The Guardian wrote:One in 40 Iraqis 'killed since invasion'

US and Britain reject journal's finding that death toll has topped 650,000

Sarah Boseley, health editor
Thursday October 12, 2006
The Guardian

Corpses of Shia family members strewn across a road after they were killed by suspected insurgents near Baquba, Iraq. Photo: Helmiy al-Azawi/Reuters
 

The death toll in Iraq following the US-led invasion has topped 655,000 - one in 40 of the entire population - according to a major piece of research in one of the world's leading medical journals.

The study, produced by the Johns Hopkins Bloomberg School of Public Health in Baltimore and published online by the Lancet, claims the total number of deaths is more than 10 times greater than any previously compiled estimate.

The findings provoked an immediate political storm. Within hours of its release, George Bush had dismissed the figures. "I don't consider it a credible report," he told reporters at the White House. "Neither does General Casey [the top US officer in Iraq], neither do Iraqi officials."
The Foreign Office also cast doubt on the findings, stating that the government preferred to rely on the body count of the Iraqi ministry of health, which recorded just 7,254 deaths between January 2005 and January 2006.

But the US researchers have the backing of four separate independent experts who reviewed the new paper for the Lancet. All urged publication. One spoke of the "powerful strength" of the research methods, which involved house-to-house surveys by teams of doctors across Iraq.

The Johns Hopkins researchers published an earlier study in the Lancet in October 2004, which caused similar shock waves. They say the new work validates the old and shows an alarming escalation in violent deaths.

Nearly a third of the deaths (31%) were ascribed to the coalition forces. Most of the deaths - 601,000 out of 655,000 - were due to violence and of those, 56% were caused by gunshot wounds. Air strikes, car bombs and other explosions accounted for a further 13-14%.

For reasons involving their own safety, the doctors did not probe whether those who died were combatants or civilians. Deaths due to disease have also risen as the conflict has damaged Iraq's health services.

The authors say their discovery that the death rate in Iraq has more than doubled from 5.5 per 1,000 a year before the invasion to 13.3 per 1,000 a year since "constitutes a humanitarian emergency".

"Although such death rates might be common in times of war," write the authors, Professor Gilbert Burnham and colleagues, "the combination of a long duration and tens of millions of people affected has made this the deadliest international conflict of the 21st century and should be of grave concern to everyone.

"At the conclusion of our 2004 study we urged that an independent body assess the excess mortality that we saw in Iraq. This has not happened.

"We continue to believe that an independent international body to monitor compliance with the Geneva conventions and other humanitarian standards in conflict is urgently needed. With reliable data, those voices that speak out for civilians trapped in conflict might be able to lessen the tragic human cost of future wars."

Yesterday the Foreign Office repeated the government's criticism of two years ago. "We will be looking at it in more detail but it is a fairly small sample they have taken and they have extrapolated across the country," said a spokesman.

"We rely on the Iraqi government themselves. They are producing their own figures these days. Our position at the moment is that whatever figures we see, all these civilian deaths are a tragedy and of great concern to us. The multinational forces and the international community have to support a democratically elected government which is trying to stamp out the violence."

The US defence department said that it always regrets the loss of life anywhere. "The coalition takes enormous precautions to prevent civilian deaths and injuries," said its spokesman, Mark Ballesteros.

"By contrast, the enemy in Iraq takes no such precautions and deliberately targets innocent civilians.

"It would be difficult for the US to precisely determine the number of civilian deaths in Iraq as a result of insurgent activity. The Iraqi ministry of health would be in a better position, with all of its records, to provide more accurate information on deaths in Iraq."

The Lancet editor, Richard Horton, says in a commentary published online with the study that the work "corroborates the impression that Iraq is descending into bloodthirsty chaos".

Plans by the Americans to reduce the number of troops in Iraq appeared yesterday to have been scuppered by the growing violence in the country.

General Peter Schoomaker, the US army chief of staff, said he was planning for troop numbers to stay at the present level through to 2010. "This is not a prediction that things are going poorly or better. It's just that I have to have enough ammo in the magazine that I can continue to shoot as long as they want us to shoot," he said.

There are 141,000 American troops in Iraq, and the US government had hinted it would begin reducing numbers to 100,000 after the inauguration of the Iraqi government. But these plans appear to have been jeopardised by increased insurgent attacks and sectarian killings.

Yesterday, Jan Egeland, the UN under-secretary for humanitarian affairs, warned: "Revenge killing seems to be totally out of control" and added that the "blunt, brutal violence" in Iraq was targeting all civilians.

But despite Dr Horton's bleak assessment, he writes, "absolute despair would be the wrong response. Instead, the disaster that is the west's current strategy in Iraq must be used as a constructive call to the international community to reconfigure its foreign policy around human security rather than national security ... Health is now the most important foreign policy issue of our time."

Guardian wrote:This Terrible Misadventure Has Killed One In 40 Iraqis

The government will do all it can to discredit the latest estimate of civilian casualties since the invasion: 650,000

Richard Horton
Thursday October 12, 2006
The Guardian

Many people refused to believe the Lancet report in 2004 from a group of American and Iraqi public-health scientists who surveyed homes across the country and found that about 100,000 additional Iraqi deaths had taken place since the coalition invasion in March 2003. Several government ministers were deployed to destroy the credibility of the findings and, in large part, they succeeded. But now their denials have come back to haunt them, for the figures from Iraq have been confirmed by a further study.

The same team from Johns Hopkins University worked with Iraqi doctors to visit over 1,800 homes in Iraq, selected randomly to make sure that no bias could creep in to their calculations.

They identified more than 12,000 family members and tracked those who had died over an interval that spanned both pre- and post-invasion periods. The Iraqi interviewers spoke fluent English as well as Arabic, and they were well trained to collect the information they were seeking. They asked permission from every family to use the data they wanted. And they chased down death certificates in over four out of five cases to make sure that they had a double check on the numbers and causes of death given to them by family members.

All of these checks and balances mean that the 650,000 additional Iraqi casualties they report since the invasion is the most reliable estimate we have of civilian deaths. Most of these deaths have been of men aged 15 to 44.

Not only do we have a better understanding of the toll our invasion has had on the country; we also understand better just how those deaths have come about. Before the invasion only a tiny proportion of deaths were due to violence. But since the invasion over half of all deaths have been due to violent causes. It is our occupation and our continued presence in Iraq that is fuelling this violence. Claims that the terrorist threat was always there are simply disproved by these findings.

The nature of these causes has changed too. Early on in the post-invasion period deaths were made worse by aerial bombing. But now gunshot wounds and car bombs are having a far greater effect. Far from our presence in Iraq stabilising the chaos or alleviating the rate at which casualties are mounting, we seem to be making the situation worse. In each year since the invasion, the mortality rates due to violence have increased.

The total figure of 650,000 is truly staggering. It represents 2.5% of the entire Iraqi population. In 2004 The Lancet was criticised for publishing a number that seemed to have a high degree of uncertainty. The best estimate then was 98,000 deaths. But the uncertainty meant that it could have been as low as 8,000 or as high as 194,000.

In the latest study there is also a large degree of uncertainty, but even the lowest possible figure it gives for the number of deaths - 400,000 - makes clear just how terrible our intervention in Iraq has been. The highest possible figure is more than 900,000. Looking at these numbers, we have to concede that we have created a humanitarian disaster of unprecedented proportions for a foreign policy that was supposed to protect civilian populations, not subject them to ever-greater harm.

Why is this Lancet estimate so much higher than the figures put out by President Bush or the Iraq Body Count website? They put the number of casualties in the tens of thousands, not the hundreds of thousands. To be fair, Iraq Body Count does not claim to publish accurate absolute numbers of deaths. Instead, their figures are valuable for measuring trends. But the reason for the discrepancy between these lower estimates and the new figure of 650,000 deaths lies in the way the number is sought. Passive surveillance, the most common method used to estimate numbers of civilian deaths, will always underestimate the total number of casualties. We know this from past wars and conflict zones, where the estimates have been too low by a factor of 10 or even 20.

Only when you go out and knock on the doors of families, actively looking for deaths, do you begin to get close to the right number. This method is now tried and tested. It has been the basis for mortality estimates in war zones such as Darfur and the Congo. Interestingly, when we report figures from these countries politicians do not challenge them. They frown, nod their heads and agree that the situation is grave and intolerable. The international community must act, they say. When it comes to Iraq the story is different. Expect the current government to mobilise all its efforts to undermine the work done by this American and Iraqi team. Expect the government to criticise the Lancet for being too political. Expect the government to do all it can to dismiss this story and wash its hands of its responsibility to take these latest findings seriously.

But if we were talking about the risk of smoking to the population, and published research demonstrating the effect of tobacco on mortality, few would dispute the message or the importance of scientists and medical journals in being actively engaged in a public debate. For Iraq, violence is the public-health priority right now. It is a proper subject for science and it is a proper subject for a medical journal to comment on.

So what is the right conclusion from this work? How should this latest research inform public policy? First, Iraq is an unequivocal humanitarian emergency. Civilians are being harmed by our presence in Iraq, not helped. That should force us to pause and ask what we are doing and why. There is no shame in saying that we have got the policy wrong. Moreover, we have a legal obligation under the Geneva conventions to do all we can to protect civilian populations. These findings show not only that are we not adhering to this legal obligation, but also that we are progressively subverting it year on year.

And finally, we can truthfully say that our foreign policy - based as it is on 19th-century notions of the nation-state - is long past its sell-by date. We need a new set of principles to govern our diplomacy and military strategy - principles that are based on the idea of human security and not national security, health and wellbeing and not economic self-interest and territorial ambition.

The best hope we can have from our terrible misadventure in Iraq is that a new political and social movement will grow to overturn this politics of humiliation. We are one human family. Let's act like it.

· Richard Horton is the editor of the Lancet

Cranius wrote:The Johns Hopkins Bloomberg School of Public Health in Baltimore...