[Mulletsoldier]

Mortality before and after the 2003 invasion of Iraq: cluster sample survey

Dr Les Roberts PhD a , Riyadh Lafta MD b, Prof Richard Garfield DrPH c, Jamal Khudhairi MD b and Gilbert Burnham MD a

Elsevier

Summary
Background
In March, 2003, military forces, mainly from the USA and the UK, invaded Iraq. We did a survey to compare mortality during the period of 14·6 months before the invasion with the 17·8 months after it.

Methods
A cluster sample survey was undertaken throughout Iraq during September, 2004. 33 clusters of 30 households each were interviewed about household composition, births, and deaths since January, 2002. In those households reporting deaths, the date, cause, and circumstances of violent deaths were recorded. We assessed the relative risk of death associated with the 2003 invasion and occupation by comparing mortality in the 17·8 months after the invasion with the 14·6-month period preceding it.

Findings
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 98000 more deaths than expected (8000–194000) 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.

Interpretation
Making conservative assumptions, we think that about 100000 excess deaths, or more have happened since the 2003 invasion of Iraq. Violence accounted for most of the excess deaths and air strikes from coalition forces accounted for most violent deaths. We have shown that collection of public-health information is possible even during periods of extreme violence. Our results need further verification and should lead to changes to reduce non-combatant deaths from air strikes.

-If Falluja cluster is included death toll may be as high as ~420,000-750,000

-Excess deaths is constituted by estimates of death toll during Sadaam's 20 year reign and applying that same rate of death over collection period

From full text:

To account for the potential that the Falluja data are profoundly skewing the mortality estimate orthe 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.

[Mulletsoldier]

More:

Iraqi dead: Do the figures lie?

Hamilton Spectator - Iraqi dead: Do the figures lie?

They're stunning enough to plunge Bush and Blair into postures of denial. So, who is being less than honest?
By Gwynne Dyer
Independant(Oct 14, 2006)
The final indignity -- if you're an Iraqi who was shot for accidentally turning into the path of a U.S. convoy (they thought you might be a terrorist) or blown apart by a car bomb or air strike or tortured and murdered by kidnappers or just for being a Sunni or a Shia -- is that President George W. Bush and Prime Minister Tony Blair will deny that your death even happened.

The script they are working from says (in Bush's words last December) that only "30,000, more or less" have been killed in Iraq during and since the invasion in March, 2003.

So they have a huge incentive to discredit the report in the British medical journal, The Lancet, this week that an extra 655,000 Iraqis have died since the invasion in excess of the natural death rate: 2.5 per cent of the population.

"I don't consider it a credible report," said Bush, without giving any reason why he didn't.

"It is a fairly small sample they have taken and they have extrapolated it across the country," said a spokesman of the British Foreign Office, as if that were an invalid methodology. But it's not.

The study, led by Dr. Les Roberts and a team of epidemiologists from the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, was based on a survey of 1,849 households, containing 12,801 people, at 47 different locations chosen at random in Iraq.

Teams of four Iraqi doctors -- two men and two women -- went from house to house and asked the residents if anybody had died in their family since January, 2002 (15 months before the invasion).

The most striking thing in the study, in terms of credibility, is that the pre-war death rate in Iraq for the period January 2002-March 2003, as calculated from their evidence, was 5.5 per thousand per year.

That is virtually identical to the U.S. government estimate of the death rate in Iraq for the same period.

Then, from the same evidence, they calculate that the death rate since the invasion has been 13.3 per thousand per year. The difference between the pre-war and post-war death rates over a period of 40 months is 665,000 deaths.

The study, largely financed by the Massachusett Institute of Technology's Center for International Studies, has been reviewed by four independent experts.

One of them, Paul Bolton of Boston University, called the methodology "excellent" and said it was standard procedure in a wide range of studies he has worked on:

"You can't be sure of the exact number, but you can be quite sure that you are in the right ballpark."

This is not a political smear job.

Johns Hopkins University, Boston University and MIT are not fly-by-night institutions, and people who work there have academic reputations to protect.

The Lancet, founded 182 years ago, is one of the oldest and most respected medical journals in the world. These numbers are real. So what do they mean?

Two-thirds of a million Iraqis have died since the invasion who would almost all be alive if it had not happened.

Human Rights Watch has estimated that between 250,000 and 290,000 Iraqis were killed in Saddam Hussein's 20-year rule, so perhaps 40,000 people might have been killed by Saddam between the invasion and now if he'd stayed in power.

(Though probably not anything like that many, really, because the great majority of Saddam's killings happened during crises like the Kurdish rebellion of the late 1980s and the Shia revolt after the 1990-91 Gulf War.)

Of the 650,000 excess deaths since March, 2003, only about 50,000 can be attributed to stress, malnutrition, the collapse of medical services as doctors flee abroad, and other side-effects of the occupation. All the rest are violent deaths, and 31 per cent are directly due to the actions of foreign "coalition" forces.

The most disturbing thing is the breakdown of the causes of death.

Over half the deaths -- 56 per cent -- are due to gunshot wounds, but 13 per cent are due to air strikes. No terrorists do air strikes. No Iraqi government forces do air strikes either because they don't have combat aircraft. Air strikes are done by "coalition forces" (i.e. Americans and British) and air strikes in Iraq have killed over 75,000 people since the invasion.

Oscar Wilde once observed that "to lose one parent ... may be regarded as a misfortune; to lose both looks like carelessness."

To lose 75,000 Iraqis to air strikes looks like carelessness, too.

Gwynne Dyer is a London-based independent journalist whose articles are published in 45 countries.

[Nullifidian]

I'm seeing more and more reports that look like this lately. Perhaps, maybe, just maybe, there's a chance that, maybe reports like this are perhaps just a little more accurate than the ones from our esteemed and oh-so-trustworthy government.

[Mulletsoldier]

Originally Posted by Nullifidian

I'm seeing more and more reports that look like this lately. Perhaps, maybe, just maybe, there's a chance that, maybe reports like this are perhaps just a little more accurate than the ones from our esteemed and oh-so-trustworthy government.

lol..I think maybe, you are 100% right bro.

[CDB]

Originally Posted by Nullifidian

I'm seeing more and more reports that look like this lately. Perhaps, maybe, just maybe, there's a chance that, maybe reports like this are perhaps just a little more accurate than the ones from our esteemed and oh-so-trustworthy government.

It's a given that the government underestimates casualties. It's in their interest to do so.

[Frank Costanza]

Originally Posted by Nullifidian

I'm seeing more and more reports that look like this lately. Perhaps, maybe, just maybe, there's a chance that, maybe reports like this are perhaps just a little more accurate than the ones from our esteemed and oh-so-trustworthy government.

Or there is an election coming up and the more negative type news comes to the forefront of those oh-so-trustworthy newspapers.

Last time I checked the Brookings Institution has nothing to do with our government.

These reporters wouldn't fudge the facts or anything though, right Dan Rather?

[Mulletsoldier]

Originally Posted by Bobo

Or there is an election coming up and the more negative type news comes to the forefront of those oh-so-trustworthy newspapers.

Last time I checked the Brookings Institution has nothing to do with our government.

These reporters wouldn't fudge the facts or anything though, right Dan Rather?

This isn't a newspaper though, and I provided a link to the full citation, registration is free. This is a cohort study whose first sample was taken before the war and a period during. It was conducted by the Lancet, one of the most widely regarded Medical Journals on the planet, funded by MIT and headed by a professor from Johns Hopkins. It was also peer reviewed by 4 independent professionals. It used Iraqi doctors so translation was not an issue, provided alternate statistics for its critics to external validity, measurement reliablity and validity, and any internal validity.

Not trying to sound like a **** either, just stating the facts.

[Frank Costanza]

Originally Posted by Mulletsoldier

This isn't a newspaper though, and I provided a link to the full citation, registration is free. This is a cohort study whose first sample was taken before the war and a period during. It was conducted by the Lancet, one of the most widely regarded Medical Journals on the planet, funded by MIT and headed by a professor from Johns Hopkins. It was also peer reviewed by 4 independent professionals. It used Iraqi doctors so translation was not an issue, provided alternate statistics for its critics to external validity, measurement reliablity and validity, and any internal validity.

Not trying to sound like a **** either, just stating the facts.

I didn't quote you, I quoted Nullifidian about his comments of more and more reports.

I also provided the Iraqi index from the Brookings Institution as well for all the statistics from the Iraqi and US governments as well as civilian orginizations and even those will be underestimated because its impossible to accurately assess statisitics within a warzone. The US government has even acknowledeged this.

You also have to take into account that the mortality rates and death toll during Saddam's reign were extremely....flawed.

[Mulletsoldier]

Originally Posted by Bobo

I didn't quote you, I quoted Nullifidian about his comments of more and more reports.

I also provided the Iraqi index from the Brookings Institution as well for all the statistics from the Iraqi and US governments as well as civilian orginizations and even those will be underestimated because its impossible to accurately assess statisitics within a warzone. The US government has even acknowledeged this.

You also have to take into account that the mortality rates and death toll during Saddam's reign were extremely....flawed.

Ahh..I thought that was in reference to me. I think the thing that struck me the most, and Gwynn Dyer mentions this as well is that during the combat period the United States estimate was almost identical to the one that the researchers had initiall arrived at. So their devices of assessment were obviously in fine working order at that point.

[Mulletsoldier]

And I will agree with the mobilization of bias as it pertains to the media, just wanted to note that IMO, I didn't feel as if the Lancet report was politically timed.

[Frank Costanza]

Originally Posted by Mulletsoldier

Ahh..I thought that was in reference to me. I think the thing that struck me the most, and Gwynn Dyer mentions this as well is that during the combat period the United States estimate was almost identical to the one that the researchers had initiall arrived at. So their devices of assessment were obviously in fine working order at that point.

The problem is you really don't have an accurate reference point pre Saddam.

I have a feeling it wasn't 5.5/1000 people.

Plus I also find it hard to believe that if we killed 650,000 people we would just be finding this out now. Its not like you can hide that many bodies without it getting out. There has to be some sort of physical evidence and I don't think the Brookings Institute would fudge the number x 10.

Is it more thant what Bush says? Of course, he's going by the Brookings Institute which are the official numbers based on a body count and the US government acknowledges that it isn't accurate but I really don't see this methodology being accurate in a warzone.

"12,801 people, at 47 different locations chosen at random in Iraq."

I just find it hard to base a report of 12,801 people for a population over 25 million, but thats me....

[Mulletsoldier]

Originally Posted by Bobo

The problem is you really don't have an accurate reference point pre Saddam.

I have a feeling it wasn't 5.5/1000 people.

Plus I also find it hard to believe that if we killed 650,000 people we would just be finding this out now. Its not like you can hide that many bodies without it getting out. There has to be some sort of physical evidence and I don't think the Brookings Institute would fudge the number x 10.

Is it more thant what Bush says? Of course, he's going by the Brookings Institute which are the official numbers based on a body count and the US government acknowledges that it isn't accurate but I really don't see this methodology being accurate in a warzone.

"12,801 people, at 47 different locations chosen at random in Iraq."

I just find it hard to base a report of 12,801 people for a population over 25 million, but thats me....

I agree on the Pre-Sadaam evidence being far from conclusive, but if you read the full citation, they provide counterarguments/proof as to that as well.

The physical evidence was based on proof of death by death certificate. The minimum number was calculated with the change of infant death rate, and the elimination of the Falluja cluster and the number still came out to ~400,000. Of those 31% were estimated from Coalition forces, which the research goes into detail as well.

As for the sample survey structure, social scientists do the exact same kind of thing in everyday applications with less people and extrapolate that to the entire population of the United States. It is a widely accepted social research method.

EDIT: The authors also adress the warzone issue as well and provide their basis for collection there. A proportionate amount of samples were in the Fallujah cluster and the same death certificate method was shown as well.