New Estimate of Violent Deaths Among Iraqis Is Lower

By David Brown and Joshua Partlow
Washington Post Staff Writers
Thursday, January 10, 2008

A new survey estimates that 151,000 Iraqis died from violence in the three years following the U.S.-led invasion of the country. Roughly 9 out of 10 of those deaths were a consequence of U.S. military operations, insurgent attacks and sectarian warfare.

The survey, conducted by the Iraqi government and the World Health Organization, also found a 60 percent increase in nonviolent deaths -- from such causes as childhood infections and kidney failure -- during the period. The results, which will be published in the New England Journal of Medicine at the end of the month, are the latest of several widely divergent and controversial estimates of mortality attributed to the Iraq war.

The three-year toll of violent deaths calculated in the survey is one-quarter the size of that found in a smaller survey by Iraqi and Johns Hopkins University researchers published in the journal Lancet in 2006.

Both teams used the same method -- a random sample of houses throughout the country. For the new study, however, surveyors visited 23 times as many places and interviewed five times as many households. Surveyors also got more outside supervision in the recent study; that wasn't possible in the spring of 2006 when the Johns Hopkins survey was conducted.

Despite reaching a lower estimate of total deaths, the epidemiologists found what they termed "a massive death toll in the wake of the 2003 invasion."

Iraq's population-wide mortality rate nearly doubled, and the death rate from violence increased tenfold after the coalition attack. Men between 15 and 60 were at the greatest risk. Their death rate from all causes tripled, and their risk of dying a violent death went up elevenfold.

Iraq's health minister, Salih al-Hasnawi, in a conference call held by WHO yesterday morning, said: "Certainly I believe this number. I think that this is a very sound survey with accurate methodology."

Other experts not involved in the research also expressed confidence in the findings, even though, as with the earlier survey, the 151,000-death estimate has a wide range of statistical uncertainty, from a low of 104,000 to a high of 223,000.

"Overall, this is a very good study," said Paul Spiegel, a medical epidemiologist at the United Nations High Commission on Refugees in Geneva. "What they have done that other studies have not is try to compensate for the inaccuracies and difficulties of these surveys, triangulating to get information from other sources."

Spiegel added that "this does seem more believable to me" than the earlier survey, which estimated 601,000 deaths from violence over the same period.

U.S. military officials yesterday pointed to the great disparity between the two estimates, noting privately that it underscores the potential for inaccuracies in such surveys. The Defense Department has not released any estimates of civilian deaths and has said often that the military takes precautions to prevent civilian casualties, while the United States' enemies in Iraq deliberately target civilians.

"It would be difficult for the U.S. to precisely determine the number of civilian deaths in Iraq as a result of insurgent activity," said Lt. Col. Mark Ballesteros, a Pentagon spokesman. "The Iraqi Ministry of Health would be in a better position, with all of its records, to provide more accurate information on deaths in Iraq."

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