20,000
Civilians Injured in Iraq War
By
Hamit Dardagan, John Sloboda and Kay Williams
Iraq
Body Count Project
08 August, 2003
Extraction
of media-reported civilian injuries from the Iraq Body Count database
and archive of war reports provides evidence of at least 20,000 civilian
injuries on top of the maximum reported 7798 deaths. 8,000 of these
injuries were in the Baghdad area alone, suggesting that the full, countrywide
picture, as with deaths, is yet to emerge.
The Iraq Body Count
Project has never published a running total of injuries suffered in
the war because injuries encompass a scale from the grievous and incapacitating
to the light and fully recuperable, and in the absence of information
about severity it makes no sense to assign the same unit value to each
report of injury. But because injuries are not all comparable does not
mean that they can or should be excluded from an accounting of the human
costs of the war. On the contrary, the need to investigate and assess
them is especially urgent, for many of the injured may still be suffering
and their condition may be improved if we act promptly.
The protagonists
of the war have repeatedly claimed an inability to provide accurate
estimates of civilian deaths. Insofar as some casualties may have been
burned beyond recognition, pulverised into dust or buried quickly according
to Islamic custom and never officially recorded, there is indeed a possibility
that not every death can be accounted for. Injuries are another matter.
The injured are alive, perhaps receiving treatment, and the cause, nature
and extent of their injuries will appear in medical, official, and informal
records.
What follows is
Iraq Body Count (IBC)'s attempt to provide an overview of the scale
of the problem that needs to be tackled more directly by those who have
the means to do so. First we analyse what the IBC data-base can tell
us about civilian injuries in Iraq, and include various accounts of
injuries suffered during the course of the war to illustrate our general
conclusions. We then discuss the potential costs of compensation, and
argue that the occupying powers have a moral and humanitarian imperative
to meet those costs. It is our hope that they do not entirely lack the
will to do so--or if they do, that their citizenry will help them to
find it.
Data are derived
from over 300 press reports
IBC archivist Kay
Williams has undertaken a content-analysis of over 300 published reports
used to establish the 150 entries in the IBC data-base of civilian deaths
to July 6 2003. Every mention of injuries in these reports has been
extracted and tabulated. In IBC terminology, each line in the on-line
data-base is referred to as an incident, even though some entries cover
multiple incidents within a locality.
There is evidence
that the "precision" or highly-targeted bombing of Baghdad
in the early days of the conflict may have injured far more people than
were killed. Conversely, deaths in the ground war, particularly when
civilian cars were fired on by heavy machine guns or tanks, may have
seen the ratios reversed, with few escaping alive from the blazing wrecks.
However, taken across all phases and arenas of the war, injuries were
probably about 3 times more numerous than deaths.
Press and media
reports for 43 IBC incidents do not mention any injuries. It cannot
be inferred from this that no injuries occurred, simply that the journalists
or reporters concerned either had no access to information about injuries,
or were concentrating simply on deaths.
Civilian injuries
were mentioned in the press and media reports for 107 incidents. The
total maximum reported injuries across all 107 incidents is 19,733.
[1] This takes account of known double counting across different incidents
using much the same methodology as has been applied to reports of deaths
in the IBC database. This total should NOT however be considered comprehensive,
and is most likely an under-estimate because:
* Our data-base
includes only stories which include reports of civilian deaths. Stories
reporting injuries but no deaths are not included in our data-base.
* The present calculations
include only media and NGO reports published up to July 6, and in particular
do not include UNICEF's July 17 report [2] of more than 1,000 children
injured since the end of the war by unexploded ordnance;
* The injured may,
and likely will, have been under-reported during the war, for reasons
including their more rapid removal (for treatment) from the scene of
incidents.
These limitations
should be borne in mind and the present study considered a "first
count", not a final or complete accounting, of the war's civilian
wounded.
3 times as many
injuries as deaths have been reported
An informative statistic
for analysing and evaluating injuries is the RATIO of injuries to deaths
for a given incident. This ratio can be calculated by dividing the maximum
estimate of injuries by the maximum estimate of deaths. If there are
equal numbers of injuries to deaths, then this ratio is 1.0. If there
are twice as many injuries as deaths, this ratio is 2.0. If there are
twice as many deaths as injuries, this ratio is 0.5.
18 of the 107 incidents
had a injury-to-death ratio of less than 1.0, and 7 incidents had a
ratio of exactly 1.0. The remaining 82 incidents had an injury-to-death
ratio of greater than 1, with a maximum ratio of 69. This maximum ratio
was provided by 207 reported injuries and 3 reported deaths during massive
aerial bombardment of Baghdad on the night of 21-22 March (IBC incident
x009). Although the reports of injuries were provided by Iraqi government
sources, independent estimates from the Red Cross confirmed at least
100 injuries, which still represents a massive injury-death ratio of
33. This lends some support to the claims that parts of the air-war
(particularly in and around Baghdad) were conducted using precision-guided
munitions, where there were few deaths but many injuries from falling
and flying masonry, shrapnel etc. Most of the larger ratios were indeed
the result of aerial bombardment, relatively early in the campaign.
The smaller ratios typically come from the later ground war and "post-war"
conflict.
If one wished to
answer the question "what is a typical, or average" ratio
of injuries to deaths, there are two statistical averaging procedures
which might be used. One is the mean ratio (the mean is the sum of all
ratios divided by the number of incidents from which ratios could be
calculated). The mean injury-death ratio is 5.0 (in other words, 5 injuries
per death).
A second averaging
procedure is the median ratio. This is found by setting out all 107
ratios in ascending order, and picking the ratio which occurs at the
54th position (i.e. in the middle of the series). The median injury-death
ratio is 2.85 (in other words, around three injuries per death).
Often the mean and
the median of a set of scores are quite close to one another. The mean
tends to differ from the median when the distribution is statistically
skewed. The distribution of injury-death ratios in the IBC data base
is indeed skewed, with a small number of incidents having very high
injury-death ratios, which are not typical of the larger number of incidents.
Only 23 of the incidents have an injury-death ratio of greater than
6, with the majority of these being below 10. However the "top"
10 incidents have injury-death ratios, in ascending order, of 10.2,
13.1, 13.9, 16.2 16.6, 17.8, 20, 24, 45, and 69. These few incidents
skew the mean upwards.
In our view, the
more "typical" estimate is given by the median. This would
suggest that, on average, in a typical incident in this war, there were
about 3 injuries for every death. Multiplying the 7711 maximum reported
deaths (up to July 7th, 2003) by the median of 2.85 provides a figure
of 21,976, which might be considered a more accurate estimate of injuries
that takes into account the 43 database entries for which injuries were
not reported and other data absent from the IBC database, as noted earlier.
Many of the reports
of injuries are simply anonymous numbers. But Western journalists were
sometimes able to get close to the field of battle and report their
encounters with the wounded.
Heartbreaking details
Some of the most
horrific scenes followed coalition air raids in and around Hillah, where,
in the first days of April, the Red Cross reported dozens of civilians
killed and more than 450 wounded by aerial bombardment, including by
suspected cluster bombs. [3]
Robert Fisk was
among the Western journalists to visit the local hospital and report
on the aftermath:
"Heartbreaking
is the only word to describe 10-year-old Maryam Nasr and her five-year-old
sister Hoda. Maryam has a patch over her right eye where a piece of
bomblet embedded itself. She also had wounds to the stomach and thighs.
I didn't realise that Hoda, standing by her sister's bed, was wounded
until her mother carefully lifted the little girl's scarf and long hair
to show a deep puncture in the right side of her head, just above her
ear, congealed blood sticking to her hair but the wound still gently
bleeding. Their mother described how she had been inside her home and
heard an explosion and found her daughters lying in their own blood
near the door. The little girls alternately smiled and hid when I took
their pictures. In other wards, the hideously wounded would try to laugh,
to show their bravery. It was a humbling experience." [4]
Futher injuries
are, of course, being sustained after the cessation of bombing, by unexploded
munitions, many fired by US or UK forces:
"Karbala is
typical. At al-Hussein hospital, 35 bodies have been brought in since
the city fell April 6, many dismembered by a cluster-bomblet blast,
according to chief surgeon Ali Iziz Ali. An additional 50 have been
treated for fractures and deep, narrow puncture wounds, typical of the
weapons. Karbala civil-defense chief Abdul Kareem Mussan says his men
are harvesting about 1,000 cluster bombs a day in places Myers said
were not targets." [5]
UNICEF has recently
reported that more than 1,000 children have been injured by unexploded
ordnance since the end of the war, including by cluster bombs (and now
unguarded) Iraqi munitions, and emphasized that "the coalition
forces have a clear obligation under humanitarian law to remove these
dangers from communities." [2]
Despite "major
hostilities" having been declared over, Iraqi civilians are still
regularly being shot and injured by American and British troops. This
incident in Majar-al-Kabir is just one of literally scores of similar
incidents all over Iraq, notable only in that this time British troops
were involved:
"Most agree
that a local man, possibly a former Ba'ath party official, started shooting
with a handgun. The British then opened fire. 'It was about 10.15 and
the market was very crowded,' said Mr Younis. 'I threw myself on the
ground and shouted to everybody to run away or get down. The shooting
lasted for about five minutes but there were bullets going everywhere.
They were firing on automatic.' .At least 17 people were hit. They included
a 13-year-old girl caught by a ricochet in the shoulder and a nine-year-old
boy. Several other casualties have spinal injuries and multiple fractures.
In all, five men died from their wounds. As the wounded lay in the bazaar
the British soldiers drove away." [6]
And sometimes, like
these descriptive on-the-scene reports, even anonymous statistics provide
shocking glimpses of the war's toll of pain, horror and long-term suffering:
The Red Cross reported
from Baghdad that during its heaviest fighting the city's hospitals
were so overwhelmed by admissions that no one could any longer keep
an accurate count, but that one major hospital alone had been admitting
the war-wounded at a rate of about 100 patients an hour. [7] And in
one of the most heart-rending of statistics, another aid organization
reported just a month into the war that a hospital, situated in one
of the poorest parts of Baghdad, "had amputated more than 100 limbs
of children in that one month." [8]
When will the injured
see justice?
A sizeable if as
yet unknown proportion of Iraqi families will contain a relative whose
life was ended or put on hold by the US or British forces. Even if only
in self-interest, the US and UK administrations should be putting the
needs of the injured at the very heart of its strategy to "win
hearts and minds". Instead, along with deaths, the maimed civilians
of Iraq have been brushed under the carpet, with the exception of a
few recipients of "high-profile" rescues (such as the air-lifting
to Kuwait of Ali Abbas who lost all his family and both of his arms,
recorded in IBC incident x025--Baghdad, March 30).
MASH units, too,
provided immediate help to some Iraqi civilians wounded in the fighting,
although it would appear that this was dependent upon the goodwill and
resources of commanding officers--and likely to be withdrawn when it
conflicted with their primary function. [9,10] Iraq's own hospitals,
run-down and neglected for years under the sanctions regime, have suffered
looting, vandalism, loss of electrical power, the deaths of staff and
even (in at least three of them [11]) direct bombardment, all attributable
to the war. But however heroic the efforts of their staff, there is
no denying that the country's health system is now in a desperate state.
To our knowledge,
no US or UK government-directed programme is specifically targeted towards
the injured civilians of Iraq: the men, women, children and old people
maimed and traumatised by the brutality of military intervention, and
no government-directed report is available on the progress, if any,
that has been made to assess and address the serious humanitarian and
health issues arising from war injuries. It has been left to a few charities
and aid-agencies, which have struggled against US obstruction to gain
a foothold for their work with the sick and injured. The United Nations
has remained ineffectual, firmly kept in the background by US diktat.
It is the most basic
of principles that those who cause damage, harm and injury are responsible
for repairing these and making amends if they have the power to do so.
"But U.S officials," the Washington Post reported in late
May, "have made clear to Iraqis that they do not intend to conduct
a complete accounting of war damages, nor compensate those who say the
occupying army owes them." [12]
Dina Sarhan, 21,
who lost a leg to US shrapnel, sought no more than a prosthetic leg
from the occupying power, only to be repeatedly turned down because
it was "up to a higher authority." One of "thousands
who incarnate the collateral damage of [the] war," she is unable
to climb the stairs in her house and is "learning to make do"
by sleeping in the dining room. She says she has forgiven the anonymous
soldiers who injured her, but recognizes all too clearly the gap between
the rhetoric and reality of modern warfare: "Mr. Bush said this
would be a clean war. Is this a clean war?"
Unfortunately the
"higher authorities" have their minds on other matters. "While
sympathetic to individual hardships suffered as a result of war, U.S.
officials say they are wary of beginning a legal process that could
entail millions of claims against them" (when material damages
as well as physical injuries are included); they also fret over "the
endemic fraud that would creep into this."
But those, surely,
are risks the US brought upon itself.
And instead of facing
up to its responsibilities, the Pentagon is already ducking them--by
restraining those of its more enlightened on-the-ground commanders who
have acted in recognition of the strength of war of victims' claims.
In a recent briefing US military leaders explicitly ruled out any compensation
for injuries (or deaths) sustained during the combat period prior to
May 1st. Families will only be eligible for compensation if they can
"prove clear-cut negligence or wrongdoing by soldiers" in
the "post-combat" phase of the occupation. This ruling will
exclude the vast majority of injuries from potential compensation. For
example, claims are ineligible in the case of soldiers mistaking civilians
for combatants. However, some military commanders have been making ad-hoc
discretionary payments to the victims or their families. When this was
pointed out, a US official said he would investigate these payments
and, if necessary, tell the commanders concerned to stop making them.
[13]
So much for the
"sympathetic" Pentagon--but exactly how justifiable is the
USA's fear of "millions" of claims against it?
Given that most
Iraqis who are asking for damages "seek a few thousand dollars
to get their lives running again", it is possible to make an estimate
of the cost of such reasonable compensation and then compare it to other
expenditures in this war. Assuming the Pentagon's "millions"
of claims were a credible prediction, then perhaps two million Iraqis
(including those seeking only compensation for financial losses) could
be awarded $10,000 each. That would amount to $20 billion, or the cost
of occupying the country for 5 months, which Sec. of State Rumsfeld
has pegged at $4 billion a month. [14]
This is a large
sum, to be sure, but not one that the US isn't already countenancing
in its open-ended occupation of Iraq. And arguably, the US occupation
could be cut short by as many months and its soldiers sent home wreathed
in roses if the US were to distribute its money in this way.
If however we restrict
our calculations to more realistic scenarios and 20,000 injury claims
at $10,000 each, the total amount awarded would be $200 million--less
than the US spends every two days on the occupation. (And approximately
the amount the UK spends monthly in its role.[15])
What excuse can
the US possibly have for declining this opportunity to do some good
for those who desperately need it (and for whose hurt it is responsible),
and in the process, win back some of that "goodwill" it has
lost in Iraq and much of the world? Even if the number of claims or
of average awards is ultimately twice or ten times higher than this,
it will still be trivial compared to the overall cost of the war and
occupation.
Hamit Dardagan,
John Sloboda and Kay Williams run the Iraq
Body Count project. They can be reached at: [email protected]
Notes:
1. As at July 7th
2003. The Minimum total count of injuries in the IBC database is 16,439.
However, given the more limited reporting of injuries by the media and
IBC's data-gathering methodology which focuses on reports of deaths,
we feel that in this instance the Maximum count (of 19,733) is likely
to be a closer approximation to the true number of wounded--and as discussed
in the body of this report, may itself be an under-estimate.
2.
http://www.un.org/
3. Pepe Escobar,
Asia Times Online, April 4 2003 http://atimes.com/atimes/Middle_East/ED04Ak07.html
4. Robert Fisk,
Independent, April 3 2003 (IBC incident x030) http://argument.independent.co.uk/commentators/
5. Michael Weisskopf,
Time Magazine, May 3 2003 (IBC incident x072) http://www.time.com/time/magazine/
6. Jason Burke,
Guardian, June 26 2003 (IBC incident x100) http://www.guardian.co.uk/Iraq/Story/0,2763,985237,00.html
7. http://www.icrc.org/
8. "But due
to the lack of time and sutures, the limbs after being amputated were
sewn up very basically and bandaged. 'They are re-opening the bandages
and trying to stitch the wounds up properly.'"--Dr Jemilah Mahmood
of Mercy Malaysia, who brought much-needed supplies to the hospital
and suffered a bullet wound in the process. Reported in The Star Online,
April 18 2003
9. "Medical
staff here [at 86th Combat Support Hospital at Tallil Airfield] have
admitted more than 500 people since the war began--most of them Iraqi
men, women and children. Many more have been treated for ailments that
didn't require hospitalization."--Associated Press, April 26 2003.
http://www.etaiwannews.com/
10. After the ordeal
of seeing their three other children killed when a US tank machine-gunned
their car in Nasiriyah, Daham and Gufran Ibed Kassim and their wounded
five-year-old daughter Mawra were taken for treatment at a US Army field
hospital:
"For two nights,
the remains of the family slept in a bed. It appears that the story
is reaching an end. 'Wait!' insists Kassim, his tears preparing themselves
for what is to come, as if his trials could get any worse. 'Don't ask
me questions. I will tell you what happened.' On the third night, that
of 27 March, 'there were some Americans wounded that night, in the fighting.
Maybe they needed the beds. So they told us we had to go outside. I
heard the order--"put them out"--and they carried us like
dogs, out into the cold, without shelter, or a blanket. It was the days
of the sandstorms and freezing at night. And I heard Zainab crying:
"Papa, Papa, I am cold, I am cold." Then she went silent.
Completely silent.' Kassim breaks off in anguish. His wife continues
the story of the night. 'What could we do? She kept saying she was cold.
My arms were broken, I could not lift or hold her. If they had given
us even a blanket, we might have put it over her. We had to sit there,
and listen to her die.'Ed Vuillamy, The Observer, July 6, 2003 http://observer.guardian.co.uk/
11. 1. Al-Rutbah
children's hospital (on March 19) http://www.fortwayne.com/
2. Al-Yarmouk, Baghdad (on April 7) http://www.28news.com/stories
3. General Surgical Hospital, Nasiriyah (on March 24) http://observer.guardian.co.uk/
12. Scott Wilson,
Washington Post, May 31 2003 http://www.washingtonpost.com/
13. "U.S. Limits
Payments to Kin of Slain Iraqi Civilians"--Robyn Dixon, LA Times,
August 4, 2003 http://www.latimes.com/
14. "The Cost
Of Occupation"--Dorothy Pomerantz, Forbes.com, July 15 2003 http://forbesbest.com/2003/07/15/cz_dp_0715conflict.html
(It has been widely mooted--including by officials in Dick Cheney's
office--that the occupation's costs could be borne directly by Iraqis
through the sale of their oil.)
15. "Cost of
occupation: £5m a day--human cost extra"--Richard Norton-Taylor
and Larry Elliott, Guardian July 17 2003 http://politics.guardian.co.uk/Print/0,3858,4714030,00.html