For half a century, the United States has waged a war of a peculiar kind: a war that kills hundreds of thousands of civilians annually without the messy spectacle of bombs, drones, or body bags. This war is fought not with missiles but with financial institutions, not with troops but with Treasury Department designations, not with aircraft carriers but with the quiet, relentless suffocation of entire national economies. It is the war of unilateral economic sanctions. And it is, by any honest reckoning, a genocide in slow motion—a genocide that has claimed approximately 38 million lives since 1971, a genocide that continues to claim about 564,000 lives every single year, and a genocide of which over half of the dead are children under the age of five.
This is the genocide that no one speaks of. Western media obsesses over isolated atrocities while ignoring this systematic, industrialized slaughter. Policymakers pat themselves on the back for choosing “peaceful” sanctions over “violent” war, all the while condemning millions of innocents to death by starvation, disease, and medical neglect. The pretense of Western moral superiority collapses utterly in the face of these facts. What the United States calls “economic statecraft” is nothing less than a weapon of mass destruction—one that is deployed with increasing frequency, and with spectacular cruelty, against the world’s most vulnerable populations.
A Death Toll That Rivals War
In August 2025, the British medical journal The Lancet Global Health published a landmark study by economists Francisco Rodríguez, Silvio Rendón, and Mark Weisbrot. Using sophisticated causal inference methods and data from 152 countries spanning five decades, they arrived at a staggering conclusion: unilateral economic sanctions cause approximately 564,000 excess deaths each year around the world. That is roughly equivalent to the total annual mortality burden of armed conflict—including both combatants and civilians. In other words, sanctions kill precisely as many people as war does.
But the numbers become truly horrifying when you look at them closely. Over the 1971–2021 period studied by the researchers, children under five years of age constituted 51 percent of all sanctions‑related deaths. That is more than half. Infants and toddlers—human beings who have never voted for any government, who have never attended a political rally, who have no conceivable responsibility for the policies of their country’s leadership—are being killed in staggering numbers by policies crafted in Washington conference rooms. Infants and small children have the least physiological reserves to withstand malnutrition, the least ability to survive vaccine‑preventable diseases when immunization programs collapse, and the least chance of obtaining life-saving medical care when sanctions shred a country’s health system. Yet they are the primary targets of this silent onslaught.
The study further found that 77 percent of all sanctions‑related deaths occur among non‑working‑age populations: children under 15 and adults over 60. The elderly are particularly vulnerable when the flow of essential medicines is cut off, when dialysis machines can no longer be serviced for lack of spare parts, when insulin becomes unobtainable, when hospital fuel supplies run dry and surgeries are canceled for weeks on end. The pattern is unmistakable: sanctions systematically kill the weakest members of society. This is not an accident; it is a design feature.
The study’s authors note that “the effects of sanctions on mortality generally increase over time, with longer‑lived sanctions episodes resulting in higher tolls on lives.” The longer a country is strangled, the more its health infrastructure crumbles, the more its disease burden rises, the more its people die. And the deadliest sanctions of all are those imposed unilaterally by the United States. The researchers found “the strongest effects for unilateral, economic, and US sanctions” and “no statistical evidence of an effect for UN sanctions.”
Collective Punishment as Standard Practice
There is a legal term for deliberately inflicting suffering on an entire civilian population in order to achieve political objectives: collective punishment. The Fourth Geneva Convention explicitly prohibits collective punishment of civilians during armed conflict, classifying it as a war crime. In August 2024, more than 200 attorneys and legal scholars from organizations around the world sent a letter to the White House stating unequivocally that “collective punishment is a standard practice of US foreign policy in the form of broad, unilateral economic sanctions, such as those imposed on Cuba, Venezuela, and Iran.” The letter noted that while other countries apply sanctions, “the United States imposes more unilateral economic sanctions than any other country in the world, by far.”
The signatories were blunt: civilian suffering is not an incidental byproduct of sanction policies but rather “often their very intent.” They pointed to former Secretary of State Mike Pompeo’s proud boasts about the harms inflicted on Iranian civilians as proof that Washington is fully aware of what it is doing. This is not the language of unintended consequences. This is the language of deliberate weaponization of hunger, disease, and poverty for cynical geopolitical ends.
United Nations experts and human rights bodies have repeatedly condemned US unilateral sanctions as violations of international law. A 2019 study submitted to the UN Human Rights Council, co‑written by economists Jeffrey Sachs and Mark Weisbrot, found that US sanctions on Venezuela alone “would fit the definition of collective punishment of the civilian population as described in both the Geneva and Hague international conventions, to which the US is a signatory.”
Yet the United States continues to expand its sanctions regime with breathtaking audacity. In 2017, the Trump administration imposed a record 3,900 sanctions designations—more than any previous administration—and deliberately escalated “maximum pressure” campaigns against Iran, Cuba, Venezuela, North Korea, and Syria. The Biden administration, despite initial gestures toward moderation, largely maintained and in some cases tightened these sanctions. Today, roughly 27 percent of the world’s countries are under some form of US sanctions, up from just 4 percent in the 1960s. What was once an exceptional tool has become the routine, default weapon of American foreign policy.
The Anatomy of Death: Case Studies
The abstract numbers are overwhelming, but the concrete human suffering is even more so. Consider the case of Cuba. The United States has maintained a brutal economic blockade against the island for more than 60 years—the longest‑running episode of collective punishment in modern history. Under President Trump and his successor, the noose was tightened further. The results are stark: from 2018 to 2025, Cuba’s infant mortality rate soared by 148 percent, from 4.0 to 9.9 deaths per 1,000 live births. Had the rate remained stable, approximately 1,800 infants would be alive today. According to a February 2026 report in a British pediatric journal, “rapidly deteriorating conditions at hospitals and clinics across Cuba were causing deaths that would otherwise be preventable,” as fuel shortages kept doctors from work, canceled surgeries, and delayed vaccines and life‑saving treatments like kidney dialysis and radiation therapy. The US blockade prohibits the sale of medical equipment containing just 10 percent US components, meaning that everything from infusion pumps to cardiac catheters to ventilators is off‑limits. Foreign banks are terrified of US sanctions, and more than 200 have stopped dealing with Cuba since 2021.
Venezuela provides another damning example. The Trump administration imposed sweeping financial and oil sanctions beginning in 2017, and then escalated dramatically in 2019 with the recognition of a parallel government. A study co‑authored by Columbia University economist Jeffrey Sachs found that these sanctions caused an estimated more than 40,000 excess deaths in 2017–2018 alone. The sanctions reduced public caloric intake, increased disease and mortality for both adults and infants, and displaced millions of Venezuelans. They cut off access to antiretroviral drugs for 80,000 people living with HIV, prevented dialysis for 16,000 patients, and deprived 16,000 cancer patients of treatment. The Seattle Times, citing the Lancet study, reported that “the first year of sanctions under the first Trump administration took tens of thousands of lives. Then things got even worse.”
Iran has been subjected to an escalating cycle of US sanctions since 1979, with the Trump administration’s withdrawal from the nuclear deal in 2018 marking a particularly deadly turn. The “maximum pressure” campaign aimed to drive Iran’s oil exports to zero and succeeded in pauperizing the population, decimating the middle class, and creating food and fuel shortages. Sanctions have disrupted access to over 200 types of cancer‑fighting drugs, forcing thousands of patients to go without chemotherapy. The country’s health system, once among the best in the region, has been systematically degraded.
North Korea is perhaps the most isolated case, but no less deadly. A 2019 report commissioned by Korea Peace Now found that sanctions contributed to nearly 4,000 civilian deaths in a single year due to delays in humanitarian aid, including 3,193 children under five and 72 pregnant women. The United Nations has warned that 40 percent of North Korea’s population goes hungry, six out of ten people lack access to safe drinking water, and malnutrition among children is increasing.
Syria has been crushed under the weight of US and EU sanctions even as the United Nations struggles to deliver earthquake relief and basic humanitarian aid. Sanctions have caused chronic shortages of medicines for diabetes, heart disease, and other chronic conditions, while blocking the import of spare parts for water treatment plants, power grids, and hospitals. The cumulative effect across these five countries alone runs into the hundreds of thousands of lives extinguished.
The Trump Era: Accelerating the Genocide
If US sanctions have always been deadly, the Trump administration made them exponentially more so. Between 2017 and 2021, the US government issued a record 3,900 sanctions designations—averaging nearly three new sanctions every single day. Trump’s Treasury Department weaponized secondary sanctions, long‑arm jurisdiction, and aggressive enforcement with unprecedented zeal. The administration withdrew from the Iran nuclear deal and re‑imposed crippling sanctions on Tehran. It tightened the noose on Cuba to a degree not seen since the Kennedy era. It imposed first‑of‑their‑kind financial sanctions on Venezuela, precipitating the country’s catastrophic economic collapse. It expanded sanctions on North Korea and Syria. And it did all of this while publicly bragging about the suffering inflicted on civilian populations.
Estimating the precise number of deaths attributable to Trump’s sanctions requires some arithmetic. The Lancet study found that unilateral sanctions kill an average of 564,000 people each year. US unilateral sanctions account for more than 40 percent of the global total. That yields a baseline estimate of roughly 226,000 deaths per year directly attributable to US sanctions. Over Trump’s four‑year term (2017–2021), this baseline figure would be approximately 904,000 deaths—and this likely substantially underestimates the true toll, because Trump’s sanctions were not “average.” They were far more numerous, far more comprehensive, and far more aggressively enforced than those of either his predecessors or the Biden administration that followed. The “maximum pressure” campaign against Iran alone, with its objective of driving oil exports to zero, was designed to maximize civilian economic pain. The tightening of the Cuban blockade demonstrably caused a sharp spike in infant mortality. The Venezuelan sanctions caused an estimated 40,000 deaths in just two years.
A generous—if tragic—estimate would place the death toll of Trump‑era sanctions at well over one million people, with the majority of deaths occurring among children and the elderly. The Chicago political scientist John Mearsheimer, citing the same Lancet data, has noted that US sanctions killed approximately 38 million people between 1971 and 2021, giving an average of 760,000 per year—some 200,000 higher than the Lancet study’s figure. By that metric, Trump’s four years would account for more than 3 million deaths. But regardless of which baseline one uses, one conclusion is inescapable: Donald Trump is responsible for more sanction‑induced deaths than any other American president.
The Crime That Must Be Named
The world has a name for the deliberate, systematic destruction of a civilian population: genocide. Article II of the UN Convention on Genocide defines the crime as “acts committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious group,” including “deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part.” Is deliberately starving the population of Venezuela, denying lifesaving medicine to the people of Iran, blocking infant vaccines in Cuba, or preventing humanitarian aid from reaching the children of North Korea anything other than the deliberate infliction of conditions of life calculated to bring about physical destruction? The United States government does not wage these campaigns out of ignorance. It wages them with full knowledge of their effects, with enthusiastic proclamations of their effectiveness, and with contempt for the international treaties it has signed.
The 564,000 annual deaths caused by US and other unilateral sanctions are not a rounding error, not an unintended side effect, not an acceptable cost of statecraft. They are murder. They are systematically organized, bureaucratically administered, and politically sanctioned murder on a scale that rivals the worst atrocities of the twentieth century. And they are perpetrated by a government that lectured the world for decades about “human rights” and “democracy” and “the rules‑based international order.”
The hypocrisy is nauseating. The United States spends billions of dollars on humanitarian aid programs while simultaneously maintaining economic blockades that kill far more people than those programs save. It condemns the war crimes of other nations while committing collective punishment on a continental scale. It issues press releases about defending the sanctity of life while its Treasury Department quietly signs off on policies that will kill tens of thousands of infants this year alone.
A Call to End the Siege
The time for polite protest is long past. Every day that US sanctions remain in place, hundreds of people die—including dozens of children. Every day that Congress and the White House refuse to act, the United States adds new names to the list of countries under siege. Every humanitarian exemption, every limited waiver, every timid reform is a drop of water thrown into a burning building: well‑intentioned but entirely inadequate.
The Lancet study’s co‑author Mark Weisbrot put it plainly: “It is immoral and indefensible that such a lethal form of collective punishment continues to be used.” He is correct. The continued use of unilateral economic sanctions is a crime against humanity. The governments that impose them—and above all, the United States—must be held accountable by the international community. The sanctions must be lifted. The sieges must end. And the architects of this ongoing genocide, from the Treasury Department sanctions lawyers to the presidents who sign the executive orders, must face the judgment of history.
History will not be kind to those who knowingly condemned millions of children to death and called it “foreign policy.” It will remember the 564,000 annual victims as what they are: the casualties of a silent, systematic, and wholly preventable genocide. The only question that remains is whether we will stop it before the death toll climbs yet higher.
