Human cost of U.S. invasion of Iraq revealed

A scientific article just published in the prestigious British medical journal, The Lancet, reports that the Iraqi death rate more than doubled for the period after the U.S. invasion in March 2003 compared to the period before, starting from January 2002. This led to an estimate that over 650,000 have died because of the invasion and occupation. Of these an estimated 600,000 were violent deaths.

These estimates far exceed the numbers that have been put forward by the U.S.-installed Iraqi government or by private organizations, including Iraq Body Count. While the earlier “counts” were based on highly selective, partial accounts, the Lancet study is based on systematic and rigorous survey and sampling methods that are widely used in public-health research.

Not surprisingly, the Bush administration has attacked the report as unreliable and exaggerated, with Bush himself saying, “It’s not credible.” The huge cost in Iraqi lives makes clear that the Bush administration, the Pentagon, the war profiteers like Halliburton and General Electric that support them and all the politicians and pundits that went along with the war are guilty of carrying out or supporting an enormous war crime. Since Bush promoted the criminal invasion with outright lies about non-existent weapons of mass destruction and false links of Iraq to 9/11, his credentials as an expert on credibility can hardly be taken seriously. However, some others without such obvious bias have also critiqued the study estimates.

Most attention has been given to the 650,000 number which the study authors present as the most likely specific number (known as a point estimate), within a range of 390,000 to 940,000 where the true number is likely to fall (known as a 95 percent confidence interval).

It is well known that any study that tries to estimate a large number, whether by counting or sampling, is subject to error. Even the U.S. Census, which expends huge resources to count all U.S. inhabitants, is widely believed to systematically undercount residents of poor communities and the undocumented. Election polls based on survey and sampling techniques often get the wrong answer.

Carrying out a systematic population survey in the chaotic, dangerous conditions of occupied Iraq is an enormous and difficult project. In the article, the authors acknowledge the limitations of their work and the possibility of error, but also present the detailed methods that indicate their estimate is likely to be as good an approximation as can be done under such circumstances.

Funding for the study was provided by the Massachusetts Institute of Technology (MIT). Three of the study authors are affiliated with the Johns Hopkins Bloomberg School of Public Health and one with the School of Medicine of Al Mustansiriya University. The authors had previously published a report estimating 100,000 excess deaths after the first 18 months of the invasion. This later study was based on a substantially larger sample.

The investigators randomly selected “clusters” of households (based on street and block locations within each of Iraq’s provinces proportional to the populations of those provinces as estimated by the Iraqi government Planning Ministry). Doctors fluent in both Arabic and English interviewed the households selected and asked who from that household had died during the study periods before and after the March 2003 invasion. A sample of 1849 households was interviewed.

Investigators were shown death certificates for 80 percent of the 629 reported deaths and over 98 percent of the sampled households responded. These are very high response rates. The investigators also took into account the clustering sampling method when making their statistical calculations to estimate the population numbers. These methods are much more likely to get a valid estimate than counting up haphazard, sporadic accounts from reporters or even morgues.

Four important aspects of the report have been largely overlooked. Critics point out that estimating large population numbers from relatively small samples can be seriously distorted by errors in the population estimates for the provinces and if the selection process did not yield a representative sample. However, the estimates of pre- and post-invasion death rates (the number who died per 1,000 per year), and particularly the relative rate, are much less susceptible to that problem.

These investigators report that overall the average rate more than doubled, from 5.5 per 1000 per year before to 13.3 per 1000 per year after the invasion; this average includes a doubling from the 2004-2005 rate of 10.9 to the 2005-2006 rate of 19.8. Even more important is that the base rate used for comparison already includes a very big increased mortality that had been taking place for the 13 years of sanctions that lasted from 1990 through 2003.

These sanctions spanned the first U.S. war against Iraq under Bush’s father George H.W. Bush, and continued through both Clinton terms and the first two years of the current Bush administration. U.N. agencies and others have estimated that between 500,000 and 1,500,000 died from the sanctions prior to the 2003 invasion. These deaths were primarily due to disease, contaminated water, destroyed sanitation and sewage and inadequate food and medicine supplies, and were mostly among newborns, young children and the elderly.

The current excess deaths, in contrast, are predominantly by violence (gunshots and bombings) and mostly among young adult males. The health emergency that started during the sanctions and that has affected the youngest and oldest, continues, and has even increased as indicated by the current study’s estimate of non-violent excess deaths that are over and above those of the period in the midst of the sanctions.

Thirdly, these estimates are only regarding deaths. The very large number of people who have been severely maimed and psychologically scarred has not even been estimated. While some attention has been given to Gulf War Syndrome-type illnesses of returning U.S. veterans with evidence of illness from unknown environmental exposures, the impact of the environmental disaster of the war and the sanctions on the people of Iraq has not been estimated. Finally, it is also quite possible that the current study underestimates the true mortality total.

No matter what that true numbers are, what is very, very clear is that hundreds of thousands of Iraqi people, mostly non-combatants, have died and even more have suffered due to the criminal invasion and occupation by the U.S., Britain and their imperialist allies. What remains to be seen is how these war criminals will be held accountable.

The complete text of the Lancet study can be seen online at: www.thelancet.com

Hillel Cohen is an epidemiologist and doctor of public health.