The
Death Toll In Iraq
The
British Government Criticises The Lancet
15 December 2004 |
A
PDF of this briefing is available here
Posted: 18 December
2004 |
CRITICISING THE
LANCET
As soon as the Lancet, the world’s leading medical journal,
published an estimate that 98,000 Iraqis have died because of
the invasion and occupation of Iraq, the British Government
attempted to undermine this work.
The Lancet estimate (usually approximated to 100,000 deaths)
includes Iraqi civilians and insurgents, and includes all causes
of death, whether violent or nonviolent, and whether they were
caused by foreigners (such as US pilots) or by Iraqis themselves.
For reasons explored in an earlier briefing (JNV 74), the 100,000
figure is likely to be an under-estimate of the death toll associated
with the conflict. The British Government, however, has sought
to portray the Lancet study as a massive over-estimate of the
likely death toll in Iraq.
THREE DIFFERENT ESTIMATES MEASURING THREE
DIFFERENT THINGS
Iraq Body Count (IBC) estimates ‘media-reported civilian
deaths in Iraq resulting directly from military action by the
USA and its allies’, including ‘civilian deaths
resulting from the breakdown in law and order, and deaths due
to inadequate health care or sanitation’: between 14,284
and 16,419 (over a period of 18 months). This is based on both
direct reports by journalists, and records from morgues and
hospitals.
The Iraqi Ministry of Health (MOH) claims to have recorded civilian
and insurgent deaths due either to terrorist incidents or to
US-led military action, based on bodies delivered to hospitals
and deaths in hospital, between 5 Apr. and 5 Oct. 2004: 3,853
(over 6 months).
Finally, the Lancet estimates extra deaths of all Iraqis from
all causes since the invasion, based on a survey of 988 households
containing 7868 residents throughout Iraq: 98,000 (over 17.8
months).
It is hardly surprising that the estimates differ. They each
measure something different (and the MOH estimate covers only
part of the post-invasion period).
ESTIMATING VIOLENT POST-INVASION DEATHS
The IBC and MOH figures are not necessarily inconsistent: extrapolating
the MOH estimate backwards (in a linear, unscientific way) to
the entire post-invasion period generates 12,000 violent deaths,
near the IBC figure.
On the other hand, the Lancet study does not estimate the number
of Iraqis (civilians, soldiers and insurgents) who have died
a violent death in the post-invasion period. It must be larger
than either the IBC or the MOH estimates.
Comparing IBC with the Lancet, it is not surprising that the
IBC record of violent deaths of civilians and insurgents reported
in the international press is much smaller than a Lancet-based
estimate of the total number of violent deaths (reported and
unreported), including those due to crime.
THE MINISTRY OF HEALTH DISCREPANCY
Comparing the MOH record and the Lancet estimate, even after
adjusting for the fact that the latter has a time period three
times as long, and includes the invasion itself, there would
seem to be a sizeable gap, one that the Blair Government finds
damning: ‘Hospitals in Iraq have no obvious reason to
under-report the number of dead and injured. The Lancet article
does not explain this discrepancy.’
In fact, the discrepancy was explained by Iraqi officials: ‘Iraqi
health and hospital officials agreed that the statistics captured
only part of the death toll... The numbers also exclude those
whose bodies were too mutilated to be recovered at car bombing
or other attacks, the ministry said. Ministry officials said
they didn’t know how big the undercount was. “We
have nothing to do with politics,” [Dr Shihab Ahmed] Jassim
[member of the Ministry of Health Operations Section] said.’
(Knight Ridder, 25 Sept.)
Knight Ridder noted that, ‘most of the dead are believed
to be civilians’. ‘Many Iraqi deaths, especially
of insurgents, are never reported, so the actual number of Iraqis
killed in fighting could be significantly higher.’ ‘Iraqi
officials said the statistics proved that U.S. airstrikes intended
for insurgents also were killing large numbers of innocent civilians.’
‘Iraqi officials said about two-thirds of the Iraqi deaths
were caused by multinational forces and police; the remaining
third died from insurgent attacks.’ ‘The ministry
is convinced that nearly all of those reported dead are civilians,
not insurgents.’ <http://tinyurl.com/3uluo>
STATISTICS AND LIES
The Foreign Office attacked the Lancet study in a statement
on 17 Nov., saying that the authors themselves ‘noted
that the data on which they based their projections was of “limited
precision”.’ (http://tinyurl.com/3hv8j)
But the ‘limitations’ identified by the authors
included more factors that might have increased the estimated
death toll, than might have lowered it. (JNV 74)
The Foreign Office cast doubt on the calculation of the conflict-related
death toll: ‘This limited precision is reflected in the
very large range which they use for their estimate of excess
mortality (8,000 - 194,000).’ This is indeed the range
of possible death tolls given by the Lancet study.
But it is highly misleading to say, as the Foreign Office does,
that ‘Although the levels of probability vary across its
range, any figure within this range is consistent with the data.’
The 98,000 figure is not only ‘consistent’ with
the data, it is the most likely figure based on the information
gathered in the study.
NORMAL DISTRIBUTION
The authors of the Lancet study wrote later: ‘If we had
just visited the 32 neighborhoods without Falluja and did not
look at the data or think about them, we would have reported
98,000 deaths, and said the measure was so imprecise that there
was a 2.5% chance that there had been less than 8,000 deaths,
a 10% chance that there had been less than about 45,000 deaths...
all of those assumptions that go with normal distributions.’
A ‘normal distribution’ of (in this case) deaths,
is a bell-shaped curve, highest in the middle, marking the most
likely number of deaths, and falling away on both sides as the
number becomes less and less likely.
If the rules of a ‘normal distribution’ were applying
in a normal fashion, there would be a 2.5% chance that the number
of conflict-related deaths was over 194,000 - or below 8,000;
and a 10% chance that the number of ‘excess’ Iraqi
deaths was below 45,000, or above another figure (around 155,000).
So it is highly misleading to say that
‘any figure within this range is consistent with the data’.
In the absence of any further information or context, the levels
of probability ‘vary’ in a particular way, becoming
more likely as you approach 98,000, and less likely as you move
away from this figure.
MORE LIKELY TO BE ABOVE THAN BELOW 100,000
But there is more information and context which alters the probabilities.
One of the Lancet authors notes: ‘We had two other pieces
of information. First, violence accounted for only 2% of deaths
before the war and was the main cause of death after the invasion.
That is something new, 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 Falluja data, which imply that there are pockets of Anbar,
or other communities like Falluja, experiencing intense conflict,
that have far more deaths than the rest of the country.’
<http://tinyurl.com/6kbvq>
Although excluded from the headline estimate, US epidemiologist
Richard Garfield continues, the Falluja data ‘tells us
that the true death toll is far more likely to be on the high-side
of our point estimate [98,000] than on the low side.’
(See JNV 74 for more details.)
FALLUJA FOOLING
The Foreign Office play fast and loose with the Falluja data,
claiming, for example that the data from the town would ‘result
in an estimated 200,000 excess deaths within Fallujah alone
over the past 18 months... almost two-thirds of the total population
of the town - which is just not credible.’
But the Lancet study says the 200,000 excess deaths would have
taken place ‘in the 3% of Iraq represented by this cluster’,
not just Falluja, but also its outlying areas, with a total
population of 739,000.
While the Foreign Office notes that ‘The authors of the
study understandably discounted the data’ from Falluja,
the FO statement does not actually acknowledge that the 98,000
estimate excludes all Falluja data.
SHIFTING RESPONSIBILITY
Having tried (and failed) to cast doubt on the scale of conflict-related
deaths uncovered by the Lancet, the Foreign Office concentrated
on trying to shift responsibility for them, pointing out, for
example, that the greatest increase in reported deaths was among
men between 15-59 years old - possible insurgents.
But the study points out that men were also more likely to be
in public and exposed to danger: 58% of vehicle accident-related
fatalities also involved men between the age of 15 and 59. The
gender-age combination proves nothing.
The FO tried other gambits: ‘Only 2 deaths are attributed
in the survey to “anti-coalition forces”... an astonishingly
small proportion’ of violent deaths.
Furthermore, ‘Since 58 of the 61 deaths attributed to
Coalition forces were said to have been caused by “helicopter
gunships, rockets or other forms of aerial weaponry”,
it cannot have been possible for the families in every case
to have known for certain who was responsible.’ Families
may have been afraid to blame ‘the deaths of their relatives
on the insurgents.’
All reasonable points, but they do not diminish the scale of
extra deaths since the invasion, nor the enormous escalation
in violent deaths.
The FO’s doubts about the balance of responsibility for
violent deaths in Iraq lead inevitably in the direction of further
inquiry.
Following the publication of the Lancet estimate, an eminent
group of retired British senior officers and diplomats wrote
to Tony Blair requesting a ‘comprehensive, independent
inquiry’ into Iraqi deaths and injuries since March 2003
– ‘and the cause of those casualties.’ (http://tinyurl.com/5sd6a)
The signatories pointed out that Mr Blair had rejected the Lancet
findings, but offered no comparable assessment of his own (the
MOH record is hardly adequate). This Mr Blair refuses to do.
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