A friendly quarrel while we agree that the US sanctions are a weapon of mass destruction and kill more people than wars do. And that we must talk much more about sanctions than we have so far.
March 16, 2026
John Mearsheimer recently stated that U.S. sanctions murdered around 38 million people between 1971 and 2021 – see the video below. It is a dramatic figure, and it has spread quickly because it captures, in one sentence, the enormous human cost of modern sanctions.
I share his concern about the destructive effects of economic coercion. But the specific number he cites — and the way he attributes it — deserves a friendly academic clarification.
The figure comes from a 2023 Lancet Global Health article estimating the mortality effects of unilateral U.S. and EU sanctions over the past half‑century. This is the first point where Mearsheimer’s shorthand diverges from the text: the study is explicitly about U.S. and European Union sanctions, not U.S. sanctions alone. Given the EU’s increasingly active sanctions policy, this distinction matters.
The second issue concerns how the Lancet researchers actually measure mortality. They do not count deaths directly caused by sanctions. They do not claim to know how many people died because a medicine could not be imported or a hospital lacked spare parts. Instead, they use a statistical causal‑inference model to estimate excess mortality associated with sanctions.
This term has a precise meaning. “Excess mortality” does not mean “deaths caused by sanctions” in the everyday sense. It means the number of deaths above what would be expected if the sanctioned country had followed the mortality trajectory of comparable, non‑sanctioned countries. To do this, the researchers assemble a large dataset covering many countries and many years, including variables such as GDP, conflict intensity, demographics, and health‑system indicators. They then compare: a) a country’s mortality before sanctions, b) its mortality after sanctions, and c) the mortality of similar countries not under sanctions during the same period.
This is a standard econometric approach — a difference‑in‑differences design — that estimates the average effect of sanctions while controlling for other factors such as war, economic collapse, or natural disasters. But it cannot identify which individual deaths were “caused” by sanctions, nor can it perfectly isolate sanctions from all other forces at work in a society.
The authors therefore speak carefully of “excess mortality associated with sanctions.”
The study provides an annualised estimate: roughly 564,000 excess deaths per year in countries under unilateral U.S. and EU sanctions. It does not give a 50‑year total. If one multiplies the annual figure by 50, one obtains about 28.2 million. The authors then compare this to an estimated 5.5 million war‑related deaths over the same period. Adding the two yields a 33‑million figure , but no the 38 million Mearsheimer mentions.
In paranthesis – but an important one – please note that the human costs of sanctions over time seem to be much higher than those of warfare – about 5 times higher!
The arithmetic is fine. But the Lancet authors themselves do not present this as a single combined death toll, nor do they frame it as “deaths caused by sanctions,” let alone “killed by the United States.” Their purpose is to show scale and association, not to produce a definitive historical body count.
My intention here is not to diminish the suffering caused by sanctions. On the contrary, I have long argued that the United States suffers from a kind of “sanctionitis” — a chronic overreliance on coercive economic measures, with more than 100,000 sanctions designations issued over the decades.
This is a serious disease of contemporary statecraft. Mearsheimer is right to draw attention to the human costs – particularly since sanctions get no media attention compared with warfare and since they are often called a “soft” weapon. Reality tells us that sanctions are a weapon of mass destruction, even though you will never get the exact numbers.
But precision matters. The Lancet study gives us powerful evidence that sanctions are associated with large increases in mortality. It does not tell us that 33 million people “died from U.S. sanctions.”
Keeping that distinction clear strengthens, rather than weakens, the critique of sanctions, particularly those that last over a long time – as in Iran. And the sanctions on Iran since 1979 is the topic of my next analysis.
