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More Iraq civilian deaths seen in study

Lancet report based on family interviews

WASHINGTON -- The first nationwide survey of Iraqi deaths since the US-led invasion concludes that about 100,000 people have died as a result of the war, including many women and children killed in coalition airstrikes.

The study last month by researchers at Johns Hopkins University, Columbia University, and Al-Mustansiriya University in Baghdad, based on interviews with about 800 randomly selected Iraqi households, derived an estimated Iraqi death toll at least three times higher than previous estimates based on media reports. The study found that the risk of death in the 18 months since the war began was 1 to 2 times higher than in the 14-month period before the war, and the risk of a violent death was 58 times higher.

"Making conservative assumptions, we think that about 100,000 excess deaths, or more, have happened since the 2003 invasion of Iraq," the medical team concluded. "Violence accounted for most of the excess deaths and airstrikes from coalition forces accounted for most violent deaths . . . the majority being violent death among women and children relating to military activity."

The authors cautioned that the study had built-in limitations: It sampled only a relatively small number of households, and team members were prevented from visiting some areas of the country due to the continuing violence.

But the study went through formal academic reviews by peers, and represents the most ambitious attempt so far to chart Iraqi casualties, which the US military says it does not compile.

The report, to be published today in the British medical journal The Lancet, said that most of the deaths were the result of bombing or rocket attacks rather than caused by soldiers on the ground. The lead author was Les Roberts of the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Roberts told the Associated Press he pushed to have the study published before the presidential election because he wanted voters to have the information before making their choice, and so that they would hold the candidates accountable for their Iraq policies.

"Civilian mortality since the war has risen due to the effects of aerial weaponry," said Dr. Richard Horton, editor of the journal and a forceful public opponent of the Iraq war. "Winning the peace now demands a thorough reappraisal of strategy and tactics to prevent further unnecessary human casualties."

News reports and several nongovernmental organizations have previously estimated that between 10,000 and 30,000 Iraqis have died.

The Pentagon yesterday did not respond to several requests to comment directly on the casualty study.

The researchers randomly selected 33 clusters of 30 households each for interviews by Iraqi researchers working with the Johns Hopkins team. Some houses were empty, and a few declined to talk. In the end, the researchers interviewed 808 households.

"We have shown that collection of public-health information is possible even during periods of extreme violence," the study said. "Our results need further verification and should lead to changes to reduce noncombatant deaths from air strikes."

According to the interviews, the main causes of death before the war were heart attacks, strokes, and other illnesses. After the outbreak of warfare, a far greater proportion of the deaths were caused by violence. The households reported 46 deaths in the 14 months before the war and 142 deaths in the last 18 months since the invasion. Excluding the results from the battle-scarred city of Fallujah, the total was 89 deaths in that period, a rate 1 times higher than before the war; including the Fallujah figures, the rate was 2 times higher.

Researchers who have done wartime casualty estimates agreed that the study is imprecise, but said they were impressed with the team's thoroughness under difficult working conditions.

For example, the team led by Johns Hopkins checked government records to confirm 78 of the deaths reported by those families.

"It's an incredibly important paper," said Dr. Roberta White, chairwoman of the environmental health department at Boston University School of Public Health. "They did a scientific study in a short period of time. They were careful and conservative in making their estimate . . . and they were able to do this when other people were saying we can't figure out how many people died."

Furthermore, the study acknowledged that the data the researchers gathered in the most violent of Iraqi cities -- Fallujah -- might skew the results, and the calculations exclude the Fallujah statistics in estimating 100,000 deaths in the last 18 months. The study adds that "this estimate would be much higher if Fallujah data are included."

Dr. Vincent Iacopino, the Nevada-based research director for Physicians for Human Rights, said wartime casualty estimates are always flawed, but they can reveal important truths. He led a team interviewing refugees from the war in Kosovo in the late 1990s that disproved Serbian claims that US bombing had caused most of the civilian casualties.

"Even though [the study] may be fraught with assumptions, as long as the assumptions are transparent, this is a very useful way to determine what has happened to these people," said Iacopino. "It raises the very real concern that more people have died than has been reported."

White, whose research centers on US soldiers who were victims of Gulf War syndrome in the 1991 conflict, said she was not concerned that the paper was published so quickly -- The Lancet printed the research less than a month after receiving it, lightning speed for an academic journal. White said the magazine has a fast-track review process for time-sensitive research, allowing independent scientists to review papers quickly.

The authors urged other scientists, public health specialists, and military officials in particular to continue analyzing the war's civilian death toll. "Our results need further verification and should lead to changes to reduce noncombatant deaths from airstrikes," said Roberts.

Bender reported from Washington and Allen from Boston. 

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