Household Survey Sees 100,000
Iraqi Deaths
The Washington Post
By EMMA ROSS
The Associated Press
Friday, October 29, 2004; 3:03 AM
LONDON - Researchers have estimated that as many as 100,000
more Iraqis - many of them women and children - died since the
start of the U.S.-led invasion of Iraq than would have been
expected otherwise, based on the death rate before the war.
Writing in the British-based medical journal The Lancet, the
American and Iraqi researchers concluded that violence accounted
for most of the extra deaths and that airstrikes by the U.S.-led
coalition were a major factor.
There is no official figure for the number of Iraqis killed
since the conflict began, but some non-governmental estimates
range from 10,000 to 30,000. As of Thursday, 1,106 U.S.
servicemen had been killed, according to the U.S. Defense
Department.
The scientists who wrote the report concede that the data they
based their projections on were of "limited precision," because
the quality of the information depends on the accuracy of the
household interviews used for the study. The interviewers were
Iraqi, most of them doctors.
Designed and conducted by researchers at Johns Hopkins
University, Columbia University and the Al-Mustansiriya
University in Baghdad, the study was published Thursday on The
Lancet's Web site.
The survey attributed most of the extra deaths to violence and
said airstrikes by coalition forces caused most of the violent
deaths.
"Most individuals reportedly killed by coalition forces were
women and children," the researchers wrote.
The report was released just days before the U.S. presidential
election, and the lead researcher said he wanted it that way. The
Lancet routinely publishes papers on the Web before they appear
in print, particularly if it considers the findings of urgent
public health interest.
Those reports then appear later in the print issue of the
journal. The journal's spokesmen said they were uncertain which
print issue the Iraqi report would appear in and said it was too
late to make Friday's issue, and possibly too late for the Nov. 5
edition.
Les Roberts, the lead researcher from Johns Hopkins, said the
article's timing was up to him.
"I emailed it in on Sept. 30 under the condition that it came
out before the election," Roberts told The Associated Press. "My
motive in doing that was not to skew the election. My motive was
that if this came out during the campaign, both candidates would
be forced to pledge to protect civilian lives in Iraq.
"I was opposed to the war and I still think that the war was a
bad idea, but I think that our science has transcended our
perspectives," Roberts said. "As an American, I am really, really
sorry to be reporting this."
Richard Peto, an expert on study methods who was not involved
with the research, said the approach the scientists took is a
reasonable one to investigate the Iraq death toll.
However, it's possible that they may have zoned in on hotspots
that might not be representative of the death toll across Iraq,
said Peto, a professor of medical statistics at Oxford University
in England.
Lancet editor Richard Horton wrote in an editorial
accompanying the survey that more household clusters would have
improved the precision of the report, "but at an enormous and
unacceptable risk to the team of interviewers."
"This remarkable piece of work represents the efforts of a
courageous team of scientists," he wrote.
To conduct the survey, investigators visited 33 neighborhoods
spread evenly across the country in September, randomly selecting
clusters of 30 households to sample. Of the 988 households
visited, 808, consisting of 7,868 people, agreed to participate.
Each household was asked how many people lived in the home and
how many births and deaths there had been since January 2002.
The scientists then compared death rates in the 15 months
before the invasion with those that occurred during the 18 months
after the attack and adjusted those numbers to account for the
different time periods.
Even though the sample size appears small, this type of survey
is considered accurate and acceptable by scientists and was used
to calculate war deaths in Kosovo in the late 1990s.
The investigators worked in teams of three. Five of the six
Iraqi interviewers were doctors and all six were fluent in
English and Arabic.
In the households reporting deaths, the person who died had to
be living there at the time of the death and for more than two
months before to be counted. In an attempt at firmer
confirmation, the interviewers asked for death certificates in 78
households and were provided them 63 times.
There were 46 deaths in the surveyed households before the
war. After the invasion, there were 142 deaths. That is an
increase from 5 deaths per 1,000 people per year to 12.3 per
1,000 people per year - more than double.
However, more than a third of the post-invasion deaths were
reported in one cluster of households in the city Fallujah, where
fighting has been most intense recently. Because the fighting was
so severe there, the numbers from that location may have
exaggerated the overall picture.
When the researchers recalculated the effect of the war
without the statistics from Fallujah, the deaths end up at 7.9
per 1,000 people per year - still 1.5 times higher than before
the war.
Even with Fallujah factored out, the survey "indicates that
the death toll associated with the invasion and occupation of
Iraq is more likely than not about 100,000 people, and may be
much higher," the report said.
The most common causes of death before the invasion of Iraq
were heart attacks, strokes and other chronic diseases. However,
after the invasion, violence was recorded as the primary cause of
death and was mainly attributed to coalition forces - with about
95 percent of those deaths caused by bombs or fire from
helicopter gunships.
Violent deaths - defined as those brought about by the
intentional act of others - were reported in 15 of the 33
clusters. The chances of a violent death were 58 times higher
after the invasion than before it, the researchers said.
Twelve of the 73 violent deaths were not attributed to
coalition forces. The researchers said 28 children were killed by
coalition forces in the survey households. Infant mortality rose
from 29 deaths per 1,000 live births before the war to 57 deaths
per 1,000 afterward.
The researchers estimated the nationwide death toll due
to the conflict by subtracting the preinvasion death rate from
the post-invasion death rate and multiplying that number by the
estimated population of Iraq - 24.4 million at the start of the
war. Then that number was converted to a total number of deaths
by dividing by 1,000 and adjusting for the 18 months since the
invasion.
"We estimate that there were 98,000 extra deaths during the
postwar period in the 97 percent of Iraq represented by all the
clusters except Fallujah," the researchers said in the
journal.
"This isn't about individual soldiers doing bad things. This
appears to be a problem with the approach to occupation in Iraq,"
Roberts said.
The researchers called for further confirmation by an
independent body such as the International Committee of the Red
Cross, or the World Health Organization.
The study was funded by the Center for International Emergency
Disaster and Refugee Studies at Johns Hopkins University and by
the Small Arms Survey in Geneva, Switzerland, a research project
based at the Graduate Institute of International Studies in
Geneva.
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On the Net:
The Lancet:http://www.thelancet.com
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