Liberating from life, in Iraq

Published : Nov 19, 2004 00:00 IST

In Baghdad, nine-year-old Ali's class remembers him by putting up his picture where he sat. Ali died in an explosion on September 30. - AWAD AWAD/AFP

In Baghdad, nine-year-old Ali's class remembers him by putting up his picture where he sat. Ali died in an explosion on September 30. - AWAD AWAD/AFP

HOW many people have died in Iraq since it was invaded in March 2003? Neither the Provisional Government in Iraq, nor the occupying U.S. forces there have ever maintained a count of the toll. The highest independent estimate of casualties placed Iraqi civilian casualties at between 10,000 and 30,000. However, the first scientific survey of casualties, "Mortality before and after the 2003 Invasion of Iraq: Cluster sample survey", published on October 29 in the online edition of The Lancet, reveals that more than 100,000 people in Iraq - mostly women and children - have died as a result of the invasion. This estimate implies that about 100 Iraqis have died for every U.S. soldier who died in Iraq since the invasion (the latest count of U.S. casualties is 1,106 deaths).

Tthe survey gathered data on mortality before the invasion (between January 1, 2002 and March 18, 2003) and compared them to the mortality data after the invasion (from March 19, 2003 to September 8-20, 2004, when the interviews were conducted). Investigators, in teams of three, fanned out across the country, visiting 33 neighbourhoods (clusters), each with 30 households. Five of the six Iraqi interviewers were doctors and all six were fluent in English and Arabic. The investigators interviewed 7,868 persons in 808 households. The sampling was extensive, covering every region of Iraq, and curtailed in scope only by the great personal risks to which interviewers would be exposed in the violence-hit country. Only persons who had been with the family at the time of their death and for at least two months prior to the survey were included in the list of casualties.

Investigators gathered information from each household (defined as a group of people living together and sleeping under the same roof) on the size of the family and the number of births and deaths since January 2002. The data enabled a comparison of mortality in the 15 months before the invasion with that during the 18 months since then. The differing time durations of the two periods were standardised to enable an accurate comparison. An expert statistician told Frontline that the method adopted by the survey was appropriate for a war-ravaged situation. He said that cluster sample surveys enable the gathering of in-depth information from participants while capturing the variations across the country. Scientists followed a similar methodology to estimate casualties in Kosovo in the 1990s.

THE survey revealed 46 deaths in the households surveyed before the war. There were 142 deaths in the same households after the invasion. This implies that the death rate more than doubled after the invasion - from 5 deaths per 1,000 people per year to 12.3 deaths per 1,000 people per year. More than one-third of the deaths in the clusters surveyed were concentrated in the Falluja area. The survey recorded 53 deaths in Fallujah, compared to 1.4 deaths that would have been expected if Iraq had not been invaded. The survey confirms that the fierce Iraqi resistance there, and the occupying forces' recourse to aerial bombardment, have resulted in the high death rates in the area. The "risk of death" in Iraq after the invasion was more than two-and-a-half times that before the occupation. Even if the high level of casualties in Falluja is ignored as an "aberration", the risk of death after the invasion was still one-and-a-half times that before the invasion. The study noted that violence was "geographically widespread", and that the "violence-specific mortality rate went up 58-fold" after the invasion. The most common causes of death before the invasion of Iraq were heart attacks, strokes and other chronic disorders; after the invasion, it was violence. About 95 per cent of such deaths have been caused by troops using bombs and firing from helicopter gunships. Infant mortality rose from 29 deaths per 1,000 live births before the invasion to 57 deaths per 1,000 since then.

Significantly, the study has shown that it is possible to "collect valid data, albeit with limited precision" even in the most difficult of situations. However, "the lack of precision does not hinder the clear identification of the major public-health problem in Iraq - violence." It pointed out that there is "little excuse" for the coalition forces not providing more accurate tallies of casualties in Iraq. It asked for its results to be confirmed by an independent body such as the World Health Organisation or the International Committee of the Red Cross. "In the interim, civility and enlightened self-interest demand a re-evaluation of the consequences of weaponry now used by coalition forces in populated areas", said the report.

The comprehensive survey was designed and conducted by a team of medical researchers from the Johns Hopkins University, Columbia University and the Al-Mustansiriya University in Baghdad. It was sponsored by the Centre for International Emergency Disaster and Refugee Studies at Johns Hopkins University and the Small Arms Survey in Geneva, Switzerland.

Les Roberts of Johns Hopkins, the team leader, told the Associated Press that he emailed the report to The Lancet on September 30 so that it could be published before the U.S. elections. He told the agency that he was not attempting to "skew the elections", but to ensure that both the leading 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."

The Lancet, a popular journal (one million registered users), and the longest continuously published medical journal (since 1823), has extensively surveyed Iraq in the last decade. It had published several studies focusing attention on health and child mortality caused by sanctions imposed on Iraq prior to the invasion.

V. Sridhar
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