Iraqi Death Toll Hugely Underestimated

[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]

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]

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.

[Dwight Schrute]

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]

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.

[Dwight Schrute]

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]

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.

[Dwight Schrute]

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]

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.

[Dwight Schrute]

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.

I'm really not concerned on how they did it at all, the problem is where are the 650,000 bodies.

If you break it down to each day, thats missing around 590 bodies everyday for the last 3 years. I believe there are some incompetent people over there, but thats a bit extreme expecially when the violence has been central in a specific area for the last year and a half.

[Mulletsoldier]

I'm really not concerned on how they did it at all, the problem is where are the 650,000 bodies.

If you break it down to each day, thats missing around 590 bodies everyday for the last 3 years. I believe there are some incompetent people over there, but thats a bit extreme expecially when the violence has been central in a specific area for the last year and a half.

Right, but on the flip side, how and more importantly why would Iraqis be producing fake death certificates?

[Dwight Schrute]

Right, but on the flip side, how and more importantly why would Iraqis be producing fake death certificates?

The study states they have 650,000 death certificates?

[Mulletsoldier]

The study states they have 650,000 death certificates?

No.

A key in this study is not only the amount of individuals they hypothesized died, but more importantly to your argument how. The majority of post-invasion deaths were of violent means (all but 50,000), and a majority of those were from gunshot wounds and airstrikes, needless to say these types of deaths are not exactly as neat as say a heart attack as it pertains to remains.

For example, the total estimated death toll of 9/11 is somewhere around 2,823. The total amount of recovered bodies? Less than 500 from latest estimates. Moreover, many of the bodies which were identified had the cause of death as "physical injury (body not found)" on the death certificate. However, you do not doubt that ~3000 individuals died on that day do you? You accept that such a violent means makes whole remains recovery negligible and in fact many people were identified solely based on part remains.

It is simply not as if everyone dies in a whole manner, and then is stacked on top of eachother for neat and tidy counting. "Hiding" 650,000 bodies becomes much easier when they are scattered body parts.

[Dwight Schrute]

No.

A key in this study is not only the amount of individuals they hypothesized died, but more importantly to your argument how. The majority of post-invasion deaths were of violent means (all but 50,000), and a majority of those were from gunshot wounds and airstrikes, needless to say these types of deaths are not exactly as neat as say a heart attack as it pertains to remains.

For example, the total estimated death toll of 9/11 is somewhere around 2,823. The total amount of recovered bodies? Less than 500 from latest estimates. Moreover, many of the bodies which were identified had the cause of death as "physical injury (body not found)" on the death certificate. However, you do not doubt that ~3000 individuals died on that day do you? You accept that such a violent means makes whole remains recovery negligible and in fact many people were identified solely based on part remains.

It is simply not as if everyone dies in a whole manner, and then is stacked on top of eachother for neat and tidy counting. "Hiding" 650,000 bodies becomes much easier when they are scattered body parts.

So you are stating that we are missing around 590 bodies each day for a 3 year period because the body parts are scattered?

They key in this study IS the amount because you are going from a bodycount of around 40,000, to a estimate of around 100,000 (in which most people agree is probably the real death toll) to a total of 650,000. The number of people IS the key and you simply can't blow up 650,000 people thorugh various means and not notice it over 3 years.

I accept the 3000 bodies died because you actually have a reference point to start with of which you can do an actual count of who is alive now and who isn't and its not based on a sample survery.

Bottom line, if 650,000 people have died then where are the records, where are the bodies? Now we have to find excuses why we can't find 650,000 bodies, or even 100,000? Or even 75,000?

And I didn't say tehy we're stacked up side by side for everyone to count. I said I find it hard to believe that since the violence is centralized in one area (since Souther Iraq and nothern Kurdish areas are relatively peaceful) that we are (the iraqi government, us governement and various media outlets) are missing 590 bodies everyday for the past 3 years.

The study is an estimate; No more, no less. Once you get that estimate you have to look for some sort of physical evidence to validate the number and this case you have to be missing almost 600 bodies everyday for a 3 year period to validate that number. That must be some meat grinder that destroys and hides that many bodies everyday.

But if you want to believe the estimate and the fact that we can scatter than many bodyparts around Baghdad then thats fine. I find it impossible to believe. The Iran-Iraq war that lasted 8 years killed less Iraqi's than this estimate and thats two coutries sending their military to fight, not collateral damage from IED's.

[Mulletsoldier]

So you are stating that we are missing around 590 bodies each day for a 3 year period because the body parts are scattered?

They key in this study IS the amount because you are going from a bodycount of around 40,000, to a estimate of around 100,000 (in which most people agree is probably the real death toll) to a total of 650,000. The number of people IS the key and you simply can't blow up 650,000 people thorugh various means and not notice it over 3 years.

I accept the 3000 bodies died because you actually have a reference point to start with of which you can do an actual count of who is alive now and who isn't and its not based on a sample survery.

Bottom line, if 650,000 people have died then where are the records, where are the bodies? Now we have to find excuses why we can't find 650,000 bodies, or even 100,000? Or even 75,000?

And I didn't say tehy we're stacked up side by side for everyone to count. I said I find it hard to believe that since the violence is centralized in one area (since Souther Iraq and nothern Kurdish areas are relatively peaceful) that we are (the iraqi government, us governement and various media outlets) are missing 590 bodies everyday for the past 3 years.

The study is an estimate; No more, no less. Once you get that estimate you have to look for some sort of physical evidence to validate the number and this case you have to be missing almost 600 bodies everyday for a 3 year period to validate that number. That must be some meat grinder that destroys and hides that many bodies everyday.

But if you want to believe the estimate and the fact that we can scatter than many bodyparts around Baghdad then thats fine. I find it impossible to believe. The Iran-Iraq war that lasted 8 years killed less Iraqi's than this estimate and thats two coutries sending their military to fight, not collateral damage from IED's.

You keep keying in on the fact that the fighting has been mainly centralized. The entire country was given equal representation in terms of family clusters sampled, and even with the all possible skewing factors of the Falluja cluster being taken out (disproportionate mortality rate due to air strikes, extremely violent neighbourhoods, overestimation of infant mortality rate) the death rate is still estimated at 37% higher than pre-invasion. As the study states:

We estimate that there were 98000 extra deaths (95% CI 8000–194000) during the post-war period in the 97% of Iraq represented by all the clusters except Falluja....This indicates a point estimate of about 200000 excess deaths in the 3% of Iraq

.

So, even solely examining the other 50% (violent deaths only occurred 15/33 clusters) of the country aside from the most violent areas it is estimated an extra 100,000 individuals died. Do I feel it is hard to "hide" 100,000 over three years across an entire country? Given the cause of death in the overwhelming majority was violent, yes. Now that is taking out all estimates out of Falluja, period, and the number is still 100,000. If you can find it in yourself to believe that somehow only 100,000 additional individuals have died over three years, than as you put, that is fine. But I personally, find it impossible.

I also notice how you insist on implying that the maximum estimate of 650,000 should and has been the centre of discussion. I have not mentioned once in this discussion that that I believe it is the maximum, in fact I have actually acknowledged the minimum estimate many times.

[Dwight Schrute]

You keep keying in on the fact that the fighting has been mainly centralized. The entire country was given equal representation in terms of family clusters sampled, and even with the all possible skewing factors of the Falluja cluster being taken out (disproportionate mortality rate due to air strikes, extremely violent neighbourhoods, overestimation of infant mortality rate) the death rate is still estimated at 37% higher than pre-invasion. As the study states:

.

So, even solely examining the other 50% (violent deaths only occurred 15/33 clusters) of the country aside from the most violent areas it is estimated an extra 100,000 individuals died. Do I feel it is hard to "hide" 100,000 over three years across an entire country? Given the cause of death in the overwhelming majority was violent, yes. Now that is taking out all estimates out of Falluja, period, and the number is still 100,000. If you can find it in yourself to believe that somehow only 100,000 additional individuals have died over three years, than as you put, that is fine. But I personally, find it impossible.

I also notice how you insist on implying that the maximum estimate of 650,000 should and has been the centre of discussion. I have not mentioned once in this discussion that that I believe it is the maximum, in fact I have actually acknowledged the minimum estimate many times.

And you don't seem to understand that I could care less about how the study was conducted because when you come down to it it is just an estimate based on a sample survery. Yes its a well respected research method, yes it seems they did a nice job, yes I tihnk its a stretch basing the entire country on 12,000 people, but I simply don't care because the bottom line is an estimate needs physical evidence if you are to hold someone accountable for deaths (since form post 2 and 3 the US governemtn is accused of lying). I am past the study and have been in the last 2 posts so therfore I move on to seeing what evidence backs up the study to begin with and the physical evidence of 650,000 or even half this number or all the way down to 100,000.

I already stated in my second post that I believe its underestimated but I do not beleive its 650,000 people. Maybe you should have stated you believed such in the first post but all I saw was accusations of the "oh-so-untrustworthy" government.

Could it be 100,000? Its possible....so what now?

I still consder the Brookings Institute a more credible report than this sample survery.

[Dwight Schrute]

I have not mentioned once in this discussion that that I believe it is the maximum, in fact I have actually acknowledged the minimum estimate many times.

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

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.

"Hiding" 650,000 bodies becomes much easier when they are scattered body parts.

I see plenty of times you focusing on the maximum or near to it. Its not a leap of faith to anyone you seem to embrace the larger number more so than the minimum, or so it seemed. I do not see you mention the minimum other than the actual study.