This
Terrible Misadventure
Has Killed One In 40 Iraqis
By Richard Horton
14 October, 2006
Lancet
Many people refused to believe
the Lancet report in 2004 from a group of American and Iraqi public-health
scientists who surveyed homes across the country and found that about
100,000 additional Iraqi deaths had taken place since the coalition
invasion in March 2003. Several government ministers were deployed to
destroy the credibility of the findings and, in large part, they succeeded.
But now their denials have come back to haunt them, for the figures
from Iraq have been confirmed by a further study.
The same team from Johns
Hopkins University worked with Iraqi doctors to visit over 1,800 homes
in Iraq, selected randomly to make sure that no bias could creep in
to their calculations.
They identified more than
12,000 family members and tracked those who had died over an interval
that spanned both pre- and post-invasion periods. The Iraqi interviewers
spoke fluent English as well as Arabic, and they were well trained to
collect the information they were seeking. They asked permission from
every family to use the data they wanted. And they chased down death
certificates in over four out of five cases to make sure that they had
a double check on the numbers and causes of death given to them by family
members.
All of these checks and balances
mean that the 650,000 additional Iraqi casualties they report since
the invasion is the most reliable estimate we have of civilian deaths.
Most of these deaths have been of men aged 15 to 44.
Not only do we have a better
understanding of the toll our invasion has had on the country; we also
understand better just how those deaths have come about. Before the
invasion only a tiny proportion of deaths were due to violence. But
since the invasion over half of all deaths have been due to violent
causes. It is our occupation and our continued presence in Iraq that
is fuelling this violence. Claims that the terrorist threat was always
there are simply disproved by these findings.
The nature of these causes
has changed too. Early on in the post-invasion period deaths were made
worse by aerial bombing. But now gunshot wounds and car bombs are having
a far greater effect. Far from our presence in Iraq stabilising the
chaos or alleviating the rate at which casualties are mounting, we seem
to be making the situation worse. In each year since the invasion, the
mortality rates due to violence have increased.
The total figure of 650,000
is truly staggering. It represents 2.5% of the entire Iraqi population.
In 2004 The Lancet was criticised for publishing a number that seemed
to have a high degree of uncertainty. The best estimate then was 98,000
deaths. But the uncertainty meant that it could have been as low as
8,000 or as high as 194,000.
In the latest study there
is also a large degree of uncertainty, but even the lowest possible
figure it gives for the number of deaths - 400,000 - makes clear just
how terrible our intervention in Iraq has been. The highest possible
figure is more than 900,000. Looking at these numbers, we have to concede
that we have created a humanitarian disaster of unprecedented proportions
for a foreign policy that was supposed to protect civilian populations,
not subject them to ever-greater harm.
Why is this Lancet estimate
so much higher than the figures put out by President Bush or the Iraq
Body Count website? They put the number of casualties in the tens of
thousands, not the hundreds of thousands. To be fair, Iraq Body Count
does not claim to publish accurate absolute numbers of deaths. Instead,
their figures are valuable for measuring trends. But the reason for
the discrepancy between these lower estimates and the new figure of
650,000 deaths lies in the way the number is sought. Passive surveillance,
the most common method used to estimate numbers of civilian deaths,
will always underestimate the total number of casualties. We know this
from past wars and conflict zones, where the estimates have been too
low by a factor of 10 or even 20.
Only when you go out and
knock on the doors of families, actively looking for deaths, do you
begin to get close to the right number. This method is now tried and
tested. It has been the basis for mortality estimates in war zones such
as Darfur and the Congo. Interestingly, when we report figures from
these countries politicians do not challenge them. They frown, nod their
heads and agree that the situation is grave and intolerable. The international
community must act, they say. When it comes to Iraq the story is different.
Expect the current government to mobilise all its efforts to undermine
the work done by this American and Iraqi team. Expect the government
to criticise the Lancet for being too political. Expect the government
to do all it can to dismiss this story and wash its hands of its responsibility
to take these latest findings seriously.
But if we were talking about
the risk of smoking to the population, and published research demonstrating
the effect of tobacco on mortality, few would dispute the message or
the importance of scientists and medical journals in being actively
engaged in a public debate. For Iraq, violence is the public-health
priority right now. It is a proper subject for science and it is a proper
subject for a medical journal to comment on.
So what is the right conclusion
from this work? How should this latest research inform public policy?
First, Iraq is an unequivocal humanitarian emergency. Civilians are
being harmed by our presence in Iraq, not helped. That should force
us to pause and ask what we are doing and why. There is no shame in
saying that we have got the policy wrong. Moreover, we have a legal
obligation under the Geneva conventions to do all we can to protect
civilian populations. These findings show not only that are we not adhering
to this legal obligation, but also that we are progressively subverting
it year on year.
And finally, we can truthfully
say that our foreign policy - based as it is on 19th-century notions
of the nation-state - is long past its sell-by date. We need a new set
of principles to govern our diplomacy and military strategy - principles
that are based on the idea of human security and not national security,
health and wellbeing and not economic self-interest and territorial
ambition.
The best hope we can have
from our terrible misadventure in Iraq is that a new political and social
movement will grow to overturn this politics of humiliation. We are
one human family. Let's act like it.
Richard Horton
is the editor of the Lancet
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