- The invasion of Iraq in March 2003 by coalition forces
has lead to the death of at least 100,000 civilians, reveals the first
scientific study to examine the issue.
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- The majority of these deaths, which are in addition those
normally expected from natural causes, illness and accidents, have been
among women and children, finds the study, released early by The Lancet
on Thursday.
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- The most common cause of death is as a direct result
of violence, mostly caused by coalition air strikes, reveals the study
of almost 1000 households scattered across Iraq. And the risk of violent
death just after the invasion was 58 times greater than before the war.
The overall risk of death was 1.5 times more after the invasion than before.
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- The figure of 100,000 is based on "conservative
assumptions", notes Les Roberts at Johns Hopkins Bloomberg School
of Public Health, Baltimore, US, who led the study.
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- That estimate excludes Falluja, a hotspot for violence.
If the data from this town is included, the study points to about 200,000
excess deaths since the outbreak of war.
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- Public health
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- "These findings raise questions for those far removed
from Iraq - in the governments of the countries responsible for launching
a pre-emptive war," writes Richard Horton, the editor of The Lancet
in a commentary accompanying the paper.
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- "In planning this war, the coalition forces - especially
those of the US and UK - must have considered the likely effects of their
actions for civilians," he writes.
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- He argues that, from a public health perspective, whatever
"planning did take place was grievously in error".
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- "The invasion of Iraq, the displacement of a cruel
dictator, and the attempt to impose a liberal democracy by force have,
by themselves, been insufficient to bring peace and security to the civilian
population. Democratic imperialism has led to more deaths, not fewer,"
he asserts.
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- He also praises the "courageous team of scientists"
for their efforts, and notes the study's limitations.
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- GPS sampling
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- The team of US and Iraqi scientists recorded mortality
during the 15 months before the invasion and the 18 months afterwards.
They carried out the survey of 988 Iraqi households in 33 different areas
across Iraq in September 2004.
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- Using a GPS (global positioning system) unit, the interviewers
randomly selected towns within governates. They then visited the nearest
30 houses to the GPS point randomly selected.
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- Families living under one roof were asked about deaths
in their household before and after the war. "Confirmation was sought
to ensure that a large fraction of the reported deaths were not fabrications,"
write the team. The interviewers did ask for death certificates, but only
in two cases for each cluster of houses. This was because of concerns that
implying the families were lying could trigger violence.
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- But the team believes that lying about deaths is unlikely
and, if anything, "it is possible that deaths were not reported"
because families might want to conceal them.
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- Horton acknowledges the potential for recall bias among
those interviewed and also the relatively small sample size. "The
research was completed under the most testing of circumstances - an ongoing
war. And therefore certain limitations were inevitable and need to be acknowledged
right away," he says.
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- But he also calls for an "urgent political and military
response".
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- - Journal reference: The Lancet (early online publication)
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