The Iraq Body Count's reality check of the latest Lancet study is below. It's noteworthy that the Iraq Body Count is antiwar. I think criticism of the Lancet study by researchers with the same bias as the Lancet researchers is particularly relevant.
Iraq Body Count Press Release 16 October 2006
Reality checks: some responses to the latest Lancet estimates
Hamit Dardagan, John Sloboda, and Josh Dougherty
Summary
A new study has been released by the Lancet medical journal estimating over 650,000 excess deaths in Iraq. The Iraqi mortality estimates published in the Lancet in October 2006 imply, among other things, that:
1. On average, a thousand Iraqis have been violently killed every single day in the first half of 2006, with less than a tenth of them being noticed by any public surveillance mechanisms;
2. Some 800,000 or more Iraqis suffered blast wounds and other serious conflict-related injuries in the past two years, but less than a tenth of them received any kind of hospital treatment;
3. Over 7% of the entire adult male population of Iraq has already been killed in violence, with no less than 10% in the worst affected areas covering most of central Iraq;
4. Half a million death certificates were received by families which were never officially recorded as having been issued;
5. The Coalition has killed far more Iraqis in the last year than in earlier years containing the initial massive "Shock and Awe" invasion and the major assaults on Falluja.
If these assertions are true, they further imply:
• incompetence and/or fraud on a truly massive scale by Iraqi officials in hospitals and ministries, on a local, regional and national level, perfectly coordinated from the moment the occupation began;
• bizarre and self-destructive behaviour on the part of all but a small minority of 800,000 injured, mostly non-combatant, Iraqis;
• the utter failure of local or external agencies to notice and respond to a decimation of the adult male population in key urban areas;
• an abject failure of the media, Iraqi as well as international, to observe that Coalition-caused events of the scale they reported during the three-week invasion in 2003 have been occurring every month for over a year.
In the light of such extreme and improbable implications, a rational alternative conclusion to be considered is that the authors have drawn conclusions from unrepresentative data. In addition, totals of the magnitude generated by this study are unnecessary to brand the invasion and occupation of Iraq a human and strategic tragedy.
iraqbodycount.org
Reality checks: some responses to the latest Lancet estimates
Introduction
There has been enormous interest and debate over the newly published Lancet Iraqi mortality estimate of 655,000 excess deaths since the invasion, 601,000 of them from violence (and including combatants with civilians). Even the latter estimate is some 12 times larger than the IBC count of violent civilian deaths reported in the international news media, which stands at something under 50,000 for the same period (although the IBC figure for this period is likely to considerably increase with the addition of as yet unprocessed data). The new Lancet estimate is also almost the same degree higher than any official records from Iraq. This contrast has provoked numerous requests for comment, and these are our first observations.
The researchers, and in particular their Iraqi colleagues who carried out the survey, should be commended for undertaking it under dangerous circumstances and with minimal resources. Efforts like theirs have consistently highlighted that much more could be done by official bodies, such as the US and UK governments, to assess the human suffering that has resulted from the invasion and occupation of Iraq.
However, our view is that there is considerable cause for scepticism regarding the estimates in the latest study, not least because of a very different conclusion reached by another random household survey, the ILCS, using a comparable method but a considerably better-distributed and much larger sample. This latter study gave a much lower estimate for violent deaths up until April 2004, despite that period being associated with the smallest number of observed deaths in the latest Lancet study.
Additionally, claims that the two Lancet studies confirm each other's estimates are overstated. Both the violent and non-violent post-invasion death estimates are actually quite different in the two studies.
What emerges most clearly from this study is that a multi-methodological approach and much better resourced work is required. Substantially more deaths have occurred than have been recorded so far, but their number still remains highly uncertain.
We also take the view that far more recognition should be accorded the many other courageous people in Iraq, be they Iraqi or international journalists, hospital, morgue, and other officials, or relief workers, who are endeavouring to keep the world informed on the country's plight. Far too many have had to pay the highest possible price for their efforts. Ignorance of this catastrophic war would be far less endemic if their day-by-day contribution were consistently given the exposure it merits. The daily toll on civilian lives resulting from the Iraq war should be front-page news in the countries that instigated it, not inside-page news.
The Lancet estimate
In October 2004 the Lancet published a random cluster sample survey estimating that 98,000 Iraqis had died as a result of the invasion up to that point (an 18-month period), and that 57,600 of these deaths were from violence. The October 2006 study comes from the same research team and provides an estimate for the 40-month period from March 2003 to June 2006 of 655,000 excess deaths, 601,000 of them from violence. The data presented do not distinguish between civilian and combatant deaths. Since IBC's work is confined to violent civilian deaths, we make no further comment on Lancet's non-violent death estimates.
The Lancet researchers visited 47 neighbourhoods and conducted interviews in 40 adjoining households in each neighbourhood. About 1,800 households containing 12,000 Iraqis were surveyed. These households reported a total of 302 violent deaths, each of which has been multiplied by two thousand to provide an estimate of how many of Iraq's estimated 26,000,000 population would have died if this proportion of deaths were representative of the country as a whole.
The study's central estimate of 601,000 violent deaths is exceptionally high. Even its lower bound 95% confidence interval of 426,000 violent deaths is shockingly large. If numbers of this magnitude are anywhere near the truth, then they reveal a disaster far greater than most could have conceived, and one which appears inconsistent with a considerable amount of other information that has emerged over the last three and a half years. Before any firm conclusions are drawn on the basis of this study, five important (and extremely anomalous) implications of the data presented by the Lancet authors require examination.
Implication one:
On average, a thousand Iraqis have been violently killed every single day in the first half of 2006, with less than a tenth of them being noticed by any public surveillance mechanisms.
Between January and June 2006, there were 91 violent deaths recorded by the Lancet survey. This would correspond to over 180,000 deaths in the first 6 months of 2006, and an average rate of 1,000 per day. The daily death rate over the same period based on UN reports (which sum Baghdad morgue and Ministry of Health data) is 80 violent deaths per day. Cumulated media reports provide a somewhat lower figure.
If the Lancet extrapolation is sound, this would imply a further 920 violent deaths every day (1000 minus 80) which have been recorded by neither officials nor the media. As these are averages, some days would see many more deaths, and others substantially fewer, but in either case, all of them would remain unnoticed.
If we consider the Lancet's June 2005 – June 2006 period, whose violent toll it estimates at 330,000, then daily estimates become lower but would still require 768 unrecorded violent deaths for every 67 that are recorded. The IBC database shows that the average number of people killed in any one violent attack is five. Therefore it would require about 150 unreported, average-size, violent assaults per day to account for 768 deaths.
It is unlikely that incidents of this scale would be so consistently missed by the various media in Iraq. Although IBC technically requires only two sources for every corroborated death in its database, we actually collect, archive and analyse every unique report we can find about each incident before it is added to our database. For larger incidents the number of reports can run into the dozens, including news published in English in the original and others, mostly the Iraqi press, published in translation. In IBC's news archive for August 2006 the average-size attack leaving 5 civilians killed has a median number of 6 reports on it.
If, as our data suggest, smaller incidents are the ones that are most likely to be under-reported, then the number of "hidden" assaults implied by this study could be far greater. For instance, if the average number of people killed in each such assault were two, then the number of unreported deadly assaults would have to rise to 380 per day.
One possible way of explaining such a very large number of small-scale unreported assaults is to suppose that many of these are the result of "secret" killings which have resulted from abduction, execution by gunfire, or beheading. But 42% of the 330,000 Lancet-estimated violent deaths in this final 13-month period are ascribed to "explosives/ordnance", car bombs, or air strikes, all of which carry a fairly heavy and hardly 'secret' toll (and will generally create at least 3 times as many wounded).
The Lancet's 2005-2006 data generates an Iraqi average daily death toll of 350 from these explosions and air strikes, of which deaths only a small fraction are officially recorded or reported. More specifically, Lancet data suggests large numbers of deadly car bombings occurring on a daily basis, of which only a small fraction are ever reported (and whose victims, including injured, fail to be recorded by hospitals).
Lancet estimates 150 people to have died from car bombs alone, on average, every day during June 2005-June 2006. IBC's database of deadly car bomb incidents shows they kill 7-8 people on average. Lancet's estimate corresponds to about 20 car bombs per day, all but one or two of which fail to be reported by the media. Yet car bombs fall well within the earlier-mentioned category of incidents which average 6 unique reports on them.
'Baghdad-weighting' of media reports, even if applicable to car bombs, is unlikely to account for this level of under-reporting, as half of the car bombs IBC has recorded have been outside Baghdad. The Pentagon, which has every reason to highlight the lethality of car bombs to Iraqis, records, on average, two to three car-bombings per day throughout Iraq, including those hitting only its own forces or causing no casualties, for the period in question.
Implication two:
Some 800,000 or more Iraqis suffered blast wounds and other serious conflict-related injuries in the past two years, but less than a tenth of them received any kind of hospital treatment.
It may be argued that deaths often fail to be reported to authorities or registered by them (although information supplied by the Lancet authors themselves casts doubt on this argument - see Implication four below). However, people suffering injuries usually make strenuous efforts to receive appropriate treatment, or if they are severely incapacitated, others see to it that they do so.
It is a long-established finding that around three times as many people are injured in modern wars as are killed in them. This is borne out in Iraq in statistics gathered by the Iraqi Ministry of Health (MoH). Their casualty monitoring centre was set up in Spring 2004 to allow the Ministry to allocate resources in response to conflict-related violence across Iraq (excluding the Kurdish-administered regions). The system is claimed to be manned 24 hours a day, with hospitals phoning the Ministry in Baghdad on a daily basis (when necessary) to report on dead and wounded from conflict-related violence,
The MoH has reported 2.9 wounded for each person killed in the period from mid-2004 to mid-2006. An almost identical ratio was confirmed in IBC's independent analysis of media-derived data for the first two years after the invasion.
If 600,000 people have died violent deaths, then the 3:1 ratio implies that 1,800,000 Iraqis have by now been wounded. This would correspond to 1 in every 15 Iraqis.
Of course, death/injury ratios vary according to the weapons being used. Bombs and air strikes leave more wounded than does gunfire, but even the latter may cause widespread injury when it is indiscriminate, as it often is in gun-battles or in "defensive" fire by US troops who come under attack. By far the lowest proportion of injured are produced in the execution of captives, whether by guns or other means.
We might therefore calculate a much more conservative estimate of wounded associated with the Lancet findings, based on the different proportions of weaponry reported in Table 4 of the Lancet paper. We assume 3 wounded for every explosive- or air strike-caused death, but only 1 wounded for every 2 gunfire deaths, and no wounded from the "unknown" and "accident" categories.
This yields a revised Lancet-based estimate of 800,000 wounded over the equivalent period for which the MoH has been collecting this information centrally. In that same two-year period the official total of wounded treated in Iraqi hospitals is recorded as 59,372.
Whether hospitals can provide a comprehensive tally of violent deaths or not, their knowledge of seriously injured should be much more complete.
Accepting the Lancet estimate would entail concluding that at least 740,000 wounded Iraqis (90% of the total) were not treated or, if treated, not recorded in any way, throughout a 2-year period beginning in mid-2004. It may be that many injured anti-occupation combatants have avoided hospitals to prevent identification or arrest, but they are hardly likely to account for more than a small fraction of this discrepancy. It would further imply that approaching 90% of Lancet's deaths are also of combatants.
In fact, even if one considers only the victims of car bombs as estimated in Lancet (who are a relatively small subset, and would have no reason to avoid - if they even had the capacity to do so - detection by authorities), then the 220,000 injured which would credibly accompany Lancet's estimates would far outstrip the 60,000 whom hospitals have recorded treating for injuries from all causes. This would be despite the existence of an ongoing, albeit imperfect, monitoring system specifically designed for such war-related casualty monitoring, one which emergency health service providers should have strong interest in maintaining in order to receive the necessary resources from the Health Ministry.
Implication three:
Over 7% of the entire adult male population of Iraq has already been killed in violence, with no less than 10% in the worst affected areas covering most of central Iraq.
Of the 287 violent post-invasion deaths recorded by the Lancet authors where the age and sex was known, 235 (82%) were adult males between 15 and 59 years old. Extrapolating to the population as a whole would mean that around 470,000 men in this age group have been killed violently, i.e. one in 15 (7%) of adult males aged 15 to 59.
But that figure, horrific enough on its own, is only the national average. According to all accounts, including Lancet's, the intensity of violence differs widely across Iraq. The Lancet authors estimate at least a 5-fold difference in levels of violence between the lowest and the highest of the 16 Iraqi provinces sampled. In the provinces containing the highest violence - with a total population of 6.4 million – the Lancet-derived proportion of men killed would begin at one in 10, and rise from there (the study did not publish sufficient data to deduce what the maxima might be). This level of adult male decimation would not just apply to a few badly affected areas, but vast swathes of central Iraq representing around a quarter of the Iraq's population.
Implication four:
Half a million death certificates were received by families which were never officially recorded as having been issued.
In 87% of cases where deaths were reported, the survey team asked to see death certificates, leading to the Lancet authors' statement that "92% of households had death certificates for deaths they reported". Assuming, as the authors do, that this is representative of the population as a whole, would imply that officials in Iraq have issued approximately 550,000 death certificates for violent deaths (92% of 601,000). Yet in June 2006, the total figure of post-war violent deaths known to the Iraqi Ministry of Health (MoH), combined with the Baghdad morgue, was approximately 50,000.
If the Lancet estimate is correct then it follows that either (a) 500,000 documented violent deaths, for which certificates were issued, have somehow managed to completely disappear without a trace to Iraqi officials or the international media or (b) there is a vast, elaborate, and very successful, cover up of this massive number of bodies and their associated paper trail being carried out in Iraq.
A "suspicion" of option (b) is offered as one possible explanation in the supplementary notes to the Lancet report, but is not addressed in any detail. Option (a), however, is argued for explicitly. The authors write that:
"Even with the death certificate system, only about one-third of deaths were captured by the government's surveillance system in the years before the current war, according to informed sources in Iraq. At a death rate of 5/1,000/year, in a population of 24 million, the government should have reported 120,000 deaths annually. In 2002, the government documented less than 40,000 from all sources. The ministry's numbers are not likely to be more complete or accurate today."
The above statement provides the sole evidentiary basis for the Lancet authors to dismiss as "expected" the factor-of-ten discrepancy between their estimates and statistics collected by the official monitoring system as it exists in Iraq. No one argues that Iraq's official figures are complete, including its officials. But could their coverage be so bad as to amount to no more than a small fraction of deaths, as suggested above?
Two points need to be made here. First, despite the confidence with which the Lancet authors make the assertion, the natural death rate of 5/1,000/year is not an established fact for Iraq in 2002. It is one estimate, a projection or extrapolation from some smaller set of known data. It may be correct, or it may not be, and there can be considerable room for debate on the matter.
Second, the figure of 40,000 claimed as the number of deaths recorded by the MoH in 2002 is false. No specific citation is offered by the Lancet authors for this figure other than a vague attribution to "informed sources in Iraq". But official Iraqi figures for 2002, forwarded to IBC courtesy of the Los Angeles Times, show that the Ministry registered 84,025 deaths from all causes in that year. This excluded deaths in the Kurdish-administered regions, which contain 12% or more of the population.
Thus, the actual MoH figure for 2002, even while excluding Kurdistan, stands at 70% of the estimate of 120,000 that, per the Lancet authors, "should have been recorded" nation-wide in 2002. It may (or may not, given its post-2004 casualty monitoring system) be true that the "ministry's numbers are not likely to be more complete or accurate today". But if their completeness is even remotely similar to 2002 (the Ministry's equivalent 2005 figures record 115,785 deaths, an average of 320 per day), then we are still left with a vast and completely unexplained chasm between the actual official figures, what may reasonably be assumed about their past completeness based on documentary evidence, and the violent death estimate offered in this new Lancet report.
Implication five:
The Coalition has killed far more Iraqis in the last year than in earlier years containing the initial massive "shock and awe" invasion and the major assaults on Falluja.
According to Lancet calculations, Coalition forces killed 32,000 Iraqis from late March 2003 to the end of April 2004. This is a period that included the large-scale invasion in which 20,000 air strikes rained 30,000 bombs on a largely urbanized country along with an untold quantity of artillery, as well as an additional 240,000 cluster bombs. This type of assault was then repeated on a smaller but still significant scale in Falluja. All available evidence points to a significant and progressive reduction in Coalition military operations overall since the first year of the invasion.
Yet, according to Lancet estimates, the number of Iraqis killed by the Coalition rose to 70,000 in year two (May 2004 – May 2005), and rose yet again in the third year (June 2005 – June 2006) to 86,000, nearly three times more than in year 1.
When looking at US air strikes, the picture becomes even more puzzling. This data is comprised of 40 deaths:
• 1 killed in January 2002-March 2003 (estimate: 2,000 killed);
• 6 killed in March 2003-April 2004 (estimate: 12,000 killed);
• 13 killed in May 2004-May 2005 (estimate: 26,000 killed);
• 20 killed in June 2005-June 2006 (estimate: 40,000 killed).
Those who keenly recall the reported carnage associated with the invasion in 2003 will scarcely credit the notion that similar events but of a much greater scale and extent have continued unremarked and unrecorded, including by locals, in a nation at the level of education and urbanisation of Iraq. Iraq is not an undeveloped society where tiny, self-sufficient communities live in isolation and ignorance of each other.
Six thousand civilians were reported killed by Coalition forces in the first three weeks of the invasion, i.e., 285 per day. The Lancet estimate of 86,000 Iraqis killed by Coalition forces in the 13 months from 2005-2006 averages 217 per day over a much longer, relentlessly sustained period. And as shocking as such a secret toll would be, it is claimed to constitute only 26% of the even greater carnage inflicted by anti-Coalition or unattributable bombs and bullets, which it is claimed killed 330,000 Iraqis in this period, also almost always without being noticed by anyone but the victims.
Concluding remarks
Could five such shocking implications be true? If they were true, they would need to be the result of a combination of the following factors:
• incompetence and/or fraud on a truly massive scale by Iraqi officials in hospitals and ministries, on a local, regional and national level, perfectly coordinated from the moment the occupation began;
• bizarre and self-destructive behaviour on the part of all but a small minority of 800,000 injured, mostly non-combatant, Iraqis;
• the utter failure of local or external agencies to notice and respond to a decimation of the adult male population in key urban areas;
• an abject failure of the media, Iraqi as well as international, to observe that Coalition-caused events of the scale they reported during the three-week invasion in 2003 have been occurring every month for over a year.
We would hope that, before accepting such extreme notions, serious consideration is given to the possibility that the population estimates derived from the Lancet study are flawed. The most likely source of such a flaw is some bias in the sampling methodology such that violent deaths were vastly over-represented in the sample. The precise potential nature of such bias is not clear at this point (it could, for example, involve problems in the application of a statistical method originally designed for studying the spread of disease in a population to direct and ongoing violence-related phenomena). But to dismiss the possibility of such bias out of hand is surely both irresponsible and unwise.
All that has been firmly documented as a result of the Lancet study is that some 300 post-invasion violent deaths occurred among the members of the households interviewed. This information, and the demographic and causative breakdowns presented in the study, are significant additions to the detailed knowledge that is painstakingly being accumulated about the individual victims of this conflict, and the tragedies that have befallen them. These 300 may be added to the roster of some 50,000 others for whom this level of detailed knowledge is available. In some - but still far too few - cases we know the name, ages, occupation, and exact circumstances of death. Information presented at this level of detail is the only way to arrive at once-for-all certainty, in a way that does justice to the victims, honours their memory, and provides the closure that only a full list, or census, can do satisfactorily.
Do the American people need to believe that 600,000 Iraqis have been killed before they can turn to their leaders and say "enough is enough"? The number of certain civilian deaths that has been documented to a basic standard of corroboration by "passive surveillance methods" surely already provides all the necessary evidence to deem this invasion and occupation an utter failure at all levels.
On 9/11 3,000 people were violently killed in attacks on the USA. Those events etched themselves into the soul of every American, and reverberated around the world. In December 2005 President George Bush acknowledged 30,000 known Iraqi violent deaths in a country one tenth the size of the USA. That is already a death toll 100 times greater in its impact on the Iraqi nation than 9/11 was on the USA. That there are more deaths that have not yet come to light is certain, but if a change in policy is needed, the catastrophic roll-call of the already known dead is more than ample justification for that change.
Note for press and media. The Lancet researchers documented 300 violent deaths. Iraq has reached such a sorry state that IBC records 300 deaths every few days. Although comment of the sort offered here is sometimes necessary, it diverts our energies away from the main work to which we are committed, and to which still far too few are contributing. In light of this we regret that, at the current time, we have extremely limited capacity to undertake interviews with individual members of the press or media, and may be unable to deal with urgent requests. Full permission is granted to cite from this release, with appropriate attribution.
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