Study estimates 655,000 excess Iraqi deaths since start of war

An estimated 655 000 more Iraqis have died as a consequence of the March 2003 military invasion of Iraq than would have been expected in a non-conflict situation, according to an Online/Article published today (Thursday October 12, 2006) by The Lancet.

In October 2004, The Lancet published a paper which estimated that nearly 100 000 excess deaths had happened in Iraq between March 2003 to September 2004 because of the invasion of military forces (See Lancet 2004; 364: 1857–64). In the latest study, Gilbert Burnham (Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA) and colleagues updated this estimate by assessing deaths in the post-invasion period - March 2003 to June 2006 - and comparing these with deaths in the pre-invasion period - January 2002 to March 2003.

The researchers randomly selected 47 sites across Iraq which contained a total of 1849 households and 12 801 household members. Each household was surveyed about births, deaths, in-migration, and out-migration between May and June this year. When there had been a death in the household, the interviewers asked about the cause of death and requested to see a copy of the death certificate. In 92% of cases, a death was confirmed by a death certificate. The team did not ask interviewees whether the people they reported dead were civilians or combatants.

The study found that of the 629 deaths reported, 547 (87%) were in the post-invasion period compared with 82 (13%) in the pre-invasion period. The mortality rate pre-invasion was 5.5 per 1000 people per year, while post-invasion this rose to 13.3 per 1000 people per year. This doubling of baseline mortality rate constitutes a humanitarian emergency, state the authors.

The researchers estimate that as a consequence of the coalition invasion, an additional 654 965 (ranging from 392 979 – 942 636) Iraqis have died above what would have been expected on the basis of the pre-invasion mortality rate.

The investigators found that the excess mortality could mainly be attributed to an increase in the rate of violent deaths, which has risen every year post-invasion. Of the 655 000 excess deaths estimated, around 601 000 would have been due to violent causes. Most violent deaths were due to gunshots (56%). Air strikes, car bombs, and other explosions each accounted for 13-14% of violent deaths. Deaths attributable to the coalition forces accounted for 31% of post-invasion violent deaths. The study found that while the proportion of deaths ascribed to coalition forces has diminished in 2006, the actual numbers have increased every year since the start of the war.

Additionally, when the researchers applied the mortality rates reported in this study to the period of the 2004 survey they found that it gave an estimate of 112 000 excess deaths in Iraq. Therefore the data presented here validates the results of the 2004 study, state the authors.

The authors conclude: "We estimate that almost 655 000 people--2•5% of the population--have died in Iraq. Although such death rates might be common in times of war, 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."

In an accompanying Comment, Richard Horton, Editor of The Lancet, states: "The natural response to this deteriorating situation is despair. Military action in Iraq has dragged on, inflaming an already volatile atmosphere. Diplomacy seems to have broken down…Yet 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, around health and well-being in addition to the protection of territorial boundaries and economic stability. Health is now the most important foreign policy issue of our time. Health and well-being – their underpinning values, their diverse array of interventions, and their goals of healing – offer several original dimensions for a renewed foreign policy that might at least be one positive legacy of our misadventure in Iraq."

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EARLY ONLINE PUBLICATION: Thursday October 12, 2006.

EMBARGO: 00:01H (London time) Thursday October 12, 2006. In North America the embargo lifts at 18:30H ET Wednesday October 11, 2006.

Contact: Tim Parsons Director, Public Affairs, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street/E3144, Baltimore, MD 21205-2179. T) 410-955-7619 tmparson@jhsph.edu

The Lancet press office T) +44 (0) 207 424 4949/4249 / 07798 882 308 pressoffice@lancet.com


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