AND NOT health literacy) Note(s): Utilized with Boolean operators (1 AND (2 OR 3 OR 4 OR 5)) Source(s): Table by author Table A1. Key words International Trade, Politics and Development 133 Paper Timeframe of records Sample size (# countries) Methods Focus on health 1 Focus on economic poverty 1 Focus on inequality 1 Focus on access to education 1 Negative impact reported 2 Title Author Year A different kind of war: The UN sanctions regime in Iraq von Sponeck 2022 1996–2003 1 Quantitaive, Qualitative x x x Yes Cuba: confronting the US embargo Schwab 1999 NN 1 Qualitative x x Yes Do International Sanctions Reduce Household and Government Consumption in Developing Countries? Williams 2021 1996–2015 30 Quantitative x Mixed Economic sanctions: a blunt instrument? Allen, Lektzian 2013 1990–2007 199 Quantitative x x Mixed Economic warfare: sanctions, embargo busting, and their human cost Naylor 2001 NN Qualitative x x Mixed Employment effects of economic sanctions in Iran Moghaddasi Kelishomi, Nistic o 2022 2008–2014 1 Quantitative x Yes Employment, Skill Upgrading, and International Trade : the Case of Sanctions Against Iran Nosratabadi 2019 2001–2015 1 Quantitative x Yes (continued) Table A2. Overview of included literature ITPD 8,3 134 Paper Timeframe of records Sample size (# countries) Methods Focus on health 1 Focus on economic poverty 1 Focus on inequality 1 Focus on access to education 1 Negative impact reported 2 Title Author Year Evidence and policy implications of sanctions in the long run: the case of Iran Laudati 2023 1989–2019 1 Quantitative x Gender x Yes Humanitarian impacts of economic sanctions on Iran and Syria Moret 2013 NN 2 Qualitative [x] Yes Identifying the Effects of Sanctions on the Iranian Economy Using Newspaper Coverage Laudati, Pesaran 2023 1979–2021 1 Quantitative x Income, Gender [x] Yes Impact of the 2017 sanctions on Venezuela - Revisiting the evidence Bahar, Bustos, Morales, Santos 2019 2010–2018 1 Qualitative x x No International sanctions and development: evidence from Latin America and the Caribbean (1950– 2019) Gonzales 2022 1950–2019 41 Qualitative x Income Yes Sanctioned to Death? The Impact of Economic Sanctions on Life Expectancy and its Gender Gap Gutmann, Neuenkirch, Neumeier 2021 1977–2012 98 Quantitative x [x] Gender [x] Yes (continued) Table A2. International Trade, Politics and Development 135 Paper Timeframe of records Sample size (# countries) Methods Focus on health 1 Focus on economic poverty 1 Focus on inequality 1 Focus on access to education 1 Negative impact reported 2 Title Author Year Sanctioned to Starve? The Impact of Economic Sanctions on Food Security in Targeted States Afesorgbor 2021 1990–2014 66 Quantitative x x Yes The Effects of the Reimposition of US Sanctions on Food Security in Iran Hejazi, Emamgholipour 2022 2017–2019 1 Quantitative x Yes The embargo as violation of human rights Bonati 2002 NN Quantitative x Yes The human capital legacy of a trade embargo Chakravarty, Parey, Wright 2021 1996–2011 1 Quantitative x x x Mixed The Impact of Sanctions on Household Welfare and Employment in Iran Salehi-Isfahani 2023 1984–2020 1 Quantitative x Yes Children of Iran: born into a Middle-Income State, Caught Between War, Embargo and Rising Social Indicators Yousefzadeh, Gassmann 2012 1984–2009 1 Quantitative Gender Yes (continued) Table A2. ITPD 8,3 136 Paper Timeframe of records Sample size (# countries) Methods Focus on health 1 Focus on economic poverty 1 Focus on inequality 1 Focus on access to education 1 Negative impact reported 2 Title Author Year Gender Aspect of Economic Sanctions : case Study of Women’s Economic Rights in Iran Taheri, Lisaniler 2018 1990–2016 1 Qualitative, Quantitative x Gender [x] Yes Gendered effects of sanctions on manufacturing employment: evidence from Iran Demir, Tabrizy 2022 1995–2014 1 Quantitative x Gender Mixed International sanctions and energy poverty in target developing countries Moteng, Raghutla, Njangang, Nembot 2023 1996–2019 97 Quantitative x Income Yes An investigation of relationship between global economic sanction and life expectancy: do financial and institutional system matter? Ha, Nam 2022 1995–2018 148 Quantitative x [x] Yes Challenge of PoliticoEconomic Sanctions on Pharmaceutical Procurement in Iran: a Qualitative Study Bastani, Dehghan, Kashfi, Dorosti, Mohammadpour, Mehralian 2022 2019 1 Qualitative x Yes (continued) Table A2. International Trade, Politics and Development 137 Paper Timeframe of records Sample size (# countries) Methods Focus on health 1 Focus on economic poverty 1 Focus on inequality 1 Focus on access to education 1 Negative impact reported 2 Title Author Year Changing views on child mortality and economic sanctions in Iraq: a history of lies, damned lies and statistics. Dyson, Cetorelli 2017 1974–2010 1 Quantitative x Yes Civil War and Economic Sanctions: analysis of Anthropometric Outcomes in Burundi Bundervoet, Verwimp 2005 1993–1998 1 Quantitative x x [x] Yes COVID-19 and Sanctions Affecting Afghans in Iran Shafaei, Block 2022 1 Qualitative x [x] Yes Dental caries experience and availability of sugars in Iraqi children before and after the United Nations sanctions Jamel, Plasschaert, Sheiham 2004 1989–1995 1 Quantitative x [x] Mixe Drug adherence of patients with epilepsy in Iran: the effects of the international economic sanctions Asadi-Pooya, Tavana, Tavana, Emami 2016 2010–2011 1 Quantitative x Yes (continued) Table A2. ITPD 8,3 138 Paper Timeframe of records Sample size (# countries) Methods Focus on health 1 Focus on economic poverty 1 Focus on inequality 1 Focus on access to education 1 Negative impact reported 2 Title Author Year The impact of the economic crisis and the US embargo on health in Cuba Garfield, Santana 1997 1980–1996 1 Quantitative x x Yes The Impact of Economlic Sanctions on Health and Human Rights in Haiti, 19911994 Gibbons, Garfield 1999 1991–1994 1 Quantitative x x x Mixed Hapatitis B infection among Iraqi children: The impact of sanctions Ali 2004 1994–1998 1 Quantitative x Yes Impact of economic sanctions on access to noncommunicable diseases medicines in the Islamic Republic of Iran Kheirandish, Varahrami, Kebriaeezade, Cheraghali 2018 2008–2013 1 Quantitative x Yes Impact of sanctions on the population of Iraq Popal 2000 1988–1999 1 Quantitative x Yes Impact of the economic sanctions on duodenal ulcer in Iraq Al Jawher 1997 1989–1993 1 Quantitative x Yes (continued) Table A2. International Trade, Politics and Development 139 Paper Timeframe of records Sample size (# countries) Methods Focus on health 1 Focus on economic poverty 1 Focus on inequality 1 Focus on access to education 1 Negative impact reported 2 Title Author Year Impacts of the international economic sanctions on Iranian patients with epilepsy Asadi-Pooya, Azizimalamiri, Badv, Yarali, Asadollahi, Homayoun, Sharifi 2019 2019 1 Qualitative x Yes International Sanctions and the Procurement of Medical Equipment in Iran: a Qualitative Study Azami, Hosseini, Alimohammadzadeh, Jafari, Bahadori 2021 2018–2019 1 Qualitative x Yes Nutritional status of Haitian children, 1978–1995: deleterious consequences of political instability and international sanctions Mulder-Sibanda 1998 1978–1994 1 Quantitative x Yes Physical rehabilitation in Iran after international sanctions: explored findings from a qualitative study Shahabi, Teymourlouy, Shabaninejad, Kamali, Lankarani, Mojgani 2020 2019 1 Qualitative x Yes Sanctions and their impacts on medical trade and health outcomes Miromanova 2023 1988–2021 67 Quantitative x [x] Gender [x] Yes (continued) Table A2. ITPD 8,3 140 Paper Timeframe of records Sample size (# countries) Methods Focus on health 1 Focus on economic poverty 1 Focus on inequality 1 Focus on access to education 1 Negative impact reported 2 Title Author Year Secular trend of infant mortality rate during wars and sanctions in Western Iraq Al-Ani, Al-Hiali, AlFarraji 2011 1987–2010 1 Quantitative x Gender Yes Relationship between Political-Economic Sanctions and Catastrophic Health Costs in Multiple Sclerosis Patients in Iran Gharibi, Imani, Haghi, Dalal 2022 2018–2019 1 Quantitative x [x] [x] Yes The effect of an international embargo on malnutrition and childhood mortality in rural Haiti Reid, Psoter, Gebrian, Wang 2007 1989–1996 1 Quantitative x Yes The effect of economic sanctions on the mortality of Iraqi children prior to the 1991 Persian Gulf War Daponte, Garfield 2000 1991 1 Quantitative x Gender Yes The Impact of Economic Sanctions on Health and Wellbeing Garfield 1999 1992–1994 3 Quantitative x x Yes (continued) Table A2. International Trade, Politics and Development 141