Last week 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 had 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 bureaucratic vigilance is not the case in present day Iraq.
In a war-ravaged country, an estimate of war-related deaths based on the method of 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. We must also 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."
Despite the scientific rigor of the Hopkins' study, there is a danger that the unsubstantiated criticism by administration. 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.
I sit on the Board of Directors for the Nobel Peace Prize-winning organization, Physicians for Social Responsibility. We care about the "Medical Consequences of the War in Iraq." In fact, that's the topic of our upcoming conference to be held at UCLA this Saturday, October 21. The conference is co-sponsored by the UCLA School of Public Health and UCLA Extension and is open to the public. Dr. David Rush, past president of the Society of Epidemiologic Research, will discuss The Lancet Iraq study.
As physicians, we realize the horrible human cost and needless suffering the American invasion has brought on the people of Iraq. The war has also terribly harmed our own American soldiers, 2,765 of whom have been killed and 20,000 of whom have suffered disabling injuries. So far, 26,000 have filed VA disability claims and 10,000 vets have sought VA counseling.
At his recent press conference, President Bush brushed aside a question to quantify the human toll of the Iraq War with the comment that "a lot of innocent people" have died. 655,000 is not a guess. It is the best estimate that we have to date of the human tragedy in Iraq.