Sarah Boseley, health editor / Guardian – 2008-01-10 20:51:42
LONDON (January 10, 2008) — An estimated 151,000 Iraqi civilians have been killed in the violence that has engulfed the country from the time of the US-led invasion until June 2006, according to the latest and largest study of deaths officially accepted by the Iraqi government.
The figures come from a household survey carried out by the World Health Organisation and the Iraqi health ministry. They are substantially lower than the 601,027 death toll reported by US researchers in 2006 in the Lancet using similar study methods, but higher than the Iraq Body Count’s (IBC) register – based on press reports – of 47,668.
The authors of the WHO/Iraqi study, published last night in the New England Journal of Medicine, say that the new number, which could be anywhere between 104,000 and 223,000 allowing for misreporting, “points to a massive death toll in the wake of the 2003 invasion and represents only one of the many health and human consequences of an ongoing humanitarian crisis”.
The Iraqi health minister, Dr Salih Mahdi Motlab Al-Hasanawi, said it was very important for the government to have reliable data on violent deaths. “There is controversy about reports from the media,” he said. Some of the information that has been published “may be used or misused for political reasons and so on”. The survey also collected data on the health of the population and availability of healthcare needed by the government.
The survey from the Iraqi Family Health Survey Group was carried out by trained employees of the health ministry who visited 10,860 households – 10 from each of more than 1,000 clusters across the 18 provinces of Iraq. Because of the insecurity, 115 (11%) of the clusters could not be visited – mostly in Anbar and Baghdad – so calculations were made to account for the probable number of deaths in those places. Researchers asked heads of households if there had been any deaths in the two years before or three years after the invasion in 2003.
Account was taken of under-reporting of deaths, which is usual in household surveys, not least because families often move when somebody dies. The survey also allowed for the out-migration of up to 2 million people between March 2003 and June 2006.
It found that 151,000 civilians died due to the conflict, which does not include accidents, suicides or deaths from disease. Unlike the Lancet study, it found no big increase in mortality across the three years. In 2003-4, 128 people died every day, in 2004-5 it dropped to 115 and in 2005-6 it rose again to 126. The daily death rates, according to the Lancet study, rose from 231 to 491 to 925.
Although the new figure is four times lower than the Lancet study, its authors, Gilbert Burnham and colleagues from Johns Hopkins University, believe their count of more than 600,000 is correct.
Les Roberts, one of the US authors who is now a professor in forced migration and health at Columbia University, said he was delighted to see the Iraqi government had accepted higher mortality figures. In June 2006 the government was relying on the IBC figure, which was 41,000. “For this to be coming from the Iraqi government is really healthy,” he said.
It was also good for science that new studies were being carried out. “But I think there is overwhelming evidence that their estimate is too low.”
The WHO/Iraqi study showed a doubling of the rate of violent deaths while the Lancet study showed a trebling. “Fundamentally, these studies are less different than people are thinking.” But the US team’s data was more accurate because all deaths were validated with death certificates. The health ministry admitted in the new paper that its figures before the invasion were too low, he said, which had also led to insufficient adjustment.
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Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey
Gilbert Burnham, Riyadh Lafta, Shannon Doocy, Les Roberts / The Lancet
Published online October 11, 2006
Background An excess mortality of nearly 100 000 deaths was reported in Iraq for the period March, 2003–September, 2004, attributed to the invasion of Iraq. Our aim was to update this estimate.
Between May and July, 2006, we did a national cross-sectional cluster sample survey of mortality in Iraq.
50 clusters were randomly selected from 16 Governorates, with every cluster consisting of 40 households. Information on deaths from these households was gathered.
Three misattributed clusters were excluded from the final analysis; data from 1849 households that contained 12 801 individuals in 47 clusters was gathered. 1474 births and 629 deaths were reported during the observation period. Pre-invasion mortality rates were 5·5 per 1000 people per year (95% CI 4·3–7·1), compared with 13·3 per 1000 people per year (10·9–16·1) in the 40 months post-invasion.
We estimate that as of July, 2006, there have been 654 965 (392 979–942 636) excess Iraqi deaths as a consequence of the war, which corresponds to 2·5% of the population in the study area. Of post-invasion deaths, 601 027 (426 369–793 663) were due to violence, the most common cause being gunfire.
Interpretation The number of people dying in Iraq has continued to escalate