Estimating Excess Mortality in Post-Invasion Iraq (New Eng Jour Med)

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Estimating Excess Mortality in Post-Invasion Iraq

Catherine A. Brownstein, M.P.H., and John S. Brownstein, Ph.D.

There is no set formula for accurately tallying deaths from humanitarian crises. When a population becomes destabilized, estimation of mortality is likely to be severely challenged. In the case of a sudden traumatic event, such as a natural disaster affecting an otherwise stable population, health and human service agencies, though compromised, may well be able to facilitate an accurate assessment of deaths through the use of prospective registries of vital events.

In the event of a military invasion and ongoing war, however, the likelihood of obtaining good demographic data plummets. A death registry is unlikely to be developed or maintained, and as conditions deteriorate, it may become increasingly unlikely that bodies can be counted at all. In Iraq, there is also a strong cultural imperative that bodies be put to rest quickly, which may affect the ability to arrive at accurate estimates. Although sentinel populations are commonly monitored to rapidly estimate mortality in developing countries when a registry is not available, the impossibility of finding reliably representative populations in countries engaged in armed conflict and the absence of an accurate population count make it difficult to extrapolate from the rates at sentinel sites to produce reliable national estimates.

A more accurate option, but one that is more dangerous for researchers, is the household survey. Even in nonemergency situations, the study design of the survey may be subject to underreporting and may not accurately reflect rates of migration and fertility. Complex computations are required to account for variation among regions and subpopulations. During conflicts, an estimation of the death rate is further complicated by the difficulties involved in creating a valid sampling frame, the problem of reporting bias, and obstacles to accurate ascertainment of causes of death. Researchers often must risk their lives if they wish their estimates to accurately represent the population, and they must spend as much time in dangerous areas as in less dangerous ones to minimize bias.

In this issue of the Journal (pages 484–493), the Iraq Family Health Survey (IFHS) study group reports the results of a household survey conducted in Iraq in 2006 and 2007 for the purpose of estimating mortality between January 2002 and June 2006. The researchers divided the country into 56 mutually exclusive sampling strata and surveyed 9345 households in total (see map). Information on all deaths within a household was sought, in an effort to estimate overall and cause-specific rates of death. The group obtained an estimate of 151,000 violent deaths, with a purported 95% confidence interval of 104,000 to 223,000 — a massive death toll — since the 2003 invasion. Violence was found to be the leading cause of death among Iraqi men between the ages of 15 and 59 years and a leading cause of death among Iraqi adults in general.

http://content.nejm.org/cgi/content/full/NEJMp0709003?query=TOC

The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.

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1. some other figures..

Is the US Responsible for
a Million Iraqi Deaths?
By Patrick McElwee and Robert Naiman*
Just Foreign Policy
September 11, 2007
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There are no competing scientific studies of post-invasion deaths in Iraq. Neither the occupying
forces nor the Iraqi government has commissioned an official, scientific study of Iraqi deaths,
despite - or perhaps because of - the centrality of the death toll to assessing the decision by the
United States to go to war. Aside from occasional unsubstantiated assertions from President Bush, the U.S. government does not even guess at Iraqi deaths. The standard estimates of Iraqi deaths quoted by the press and dominant policy makers come from two clearly inadequate sources: media reports and politicized assertions by the Iraqi government.
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The Iraqi government used to release regular estimates of deaths in the country, but these were
politically biased and unreliable. In early 2006, the Iraqi Minister of Health publicly estimated
between 40,000 and 50,000 violent Iraqi civilian deaths since the invasion. In October 2006, the same week a study was published in the Lancet estimating 650,000 deaths, the Minister tripled his estimate, saying there had been 150,000. There is simply no centralized reporting mechanism that can count, one-by-one, all violent deaths in Iraq.

As of this writing, Iraq Body Count reports that between 69,000 and 76,000 Iraqi civilians have been killed. But, as Les Roberts, co-author of the Lancet study, points out, "There have to be at least 120,000 and probably 140,000 deaths per year from natural causes in a country with the population of Iraq." If the Iraq Body Count figure captured all deaths (which the group does not claim), then the annual death rate for the past four years has increased less than 15 percent. Roberts remarks that this is not consistent with "numerous stories we hear about overflowing morgues, the need for new cemeteries and new body collection brigades." Estimates of violent deaths on the scale of the Iraq Body Count numbers are also hard to reconcile with estimates that 4 million Iraqis have fled their homes, since interviews with refugees indicate that the violent death of family members was often the event that precipitated flight.

The Iraq Study Group itself found that "there is significant underreporting of the violence in Iraq." They cite a day in July 2006 when U.S. intelligence reported 93 attacks. "Yet a careful review of reports for that single day brought to light 1,100 acts of violence." The British daily Independent reports that the Iraqi government bans journalists from the scenes of bombings and has banned hospitals from providing information on casualties.

On January 9, 2007, a reporter from Fox News was embedded with the U.S. Air Force. He reported that
planes taking off from his location "dropped thousands of pounds of munitions. They bombed 25 targets deep inside Iraq." Yet no reports of any deaths from those bombings reached the English-language press. About the Author: Patrick McElwee is a policy analyst and Robert Naiman is a senior policy analyst at Just Foreign Policy, www.justforeignpolicy.org . Their counter of Iraqi deaths can be found at
http://www.globalpolicy.org/security/issue ...



Holocaust Denial, American Style
Traditional U.S. media have refused to acknowledge the massive number of Iraqis killed since the
invasion.
by Mark Weisbrot
www.alternet.org, November 21, 2007

Iranian President Mahmoud Ahmedinejad's flirtation with those who deny the reality of the Nazi
genocide has rightly been met with disgust. But another holocaust denial is taking place with little notice: the holocaust in Iraq. The average American believes that 10,000 Iraqi civilians have been killed since the US invasion in March 2003. The most commonly cited figure in the media is 70,000. But the actual number of people who have been killed is most likely more than one million.
This is five times more than the estimates of killings in Darfur and even more than the genocide in Rwanda 13 years ago.
The estimate of more than one million violent deaths in Iraq was confirmed again two months ago in a poll by the British polling firm Opinion Research Business, which estimated 1,220,580 violent deaths since the US invasion. This is consistent with the study conducted by doctors and scientists from the Johns Hopkins University School of Public Health more than a year ago. Their study was published in the Lancet, Britain's leading medical journal. It estimated 601,000 people killed due to violence as of July 2006; but if updated on the basis of deaths since the study, this estimate would also be more than a million. These estimates do not include those who have died because of public health problems created by the war, including breakdowns in sewerage systems and electricity, shortages of medicines, etc.
Amazingly, some journalists and editors - and of course some politicians - dismiss such measurements because they are based on random sampling of the population rather than a complete count of the dead. While it would be wrong to blame anyone for their lack of education, this disregard for scientific methods and results is inexcusable. As one observer succinctly put it: if you don't believe in random sampling, the next time your doctor orders a blood test, tell him that he needs to take all of it.
The methods used in the estimates of Iraqi deaths are the same as those used to estimate the deaths in Darfur, which are widely accepted in the media. They are also consistent with the large numbers of refugees from the violence (estimated at more than four million). There is no reason to disbelieve them, or to accept tallies such as that the Iraq Body Count (73,305 - 84,222), which include only a small proportion of those killed, as an estimate of the overall death toll.
Of course, acknowledging the holocaust in Iraq might change the debate over the war. While Iraqi lives do not count for much in US politics, recognizing that a mass slaughter of this magnitude is taking place could lead to more questions about how this horrible situation came to be. Right now a
convenient myth dominates the discussion: the fall of Saddam Hussein simply unleashed a civil war that was waiting to happen, and the violence is all due to Iraqis' inherent hatred of each other.
In fact, there is considerable evidence that the occupation itself - including the strategy of the
occupying forces - has played a large role in escalating the violence to holocaust proportions. It is in the nature of such an occupation, where the vast majority of the people are opposed to the
occupation and according to polls believe it is right to try and kill the occupiers, to pit one ethnic group against another. This was clear when Shiite troops were sent into Sunni Fallujah in 2004; it is obvious in the nature of the death-squad government, where officials from the highest levels of the Interior Ministry to the lowest ranking police officers - all trained and supported by the US military - have carried out a violent, sectarian mission of "ethnic cleansing." (The largest proportion of the killings in Iraq are from gunfire and executions, not from car bombs). It has become even more obvious in recent months as the United States is now arming both sides of the civil war, including Sunni militias in Anbar province as well as the Shiite government militias.
Is Washington responsible for a holocaust in Iraq? That is the question that almost everyone here
wants to avoid. So the holocaust is denied.

Mark Weisbrot is Co-Director and co-founder of the Center for Economic and Policy Research. He
received his Ph.D. in economics from the University of Michigan. He is co-author, with Dean Baker, of Social Security: The Phony Crisis (University of Chicago Press, 2000), and has written numerous
research papers on economic policy. He is also president of Just Foreign Policy.http://www.thirdworldtraveler.com/Iraq/US_Holocaust_Den...

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2. and another...

Iraq Death Toll Rivals
Rwanda Genocide, Cambodian Killing Fields
By Joshua Holland
AlterNet
September 17, 2007
http://www.globalpolicy.org/security/issue...
According to a new study, 1.2 million Iraqis have met violent deaths since the 2003 invasion, the
highest estimate of war-related fatalities yet. The study was done by the British polling firm ORB,
which conducted face-to-face interviews with a sample of over 1,700 Iraqi adults in 15 of Iraq's 18
provinces. Two provinces -- al-Anbar and Karbala -- were too dangerous to canvas, and officials in a third, Irbil, didn't give the researchers a permit to do their work. The study's margin of error was plus-minus 2.4 percent. Field workers asked residents how many members of their own household had been killed since the invasion. More than one in five respondents said that at least one person in their home had been murdered since March of 2003. One in three Iraqis also said that at least some neighbors "actually living on street" had fled the carnage, with around half of those having left the country. In Baghdad, almost half of those interviewed reported at least one violent death in their household.
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These numbers suggest that the invasion and occupation of Iraq rivals the great crimes of the last century -- the human toll exceeds the 800,000 to 900,000 believed killed in the Rwandan genocide in 1994, and is approaching the number (1.7 million) who died in Cambodia's infamous "Killing Fields" during the Khmer Rouge era of the 1970s.
While the stunning figures should play a major role in the debate over continuing the occupation, they probably won't. That's because there are three distinct versions of events in Iraq -- the bloody criminal nightmare that the "reality-based community" has to grapple with, the picture the commercial media portrays and the war that the occupation's last supporters have conjured up out of thin air.

Similarly, American discourse has also developed three different levels of Iraqi casualties. There's the approximately 1 million killed according to the best epidemiological research conducted by one of the world's most prestigious scientific institutions, there's the 75,000-80,000 (based on news reports) the Washington Post and other commercial media allow, and there's the clean and antiseptic blood-free war the administration claims to have fought (recall that they dismissed the Lancet findings out of hand and yet offered no numbers of their own). Here's the troubling thing, and one reason why opposition to the war isn't even more intense than it is: Americans were asked in an AP poll conducted earlier this year how many Iraqi civilians they thought had been killed as a result of the invasion and occupation, and the median answer they gave was 9,890. That's less than a third of the number of civilian deaths confirmed by U.N. monitors in 2006 alone.
According to a 2005 report by Lt. Col. Dean Mengel at the Army War College, the number of rounds being fired off is enormous: noted that the Army estimated it would need 1.5 billion small arms rounds per year, which was three times the amount produced just three years earlier. In another, it was noted by the Associated Press that soldiers were shooting bullets faster than they could be produced by the manufacturer. 1.5 billion rounds per year …
Given that the estimated number of active insurgents in Iraq has never exceeded 30,000 -- and is usually given as less than 20,000 -- that leaves a lot of deadly lead flying around. Everyone agrees that the U.S. soldier is the best-trained fighter on earth, so it's somewhat bizarre that war supporters believe their shots rarely hit anybody.
Joshua Holland is an AlterNet staff writer.