The revelation that 100,000 Iraqis have died in the course of the US-led invasion and occupation of the country seems set to haunt the new American president, writes Amira Howeidy The number of civilian deaths in Iraq attributable to the US-UK-led invasion is far greater than anyone had previously expected, according to an article in the latest issue of Britain's foremost medical journal, The Lancet. As president George W Bush continued to defend his country's war strategy in the run-up to Tuesday's presidential elections, The Lancet dated 30 October published a study proving him wrong, if not a liar. The findings of the first scientific study of civilian casualties in Iraq reveal that at least 100,000 Iraqi civilians, mostly women and children, have died in only 17 months as a result of the invasion. Both Bush and his opponent John Kerry virtually ignored the shocking results of the body count, and the report was barely mentioned in the US media. The only official reaction came from the UK, which questioned the accuracy of the report's findings. A spokesperson for the British Prime Minister's office on Monday charged that the study "assumed that Iraq was uniform in terms of intensity of conflict. It wasn't. [And] that bombing was general throughout Iraq, which was not the case." Making "conservative assumptions", the study published in The Lancet said that about 100,000 "excess deaths or more" have occurred since the March 2003 invasion. The survey group compared mortality in Iraq during the 14.6 months preceding the invasion with figures for the 17.8 months following it. They concluded that the risk of death was estimated to be 2.5 fold higher after the invasion when compared with the pre-invasion period. The report's lead investigator, Les Roberts, was horrified by the "very little coverage of the report in the US media". US newspapers have been scared off because of the timing, as the report was released right before the elections, he told Al-Ahram Weekly in a telephone interview. "My intention was to have it released a couple of weeks before the election -- not to influence the election, but to have it benefit the Iraqi people. [I wanted] both candidates to pledge to save Iraqi civilians." But the timing of the report's release only days before 2 November seems to have backfired. "I feel bad about it, I think I blew it," Roberts said. "I don't think I did justice to the Iraqi people." The report's release was delayed for logistical reasons and because of extensive peer- reviewing before it was published. Roberts said he was "hopeful but not confident" that the report's findings will modify the behaviour of the occupation forces to avoid excessive killing of civilians. Because two-thirds of all violent deaths were reported in one cluster in the city of Fallujah, "an extreme statistical outlier", these figures were excluded from the overall estimate. Even excluding the Fallujah data, the risk of death from violence in the period after the invasion was "58 times higher than the period before the war" said the study. It also concluded that "widespread" violence accounted for most of the excess deaths, while air strikes from coalition forces accounted for most violent deaths. In addition, most individuals reportedly killed by coalition forces were women and children. "We now know that the war was not just illegal and unnecessary," Lindsey German, convenor of the UK's Stop the War Coalition, told the Weekly, "but is turning into the bloodiest war involving Britain for a long time." Most of the deaths are from air strikes, she said, "which puts the action of the US and British governments in the category of war crimes, on a par with the deliberate targeting of civilians at Guernica in 1937 and at Dresden in 1944." The report is based on a cluster sample survey undertaken throughout Iraq during September 2004. Thirty-three randomly selected clusters of 30 households each were interviewed by a team of seven Iraqis, to gather information about household composition, births and deaths since January 2002. In those households reporting deaths, the date, cause and circumstances of violent deaths were recorded. The study then 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. Before the invasion, the crude mortality rate was 5 per 1000 people per year. This number increased to 7.9 per 1000 people per year following the invasion. "We were stunned by the size of the figure, largely because of the very high number in relation to previous figures," Human Rights Watch (HRW) senior military analyst Marc Garlasco told the Weekly. "The occupying power is required to provide security for the population under the Geneva Conventions, and that has obviously not happened." The report's significance, say experts, also lies in the fact that it has shown that even in extremely difficult circumstances, the monitoring of casualties is possible. Although the staggering 100,000 figure is much higher than any previous estimates of the war's casualties from sources such as Iraqbodycount.net, the report argues that this should not really be a surprise. "What is particularly revealing about the Iraqbodycount.net system is that, as a monitor of trends, it closely parallels the results found in this survey," said the report. "Most casualties arose after the end of major hostilities in May 2003, and the rate of civilian deaths has been rising in recent months. This finding indicates that passive media-based monitoring should have a role in future conflicts where the collection of health data is not practical. However, it should be used as a monitor of trends rather than as a count estimator, as Iraqbodycount.net has been commonly cited in the media." A number of observers have already criticised the report's methodology, but it seems that they have misunderstood its scientific approach. One widely read critique published in Slate.com, for example, disputed the complicated CI (confidence interval) mortality estimate which is referred to in the report as "95 per cent CI 8000-194,000". The Slate article charged that "it means that the authors are 95 percent confident that the war-caused deaths totalled some number between 8,000 and 194,000." In a written response to this critique, the report's co-author, Richard Garfield, said that the report's authors do allow a margin of sampling error. While it is correct to say that the 98,000 additional deaths are not hard-and-fast, Garfield added that "research is more than summarising data, it is also interpretation." To understand what is meant by the confidence interval, suppose that the researchers had just visited the 32 neighbourhoods excluding Fallujah and recorded the data without examining them or thinking about them. Garfield argues that in that case, they would have reported 98,000 deaths. Nevertheless, there would still be a 2.5 per cent chance that there had been less than 8,000 deaths, a 10 per cent chance that there had been less than about 45,000 deaths -- all of the assumptions that go with normal distributions would have a quantifiable probability attached to them. "But we had two other pieces of information," Garfield explained. "First, violence accounted for only 2 per cent of deaths before the war and was the main cause of death after the invasion. That is something new and consistent with the dramatic rise in mortality and reduces the likelihood that the true number was at the lower end of the confidence range. Secondly, there is the Fallujah data, which imply that there are pockets of Anbar, or other communities like Fallujah, experiencing intense conflict, that have far more deaths than the rest of the country. We set aside these data in statistical analysis because the result in this cluster was such an outlier, but it tells us that the true death toll is far more likely to be on the high-side of our point estimate than on the low side." According to HRW's Garlasco, the main cause of civilian deaths during air strikes was poor intelligence -- the coalition often shot very accurately, but at the wrong targets. "Just because your weapons are accurate does not mean they minimise civilian casualties. Unless the information guiding them is also accurate, smart weapons become as dumb as any bomb." While acknowledging that the US election has naturally distracted media attention in the US, Garlasco suggested that this study should still have received much more airplay than it did. "The coverage shows that the American media continues to report with a certain bias of not confronting how the war affects the civilians in Iraq." The study was funded and approved by the Johns Hopkins Bloomberg School of Public Health. The Small Arms Survey in GenevaSwitzerland contributed to the funding. Researchers from the Johns Hopkins School of Public Health, Columbia University and Iraq's Al-Mostaneseriya University contributed to the report. The study urged an "independent body", such as the International Committee of the Red Cross (ICRC), Epicentre, or the World Health Organisation (WHO), to confirm the results of the report. When contacted for a comment, ICRC's Rana Zidani said that because the ICRC is not present in Iraq it can neither confirm nor deny the report's findings. "Conducting our own body count is not an option at the moment," she told the Weekly. No official comments were made in the Arab world. In an editorial entitled "Iraqi Hiroshima", in Al-Quds Al-Arabi on Monday, editor Abdel-Bari Atwan said that the US government had "concealed the number of Iraqi casualties and only bothered to count the number of its soldiers, because the Iraqi citizen has no value or respect, dead or alive". If this is the number of deaths now, Atwan asked, how many more will die when the occupation forces invade Fallujah and the rest of the "Sunni triangle". "These are horrifying figures indeed, but what is more horrifying is the deafening silence of the international community." The full report is available on the Lancet website: www.thelancet.com
