100,000

[PrincessFiona]

The new Lancet article (medical journal) out estimates the Iraqi civilian death toll since the invasion at 100,000 They did a comprehensive household survey to get this data.

That is a huge number...I have been freaked out about it since I read it....I think this is something that knows no party lines...it's just sad.

kris

[SueC]

Oh my gosh, that is horrible! Everytime I hear on the news about the Iraqi deaths I'm relieved it isn't more of our guys, but saddened since I know there are regular people just like us living and working over there.

[Rapunzel]

Ahhh, good propaganda at it's finest. Here's some perspective:

http://www.techcentralstation.com/102904J.html

"The risk of death was estimated to be 2.5-fold (95% CI 1.6-4.2) higher after the invasion when compared with the preinvasion period. Two-thirds of all violent deaths were reported in one cluster in the city of Falluja. If we exclude the Falluja data, the risk of death is 1.5-fold (1.1-2.3) higher after the invasion. We estimate that 98 000 more deaths than expected (8000-194 000) happened after the invasion outside of Falluja and far more if the outlier Falluja cluster is included. The major causes of death before the invasion were myocardial infarction, cerebrovascular accidents, and other chronic disorders whereas after the invasion violence was the primary cause of death. Violent deaths were widespread, reported in 15 of 33 clusters, and were mainly attributed to coalition forces. Most individuals reportedly killed by coalition forces were women and children. The risk of death from violence in the period after the invasion was 58 times higher (95% CI 8.1-419) than in the period before the war."



Have a look at those confidence levels. Yup, 95%. That is, a one in twenty chance that the effect simply does not exist. Look at the relative risk ratios (leave out Falluja; I don't think anyone is really very surprised to see a higher mortality rate there): 1.1-2.3. It isn't just that it is an absurdly wide one (note, a relative risk ratio of 1 would mean no effect whatsoever) it is that if this paper was written to generally accepted statistical standards it would never have been published. With a 95% confidence level a relative risk ratio of anything less than three is regarded as statistically insignificant. Just to clarify that, by "insignificant" no one is stating that it is not important to those people who undoubtedly have been killed during the War. What is being said is that we don't have enough information to be able to say anything meaningful about it. "Statistically insignificant" means "we don't know".



In effect, what has been found in this paper is nothing. Nada. Zip.

It might be helpful to know the above before you swallow a headline hook, line, and sinker....

Jennifer

[Rapunzel]

I might add, the Lancet decided NOT to take the customary route of lengthy review prior to publication for the article it published. Instead it did a fairly odd "fast-tracking" of the piece. It would normally take an article months to reach publication - but the Lancet apparently felt it was necessary to get this out ASAP in late October - and, despite the fact that it was not exactly scientificly solid information being provided in the article.

It's a shame that medical journals are now entering the world of presidential politics. Just another circle around the flushing toiletbowl....

Jennifer

This, however, is probably the best estimate we can get since the Bush administration refuses to even engage in a count.

[PrincessFiona]

The actual discussion section of the paper. Here the authors discuss both the limitations of their findings and how the deaths could have been both over-under reported. :

Discussion
This survey indicates that the death toll associated with the invasion and occupation of Iraq is probably about 100 000 people, and may be much higher. We have shown that even in extremely difficult circumstances,
the collection of valid data is possible, albeit with limited precision. In this case, the lack of precision does not
hinder the clear identification of the major public-health problem in Iraq?violence.

Several limitations exist with this study. Most importantly, the quality of data about births, deaths, and household composition is dependent on the accuracy of the interviews. We attempted to confirm two non-infant deaths per cluster, but in four of the 33 clusters no noninfant
deaths were reported, and in some clusters
interviewers confirmed deaths in more than two households. In 63 of 78 (81%) households where confirmations were attempted, respondents were able to
produce the death certificate for the decedent. When households could not produce the death certificate,
interviewers felt in all cases that the explanation offered was reasonable?eg, the death had been very recent, the certificate was locked away and only the husband who
was not home had the key. We think it is unlikely that deaths were falsely recorded. Interviewers also believed that in the Iraqi culture it was unlikely for respondents
to fabricate deaths.

It is possible that deaths were not reported, because
families might wish to conceal the death or because
neonatal deaths might go without mention. In other
settings, under-reporting of neonatal and infant deaths
in similar surveys has been documented.18,19 In
particular, the further back in time the infant death
occurred, the less likely it was to be reported. The recall
period of this survey, 2.7 years, was longer than most
surveys of crude mortality. Thus, infant deaths from
earlier periods might be under-reported, and recent
infant deaths might be more readily reported, producing
an apparent but spurious increase in infant mortality.
We do not think that this is a major factor in this survey
for two reasons. First, the preconflict infant mortality
rate (29 deaths per 1000 livebirths) we recorded is
similar to estimates from neighbouring countries.20
Second, the January, 2002, to March, 2003, rate applied
to the 366 births recorded in the interview households
post-invasion would project 10.4 infant deaths, whereas
we noted 21 to have happened. Of these, three were
attributed to coalition bombings and three to births at
home when security concerns prevented travel to
hospital for delivery. Thus, most of the increase in infant
mortality is plausibly linked to the conflict, although we
acknowledge the potential for recall bias to create an
apparent increase in infant mortality.

We believe it unlikely that recall bias existed in the
reporting of non-infant deaths, because of the certainty
and precision with which these deaths were reported,
and the importance of burial ceremonies in the Iraqi
culture. The under-reporting of adult deaths recently or
since the invasion to hide combatant deaths would lead
us to underestimate the death toll associated with the
invasion and occupation of Iraq.

Possibly, respondents did not accurately describe the
composition of their households. Although certain
individuals might wish to remain hidden, the study team
thought that respondents would claim to have more
household members than were actually present to justify
more ration distributions. This would have the effect of
lowering mortality estimates and thus lowering our
estimate of the death toll associated with this conflict.
Finally, the sampling strategy somehow might not
have captured the overall mortality experience in Iraq.
This could occur through one of two mechanisms. First,
the use of government population estimates and the
selection of households might have under-represented
groups such as the homeless, transients, and military
personnel. The requirement that the deceased reside in
the house for more than 2 months directly before the
date of death probably excluded most military casualties.

Second, as Spiegel and colleagues documented in
Kosovo,21 there can be a dramatic clustering of deaths in
wars where many die from bombings. The cluster survey
methodology we used may have, by chance, missed
small areas where a disproportionate number of deaths
occurred, or conversely, selected a neighbourhood that
was so severely affected by the war that it represents
virtually none of the population and thus has skewed the
mortality estimate too high. The results from Falluja
merit extra consideration in this regard.

Falluja was atypical, and perhaps a problematic cluster
in three respects. First, it was probably the most violent
city in Iraq at the time of the survey. Falluja was the only
cluster where GPS units could not be used to find the
random starting point. These devices have military uses
and their possession resulted in the imprisonment and
death of many Iraqis during the previous regime. Since
interviewers were stopped and searched repeatedly
getting into Falluja, the use of a GPS unit could have
resulted in the killing of interviewers. Stopping a car in
Falluja at a random point at the date of the visit (Sept 20)
and walking away from it was also likely to result in the
killing of interviewers. For Falluja, the team assumed an
approximate size of the town. They picked a distance
down a main road and a number of blocks to the side
based on random number selection. Interviewers walked
the final 700 m estimating the distance. This presents
the potential of subconscious or other forces influencing
the selection of the starting point.

Second, at all sites, only 64 households (<8%) were
recorded as empty at the time of our visit, and none were
abandoned after all or most of the residents had died. In
Falluja, 23 households of 52 visited (44%) were either
temporarily or permanently abandoned. Neighbours
interviewed described widespread death in most of the
abandoned houses but could not give adequate details for
inclusion in the survey. This presents the possibility that
far more deaths had occurred than were reported and the
interviewees that remained were the relatively lucky ones
(underestimating mortality), or large numbers of
residents had fled elsewhere and were still alive. Thus,
the deaths reported by the remaining families might
represent a disproportionate number of deaths from the
larger community that used to live in the area, leading
the interview data to overestimate mortality.

Third, interviewers might, by chance, have gone to an
atypical area for the Falluja cluster. We do not believe
this to be the case. In the random selection process,
other heavily damaged cities such as Ramadi, Najaf, and
Tallafar were not selected. Moreover, the cluster in
Thaura (Sadr City), the site of the most intense fighting
in Baghdad, by random chance was in an unscathed
neighbourhood with no reported deaths from the
months of recent clashes. In Falluja, the team noted that
vast areas of the city had been devastated to an equal or
worse degree than the area they had randomly chosen to
survey. We suspect that a random sample of 33 Iraqi
locations is likely to encounter one or a couple of
particularly devastated areas. Nonetheless, since 52 of 73
(71%) violent deaths and 53 of 142 (37%) deaths during
the conflict occurred in one cluster, it is possible that by
extraordinary chance, the survey mortality estimate has
been skewed upward.

To account for the potential that the Falluja data are
profoundly skewing the mortality estimate or the
potential that there is a recall bias in the infant
mortality data, a lowest plausible death toll has been
calculated excluding the Falluja data and assuming that
half the measured increase in infant mortality has been
an artifact of selective recall. Removing half the
increase in infant deaths and the Falluja data still
produces a 37% increase in estimated mortality. The
inclusion of this estimate does not mean that
investigators believe that either bias has occurred.
Instead, this estimation reflects the concern that
investigators cannot fully discard the potential for bias
from these two factors.

The increase in reported infant mortality among
interviewed households is consistent with a well
documented pattern seen in armed conflict.22,23 Many
mothers reported that security concerns led them to
deliver their children at home since the invasion. It is
surprising that beyond the elevation in infant mortality
and the rate of violent death, mortality in Iraq seems
otherwise to be similar to the period preceding the
invasion. This similarity could be a reflection of the
skill and function of the Iraqi health system or the
capacity of the population to adapt to conditions of
insecurity.

Passive surveillance systems often have low sensitivity,
and the fact that the estimate of coalition casualties from
http://www.iraqbodycount.net is a third to a tenth the
estimate reported in this survey should be of little
surprise. What is particularly revealing about the
Iraqbodycount.net system is that, as a monitor of trends,
it closely parallels the results found in this survey: most
casualties arose after the end of major hostilities in May,
2003, and the rate of civilian deaths has been rising in
recent months. This finding indicates that passive
media-based monitoring should have a role in future
conflicts where the collection of health data is not
practical. However, it should be used as a monitor of

trends rather than as a count estimator, as
Iraqbodycount.net has been most commonly cited in the
media.14

Despite widespread Iraqi casualties, household
interview data do not show evidence of widespread
wrongdoing on the part of individual soldiers on the
ground. To the contrary, only three of 61 incidents (5%)
involved coalition soldiers (all reported to be American
by the respondents) killing Iraqis with small arms fire.
In one of the three cases, the 56-year-old man killed
might have been a combatant. In a second case, a
72-year-old man was shot at a checkpoint. In the third,
an armed guard was mistaken for a combatant and shot
during a skirmish. In the latter two cases, American
soldiers apologised to the families of the decedents for
the killings, indicating a clear understanding of the
adverse consequences of their use of force. The
remaining 58 killings (all attributed to US forces by
interviewees) were caused by helicopter gunships,
rockets, or other forms of aerial weaponry.

Many of the Iraqis reportedly killed by US forces could
have been combatants. 28 of 61 killings (46%) attributed
to US forces involved men age 15?60 years, 28 (46%)
were children younger than 15 years, four (7%) were
women, and one was an elderly man. It is not clear if the
greater number of male deaths was attributable to
legitimate targeting of combatants who may have been
disproportionately male, or if this was because men are
more often in public and more likely to be exposed to
danger. For example, seven of 12 (58%) vehicle accidentrelated
fatalities involved men between 15 and 60 years
of age.

US General Tommy Franks is widely quoted as saying
?we don?t do body counts?.14 The Geneva Conventions
have clear guidance about the responsibilities of
occupying armies to the civilian population they control.
The fact that more than half the deaths reportedly
caused by the occupying forces were women and
children is cause for concern. In particular, Convention
IV, Article 27 states that protected persons ?. . . shall be
at all times humanely treated, and shall be protected
especially against acts of violence . . .?. It seems difficult
to understand how a military force could monitor the
extent to which civilians are protected against violence
without systematically doing body counts or at least
looking at the kinds of casualties they induce. This
survey shows that with modest funds, 4 weeks, and
seven Iraqi team members willing to risk their lives, a
useful measure of civilian deaths could be obtained.
There seems to be little excuse for occupying forces to
not be able to provide more precise tallies. In view of the
political importance of this conflict, these results should
be confirmed by an independent body such as the
ICRC, Epicentre, or WHO. In the interim, civility and
enlightened self-interest demand a re-evaluation of the
consequences of weaponry now used by coalition forces
in populated areas.

A 95% confidence interval actually means that there is a 5% chance that the death toll is not up by 60%.


Let's just say that the 100,000 people is overinflated. iraqbodycount admits to underreporting...so...let's double the iraq body count estimates and say that there are 35-40,000 innocent Iraqis who have died. Is that number ok? 3000 people died at the hands of bin Laden (not from Iraq or related to Iraq btw) and we were rightly outraged. The familes and our country continue to mourn the loss of those completely innocent lives.

We went into Iraq to rid them of their wmds...which didn't exist....after being attacked by AlQaeda from Afghanistan. We ignored the pleas of other countries to slow down and demonized americans who also felt we should wait for all of the evidence to come in. Then we said we went into Iraq to liberate them from a dictator (forget the many dictators around the world..think N. Korea who 1. admitted to building nukes and where 2.pregnant women who try and escape the country are held in concentration camps and are forced to watch as their babies are then killed in front of them after birth). If we have only killed 35,000 Iraqi civilians, imagine the outrage. I would be outraged if a country came in to liberate my family...and then...killed and mamed 1/2 of my family.

For a better number value, we should just turn to the estimates given by our own government....except of course, they don't exist. That is a clear breech of the Geneva Convention, which we support only when we don't have to follow it.

cheers...and thanx for the debate.


kris

[DCJenn]

The reality is that it doesn't really matter whether it's 100,000 or 80,000 or 150,000. What matters is that we are at the minimim, partially responsible for these deaths. (in same cases, wholly responsible)

The argument that Saddam Hussein was also responsible for the deaths of his people is valid.

It is sad. It's also sad that genocide is occurring in the Sudan and that the people of North Korea are starving to death. It's sad that there are Americans with no jobs and no way to support their families, and that there are people still being jailed for expressing opinions all over the world. It's said that women are second class citizens more places than not.

So, my point is that to politicize the obvious subverts the tragedy. What difference does it make how many people were killed? Come on, the fact that there were ANY should make ALL of us stop and think. Whether or not you support the war, and the various reasons why we are there, the fact is that it's a high price to pay. and whether it is worth the price, isn't for any of us to say. We aren't there, and hopefully won't be while the conflict continues.

Jenn

PS- as much as the Washington Post is the 'liberal' newpaper in town, the Washington Times is conservative. The agenda with the Times is also to put a positive spin on the Moonies, as it is owned by the good Reverend himself.

[Rapunzel]

My point is that this article IS political ammunition. What will be quoted by newssources is exactly what Kris stated in her original post: a sensational, over-inflated number without explanation.

The bottom line is that if you look at the author's own words you see that these deaths are directly attributable to Iraqis themselves and imported terrorist fighters. In fact, there really isn't even a good, solid number available on if the tens of thousands who have died are mostly enemy combatants. Why do mothers feel too scared to deliver in hospitals? Because in some areas there are violent men willing to draw U.S. forces into densely populated areas (ie that's where they start shooting U.S. forces and where they run when they are pursued).

It's absolutely sickening that a people will do this to their own civilians. But, of course, we know there has been a general lack of humanity in Iraq for a very long time. It's awful that there are so many innocents suffering because of the horrendous acts of their countrymen who fight harder the closer they get to having real elections in their nation....

I do believe that this article is meant to be political fodder. The timing of the article coupled with it's "fast track" publication are suspect. Combine that with the obvious sensationalized reaction of those who are looking to jump on any reason to attack Bush's decision to invade Iraq (ahem, Kris) and you get politics as usual. When viewed in perspective any increase in deaths in Iraq is obvious - there are a number of people loyal to Hussein who have been killed and tons of "imported" terrorists who are being targeted. Couple that with the civilian deaths caused by terrorist tactics and it just doesn't take a brain surgeon (haha) to figure out that we should expect additional deaths in Iraq. That's not how the spin is going to happen though, just look at the posts on this thread for example....

And, you're NOT going to hear on the news that the 100,000 number cited is most likely incorrect both statistically and when viewed with other available data. You didn't get that little bit of information from the original post - until I pointed out the details of the article, only THEN did the actual facts (rather than sensationalized and politicized statements) get aired. It's the same thing with news organizaitons looking for sensational headlines....

Jennifer