The Lancet Iraqi deaths study

My friend Jason sent me a copy of The Lancet study about the Iraqi deaths. You can read the whole text yourself at thelancet.com. The whole text is here:
http://www.thelancet.com/journals/lancet/article/
PIIS0140673606694919/fulltext?isEOP=true

The web address of the study is:

So, John, that answers your question of whether or not it is easily accessible! I haven't seen the study in local book stores; I'd imagine I could find a copy at ULM.

One thing I wasn't sure from yesterday's reporting was whether the 655,000 figure was total deaths since after the war or additional deaths caused by the war. I thought it might have been total, but according to the report they clearly state that the number is 655,000 more Iraqi deaths due to the war.

Here are some important excerpts:

"A sample size of 12000 was calculated to be adequate to identify a doubling of an estimated pre-invasion crude mortality rate of 5·0 per 1000 people per year with 95% confidence and a power of 80%, and was chosen to balance the need for robust data with the level of risk acceptable to field teams."

"Separation of combatant from non-combatant deaths during interviews was not attempted, since such information would probably be concealed by household informants, and to ask about this could put interviewers at risk."

"At the conclusion of household interviews where deaths were reported, surveyors requested to see a copy of any death certificate and its presence was recorded. Where differences between the household account and the cause mentioned on the certificate existed, further discussions were sometimes needed to establish the primary cause of death."

"Of the 629 deaths reported, 547 (87%) were in the post-invasion period (March, 2003, to June, 2006) compared with 82 (13%) in the pre-invasion period (January, 2002, to March, 2003; table 2). Most deaths (n=485; 77%) were in males, and this was true for both periods, but more pronounced in the pre-invasion period (57 of 82 deaths pre-invasion vs 428 of 547 deaths post-invasion). The male-to-female ratio of post-invasion deaths was 3·4 for all deaths, and 9·8 for violent deaths (all deaths: 144 female, 485 male; violent death: 28 female, 274 male). In general, deaths by age group followed the expected J-shaped demographic curve; however, by contrast, most deaths in males were in the middle age groups (figure 1)."

"Of the 302 violent deaths, 274 (91%) were of men, and within this group, deaths concentrated in the 15–29 and 30–44 year old age groups (figure 1). Most violent deaths were due to gunshots (56%); air strikes, car bombs, and other explosions/ordnance each accounted for 13–14% of violent deaths. The number of deaths from gunshots increased consistently over the post-invasion period, and a sharp increase in deaths from car bombs was noted in 2006."

"The male-to-female ratio of non-violent deaths was 1·8 (211 male vs 116 female deaths; p<0·0001). 17% of non-violent deaths occurred in those aged under 15 years, 32% in 15–59 year olds, and 52% in those over 60 years. Non-violent deaths by time, age, and cause are described in table 2. Cardiovascular conditions were the main cause of non-violent death and accounted for 37% of non-violent deaths over the entire study period. Other notable sources of non-violent mortality included cancer (14%), chronic illnesses (13%), infant deaths (12%), accidents (11%), and old age (8%). Causes of non-violent deaths were much the same both pre-invasion and post-invasion (p=0·290)."

There's a discussion of the way they did this survey versus "passive surveillance methods". They point out that except for the war in Bosnia passive surveillance has never found more than 20% of the deaths during a conflict. In Guatemala, the number was 50% during periods of low violence but 5% in periods of high violence.

This is important. If the Pentagon is getting a figure around 30,000, and Iraq Body Count is around 44,000 to 49,000 through passive means, historically you would expect these numbers to be far too low.

"Deaths were not classified as being due to coalition forces if households had any uncertainty about the responsible party; consequently, the number of deaths and the proportion of violent deaths attributable to coalition forces could be conservative estimates." I will point out here that in spite of the privacy used in taking the survey, families angry that the coallition was there in the first place might blame the coallition for the deaths even if it was unwarranted. Later in the report, the authors admit this could be a problem.

The section on bias and error is important. There are a few reasons they may have under reported deaths. One is the possibility of migration bringing people into an area that was previously peaceful. The demographic data uses was two years old. I suspect this could be a big factor in why the rates were so high. For instance, if you interviewed people in Baghdad and interviewed people in a quiet village away from Baghdad, if the quiet village had people there who moved from violent Baghdad they would skew the sample. They had a 92% corroboration rate (meaning they could corroborate 92% of the deaths). Child deaths could be under reported. Also, they had to throw out three clusters due to errors; those three areas are not in the survey, thus they, too, could be under reported.

Here is one of the last statements: "At the conclusion of our 2004 study we urged that an independent body assess the excess mortality that we saw in Iraq. This has not happened. We continue to believe that an independent international body to monitor compliance with the Geneva Conventions and other humanitarian standards in conflict is urgently needed. With reliable data, those voices that speak out for civilians trapped in conflict might be able to lessen the tragic human cost of future wars."

There is a trend of escalating violence in this study that, regardless of what opponents think of the methodolgy, supports the contention that violence is increasing in Iraq. I think John said it very well in his comment on my piece yesterday, that the number of actual deaths is probably somewhere below this survey's number but greater than that listed by the administration. Unless an international body is allowed into Iraq to do a more in depth study, one where the lives of the surveyers are not in as much risk, no one will know for sure.