MORE than three years after United States-led forces invaded Iraq there are still no estimates of the human cost of the war. Specifically, how many Iraqi people have died? Neither the U.S. government, which bears moral responsibility for the occupation, nor the government in Baghdad has ever offered a timely, credible and accurate estimate of the death toll. Yet, when The Lancet, the reputed medical journal, recently published the results of a detailed study, which estimated that 650,000 Iraqi people have died since the 2003 invasion, both governments offhandedly dismissed it. Even sections of the media that are generally against the occupation have termed the report "controversial" without bothering to get the results vetted by expert statisticians or epidemiologists.
U.S. President George W. Bush, while admitting that "a lot of innocent people" have died, said he did not consider the report "credible". The Iraqi government also wrote off the results of the survey, claiming that the toll was "inflated" and "far from the truth" and that it "exceeds the reality in an unreasonable way".
The study was conducted by the Johns Hopkins Bloomberg School of Public Health in association with the School of Medicine at the Al Mustansiriya University in Baghdad. The authors of the present study had conducted a similar exercise in 2004, which estimated that about 100,000 people might have died between March 2003 and September 2004 (Frontline, November 19, 2004).
The study estimates the death rate in Iraq at 13.2 per thousand per annum in the 40-month period since the invasion compared with 5.5 per thousand per annum pre-invasion. It estimates that there have been 654,965 "excess deaths" in Iraq. That is, if Iraq had not been invaded and if mortality rates had been at normal pre-invasion levels, there would have been 654,965 fewer deaths. The casualty estimates imply that 2.5 per cent of the Iraqi population has been wiped out after the invasion. Nearly 92 per cent of the "excess deaths" were attributable to violence, mostly from gunshot wounds, and nearly 60 per cent of the violent deaths were of men aged between 15 and 44. Respondents of the survey attributed nearly one-third of the deaths to coalition forces. Even the deaths attributable to "non-violent" causes are linked to the state of Iraq after the invasion, particularly the lack of medicines, electricity and other basic amenities and poor sanitation.
How does one estimate the extent of death in a country that is not only under occupation but is also suffering the pangs of a civil war? The study proves that although the task is not an easy one, it is certainly not impossible. Most of the estimates of casualties in Iraq have come from "passive surveillance", essentially on the basis of anecdotal reports, particularly by the media. But it is well known that these estimates (for instance, by the United Kingdom-based Iraq Body Count, which monitors the toll on a daily basis) seriously understate the extent of death.
In contrast, the Johns Hopkins study is the first comprehensive estimate. Using sampling techniques similar to those adopted to estimate voting intent or television viewing preferences, the estimate is based on an actual field survey of households across Iraq, conducted between May and July 2006. The survey team, whose members were all Iraqi medical doctors fluent in both English and Arabic, interviewed representatives of 1,849 households (more than 12,000 people) across Iraq. Significantly, 92 per cent of the respondents reporting deaths produced death certificates.
After the 2004 survey, there was a concerted attempt to discredit the findings of the Johns Hopkins team. Media reports, relying on non-specialist sources, denigrated the study. The survey method was criticised although it had relied on the same method adopted by organisations of the United Nations, the U.S. Agency for International Development and other agencies around the world. In response to criticism of the 2004 survey, Les Roberts, report co-author and an associate with the Bloomberg School of Public Health's Center for International Emergency, Disaster and Refugee Studies, pointed out, "It is odd that the logic of epidemiology embraced by the press every day regarding new drugs or health risks somehow changes when the mechanism of death is their armed forces."
Gilbert Burnham, lead author of the study and co-director of the Bloomberg School's Center for Refugee and Disaster Response, explained that their total estimate of deaths was much higher than other mortality estimates because the study "used a population-based, active method for collecting mortality information rather than passive methods that depend on counting bodies or tabulated media reports of violent deaths."
The study's finding on the sharp increase in mortality rates classifies the situation in Iraq as being "a humanitarian emergency", according to internationally accepted norms in disaster management.