LONDON — The final indignity, if you are an Iraqi who was shot for accidentally turning into the path of a U.S. military convoy (they thought you might be a terrorist), or blown apart by a car bomb or an airstrike, or tortured and murdered by kidnappers, or just for being a Sunni or a Shiite, is that U.S. President George W. Bush and British Prime Minister Tony Blair will deny that your death happened. The script they are working from says (in Bush’s words last December) that only “30,000, more or less” have been killed in Iraq during and since the invasion in March, 2003.
So they have a huge incentive to discredit the report in the British medical journal The Lancet last week that an extra 655,000 Iraqis have died since the invasion in excess of the natural death rate: 2.5 percent of the population.
“I don’t consider it a credible report,” said Bush, without giving any reason why he didn’t.
“It is a fairly small sample they have taken and they have extrapolated it across the country,” said a spokesman of the British Foreign Office, as if that were an invalid methodology. But it’s not.
The study, led by Dr. Les Roberts and a team of epidemiologists from the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, was based on a survey of 1,849 households, containing 12,801 people, at 47 different locations chosen at random in Iraq. Teams of four Iraqi doctors — two men and two women — went from house to house and asked the residents if anybody had died in their family since January, 2002 (15 months before the invasion).
If anybody had, they then inquired when and how the person had died. They asked for death certificates, and in 92 percent of cases the families produced them. Then the Johns Hopkins team of epidemiologists tabulated the statistics and drew their conclusions.
The most striking thing in the study, in terms of credibility, is that the prewar death rate in Iraq for the period January 2002-March 2003, as calculated from their evidence, was 5.5 per thousand per year. That is virtually identical to the U.S. government estimate of the death rate in Iraq for the same period. Then, from the same evidence, they calculate that the death rate since the invasion has been 13.3 per thousand per year. The difference between the prewar and postwar death rates over a period of 40 months is 655,000 deaths.
More precisely, the deaths reported by the 12,801 people surveyed, when extrapolated to the entire country, indicates a range of between 426,369 and 793,663 excess deaths — but the sample is big enough that there is a 95 percent certainty that the true figure is within that range. What the Johns Hopkins team have done in Iraq is more rigorous version of the technique that is used to calculate deaths in southern Sudan and the eastern Congo. To reject it, you must either reject the whole discipline of statistics, or you must question the professional integrity of those doing the survey.
The study, which was largely financed by the Massachusetts Institute of Technology’s Center for International Studies, has been reviewed by four independent experts. One of them, Paul Bolton of Boston University, called the methodology “excellent” and said it was standard procedure in a wide range of studies he has worked on: “You can’t be sure of the exact number, but you can be quite sure that you are in the right ballpark.”
This is not a political smear job. Johns Hopkins University, Boston University and MIT are not fly-by-night institutions, and people who work there have academic reputations to protect. The Lancet, founded 182 years ago, is one of the oldest and most respected medical journals in the world. These numbers are real. So what do they mean?
Two-thirds of a million Iraqis have died since the invasion who would almost all be alive if it had not happened. Human Rights Watch has estimated that between 250,000 and 290,000 Iraqis were killed during Saddam Hussein’s 20-year rule, so perhaps 40,000 people might have died between the invasion and now if he had stayed in power. (Though probably not anything like that many, really, because the great majority of Saddam’s killings happened during crises like the Kurdish rebellion of the late 1980s and the Shiite revolt after the 1990-91 Gulf War.)
Of the 655,000 excess deaths since March 2003, only about 50,000 can be attributed to stress, malnutrition, the collapse of medical services as doctors flee abroad, and other side effects of the occupation. All the rest are violent deaths, and 31 percent are directly due to the actions of foreign “coalition” forces.
The most disturbing thing is the breakdown of the causes of death. Over half the deaths — 56 percent — are due to gunshot wounds, but 13 percent are due to airstrikes. Terrorists don’t do airstrikes. No Iraqi government forces do airstrikes, either, because they don’t have combat aircraft. Airstrikes are done by “coalition forces” (i.e. Americans and British), and airstrikes in Iraq have killed over 75,000 people since the invasion.
Oscar Wilde once observed that “to lose one parent . . . may be regarded as a misfortune; to lose both looks like carelessness.” To lose 75,000 Iraqis to airstrikes looks like carelessness, too.