On October 10, 2006 the esteemed medical journal The Lancet released an epidemiological study concluding that 655,000 Iraqis died from war-related injury and disease from March 2003 to July 2006. This shockingly high figure has drawn attacks from the Bush administration and right-wing pundits.
Speaking as a medical doctor, I wish to set the record straight. The Lancet study is sound science. The study followed a strict, widely accepted methodology to arrive at its sobering conclusion. The study is being attacked not on scientific grounds, but for ideological reasons.
People may not realize that The Lancet is the world’s most prestigious medical journal. Prior to publication, the Iraq study was subjected to a thorough peer-review by specialists in the field of epidemiology.
Three of the study’s authors, Gil Burnham, Shannon Doocy, and Les Roberts, are doctors at Johns Hopkins University Bloomberg School of Public Health. The fourth author, Riyadh Lafta, is on the faculty of Al Mustansiriya University in Baghdad. Under dangerous conditions, researchers conducted a cross-sectional cluster sample survey involving a total of 1849 Iraqi households, in 47 different
neighborhoods, in 18 regions across Iraq. The survey documented a four-fold increase in the crude mortality rate from the pre-invasion to the post-invasion periods and, in addition, characterized the causes of death.
The investigators followed the same methodology in Iraq that has been used in estimating death and disease in other conflicts such as Darfur and the Congo—where the Bush administration uncritically accepted their results. The public health tool they employed—cluster surveys—has been demonstrated time and again to be the best method of estimating rates of death in areas where vital statistics are not scrupulously maintained. Such bureau cratic vigilance is not the case in present day Iraq.
In a war-ravaged country, merely counting bodies will radically underestimate the number of people who have died. In Iraq today, there have been numerous reports of mass graves and of bodies dumped in fields, beside roads, or in the Tigris River. These deaths are, by and large, not reported to authorities, as some of these deaths may be linked to police forces. One must also consider the Muslim practice of burial where internment is swift — often on the same day. Therefore, relying on media reports of the number killed, morgue logs, or Iraq Ministry or US military counts will not provide an accurate estimate of the death toll. Further, we must not discount the possibility of bias by government officials; the US and Iraq have much to gain by minimizing civilian deaths.
Since the media has been unable to find a scientist critical of the study, they’ve turned to policy wonks with literally no expertise in the health sciences. Danielle Pletka of the American Enterprise Foundation derides the study, but her advanced degree is in international studies.
Neither does Anthony Cordesman of the Center for Strategic and International Studies nor Michael E. O’Hanlon of Brookings have a health background. At his October 11 press conference President Bush asserted “No, I don’t call it a credible report.” He said he asked the generals and the generals told him it was wrong. When asked to give a precise number of Iraqi war-related deaths the President demurred, saying “I do know that a lot of innocent people have died.”
In this age where fact shares equal time with conjecture, critics have attempted to discredit the Hopkins’ study without specifically addressing the science whatsoever.
If the administration believes the Hopkins’ study to be flawed, the federal government should fund its own study of Iraqi mortality, and submit the methodology and results to a medical journal subject to independent peer review. After all, the Hopkins’ study was funded in large part by a $50,000 grant from MIT; surely the federal government could afford such a study.