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Re: 100,000 Iraqis died in 18 months of war
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Guess who's back in the muthf$&%$en house


100,000 Dead—or 8,000
How many Iraqi civilians have died as a result of the war?
By Fred Kaplan
Posted Friday, Oct. 29, 2004, at 3:49 PM PT

The authors of a peer-reviewed study, conducted by a survey team from Johns Hopkins University, claim that about 100,000 Iraqi civilians have died as a result of the war. Yet a close look at the actual study, published online today by the British medical journal the Lancet, reveals that this number is so loose as to be meaningless.

The report's authors derive this figure by estimating how many Iraqis died in a 14-month period before the U.S. invasion, conducting surveys on how many died in a similar period after the invasion began (more on those surveys later), and subtracting the difference. That difference—the number of "extra" deaths in the post-invasion period—signifies the war's toll. That number is 98,000. But read the passage that cites the calculation more fully:

We estimate there were 98,000 extra deaths (95% CI 8000-194 000) during the post-war period.

Readers who are accustomed to perusing statistical documents know what the set of numbers in the parentheses means. For the other 99.9 percent of you, I'll spell it out in plain English—which, disturbingly, the study never does. It means that the authors are 95 percent confident that the war-caused deaths totaled some number between 8,000 and 194,000. (The number cited in plain language—98,000—is roughly at the halfway point in this absurdly vast range.)

This isn't an estimate. It's a dart board.

Continue Article

Imagine reading a poll reporting that George W. Bush will win somewhere between 4 percent and 96 percent of the votes in this Tuesday's election. You would say that this is a useless poll and that something must have gone terribly wrong with the sampling. The same is true of the Lancet article: It's a useless study; something went terribly wrong with the sampling.

The problem is, ultimately, not with the scholars who conducted the study; they did the best they could under the circumstances. The problem is the circumstances. It's hard to conduct reliable, random surveys—and to extrapolate meaningful data from the results of those surveys—in the chaotic, restrictive environment of war.

However, these scholars are responsible for the hype surrounding the study. Gilbert Burnham, one of the co-authors, told the International Herald Tribune (for a story reprinted in today's New York Times), "We're quite sure that the estimate of 100,000 is a conservative estimate." Yet the text of the study reveals this is simply untrue. Burnham should have said, "We're not quite sure what our estimate means. Assuming our model is accurate, the actual death toll might be 100,000, or it might be somewhere between 92,000 lower and 94,000 higher than that number."

Not a meaty headline, but truer to the findings of his own study.

Here's how the Johns Hopkins team—which, for the record, was led by Dr. Les Roberts of the university's Bloomberg School of Public Health—went about its work. They randomly selected 33 neighborhoods across Iraq—equal-sized population "clusters"—and, this past September, set out to interview 30 households in each. They asked how many people in each household died, of what causes, during the 14 months before the U.S. invasion—and how many died, of what, in the 17 months since the war began. They then took the results of their random sample and extrapolated them to the entire country, assuming that their 33 clusters were perfectly representative of all Iraq.

This is a time-honored technique for many epidemiological studies, but those conducting them have to take great care that the way they select the neighborhoods is truly random (which, as most poll-watchers of any sort know, is difficult under the easiest of circumstances). There's a further complication when studying the results of war, especially a war fought mainly by precision bombs dropped from the air: The damage is not randomly distributed; it's very heavily concentrated in a few areas.

The Johns Hopkins team had to confront this problem. One of the 33 clusters they selected happened to be in Fallujah, one of the most heavily bombed and shelled cities in all Iraq. Was it legitimate to extrapolate from a sample that included such an extreme case? More awkward yet, it turned out, two-thirds of all the violent deaths that the team recorded took place in the Fallujah cluster. They settled the dilemma by issuing two sets of figures—one with Fallujah, the other without. The estimate of 98,000 deaths is the extrapolation from the set that does not include Fallujah. What's the extrapolation for the set that does include Fallujah? They don't exactly say. Fallujah was nearly unique; it's impossible to figure out how to extrapolate from it. A question does arise, though: Is this difficulty a result of some peculiarity about the fighting in Fallujah? Or is it a result of some peculiarity in the survey's methodology?

There were other problems. The survey team simply could not visit some of the randomly chosen clusters; the roads were blocked off, in some cases by coalition checkpoints. So the team picked other, more accessible areas that had received similar amounts of damage. But it's unclear how they made this calculation. In any case, the detour destroyed the survey's randomness; the results are inherently tainted. In other cases, the team didn't find enough people in a cluster to interview, so they expanded the survey to an adjoining cluster. Again, at that point, the survey was no longer random, and so the results are suspect.

Beth Osborne Daponte, senior research scholar at Yale University's Institution for Social and Policy Studies, put the point diplomatically after reading the Lancet article this morning and discussing it with me in a phone conversation: "It attests to the difficulty of doing this sort of survey work during a war. … No one can come up with any credible estimates yet, at least not through the sorts of methods used here."

The study, though, does have a fundamental flaw that has nothing to do with the limits imposed by wartime—and this flaw suggests that, within the study's wide range of possible casualty estimates, the real number tends more toward the lower end of the scale. In order to gauge the risk of death brought on by the war, the researchers first had to measure the risk of death in Iraq before the war. Based on their survey of how many people in the sampled households died before the war, they calculated that the mortality rate in prewar Iraq was 5 deaths per 1,000 people per year. The mortality rate after the war started—not including Fallujah—was 7.9 deaths per 1,000 people per year. In short, the risk of death in Iraq since the war is 58 percent higher (7.9 divided by 5 = 1.58) than it was before the war.

But there are two problems with this calculation. First, Daponte (who has studied Iraqi population figures for many years) questions the finding that prewar mortality was 5 deaths per 1,000. According to quite comprehensive data collected by the United Nations, Iraq's mortality rate from 1980-85 was 8.1 per 1,000. From 1985-90, the years leading up to the 1991 Gulf War, the rate declined to 6.8 per 1,000. After '91, the numbers are murkier, but clearly they went up. Whatever they were in 2002, they were almost certainly higher than 5 per 1,000. In other words, the wartime mortality rate—if it is 7.9 per 1,000—probably does not exceed the peacetime rate by as much as the Johns Hopkins team assumes.

The second problem with the calculation goes back to the problem cited at the top of this article—the margin of error. Here is the relevant passage from the study: "The risk of death is 1.5-fold (1.1 – 2.3) higher after the invasion." Those mysterious numbers in the parentheses mean the authors are 95 percent confident that the risk of death now is between 1.1 and 2.3 times higher than it was before the invasion—in other words, as little as 10 percent higher or as much as 130 percent higher. Again, the math is too vague to be useful.

There is one group out there counting civilian casualties in a way that's tangible, specific, and very useful—a team of mainly British researchers, led by Hamit Dardagan and John Sloboda, called Iraq Body Count. They have kept a running total of civilian deaths, derived entirely from press reports. Their count is triple fact-checked; their database is itemized and fastidiously sourced; and they take great pains to separate civilian from combatant casualties (for instance, last Tuesday, the group released a report estimating that, of the 800 Iraqis killed in last April's siege of Fallujah, 572 to 616 of them were civilians, at least 308 of them women and children).

The IBC estimates that between 14,181 and 16,312 Iraqi civilians have died as a result of the war—about half of them since the battlefield phase of the war ended last May. The group also notes that these figures are probably on the low side, since some deaths must have taken place outside the media's purview.

So, let's call it 15,000 or—allowing for deaths that the press didn't report—20,000 or 25,000, maybe 30,000 Iraqi civilians killed in a pre-emptive war waged (according to the latest rationale) on their behalf. That's a number more solidly rooted in reality than the Hopkins figure—and, given that fact, no less shocking.

Related in SlateIn October 2001, Chris Suellentrop explained the difficulties of counting the number of Iraqi children "killed" by U.N. sanctions on Saddam Hussein's regime.

Fred Kaplan writes the "War Stories" column for Slate






Jesus on Dope wrote:
>Press
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>Updated: Thu. Oct. 28 2004 11:29 PM ET
>
>LONDON — A survey of deaths in Iraqi households estimates that as many as 100,000 more people may have died throughout the country in the 18 months since the U.S.-led invasion than would be expected based on the death rate before the war.
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>There is no official figure for the number of Iraqis killed since the conflict began, but some non-governmental estimates range from 10,000 to 30,000. As of Wednesday, 1,081 U.S. servicemen had been killed, according to the U.S. Defense Department.
>
>The scientists who wrote the report concede that the data they based their projections on were of "limited precision," because the quality of the information depends on the accuracy of the household interviews used for the study. The interviewers were Iraqi, most of them doctors.
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>Designed and conducted by researchers at Johns Hopkins University, Columbia University and the Al-Mustansiriya University in Baghdad, the study is being published Thursday on the Web site of The Lancet medical journal.
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>The survey indicated violence accounted for most of the extra deaths seen since the invasion, and airstrikes from coalition forces caused most of the violent deaths, the researchers wrote in the British-based journal.
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>"Most individuals reportedly killed by coalition forces were women and children," they said.
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>The report was released just days before the U.S. presidential election, and the lead researcher said he wanted it that way. The Lancet routinely publishes papers on the Web before they appear in print, particularly if it considers the findings of urgent public health interest.
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>Those reports then appear later in the print issue of the journal. The journal's spokesmen said they were uncertain which print issue the Iraqi report would appear in and said it was too late to make Friday's issue, and possibly too late for the Nov. 5 edition.
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>Les Roberts, the lead researcher from Johns Hopkins, said the article's timing was up to him.
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>"I emailed it in on Sept. 30 under the condition that it came out before the election," Roberts told The Asocciated Press. "My motive in doing that was not to skew the election. My motive was that if this came out during the campaign, both candidates would be forced to pledge to protect civilian lives in Iraq.
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>"I was opposed to the war and I still think that the war was a bad idea, but I think that our science has transcended our perspectives," Roberts said. "As an American, I am really, really sorry to be reporting this."
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>Richard Peto, an expert on study methods who was not involved with the research, said the approach the scientists took is a reasonable one to investigate the Iraq death toll.
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>However, it's possible that they may have zoned in on hotspots that might not be representative of the death toll across Iraq, said Peto, a professor of medical statistics at Oxford University in England.
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>Lancet editor Richard Horton wrote in an editorial accompanying the survey that more household clusters would have improved the precision of the report, "but at an enormous and unacceptable risk to the team of interviewers."
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>"This remarkable piece of work represents the efforts of a courageous team of scientists," he wrote.
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>To conduct the survey, investigators visited 33 neighborhoods spread evenly across the country in September, randomly selecting clusters of 30 households to sample. Of the 988 households visited, 808, consisting of 7,868 people, agreed to participate. Each group At each one they asked how many people lived in the home and how many births and deaths there had been since January 2002.
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>The scientists then compared death rates in the 15 months before the invasion with those that occurred during the 18 months after the attack and adjusted those numbers to account for the different time periods.
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>Even though the sample size appears small, this type of survey is considered accurate and acceptable by scientists and was used to calculate war deaths in Kosovo in the late 1990s.
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>The investigators worked in teams of three. Five of the six Iraqi interviewers were doctors and all six were fluent in English and Arabic.
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>In the households reporting deaths, the person who died had to be living there at the time of the death and for more than two months before to be counted. In an attempt at firmer confirmation, the interviewers asked for death certificates in 78 households and were provided them 63 times.
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>There were 46 deaths in the surveyed households before the war. After the invasion, there were 142 deaths. That is an increase from 5 deaths per 1,000 people per year to 12.3 per 1,000 people per year — more than double.
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>However, more than a third of the post-invasion deaths were reported in one cluster of households in the city Fallujah,
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>where fighting has been most intense recently. Because the fighting was so severe there, the numbers from that location may have exaggerated the overall picture.
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>When the researchers recalculated the effect of the war without the statistics from Fallujah, the deaths end up at 7.9 per 1,000 people per year — still 1.5 times higher than before the war.
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>Even with Fallujah factored out, the survey "indicates that the death toll associated with the invasion and occupation of Iraq is more likely than not about 100,000 people, and may be much higher," the report said.
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>The most common causes of death before the invasion of Iraq were heart attacks, strokes and other chronic diseases. However, after the invasion, violence was recorded as the primary cause of death and was mainly attributed to coalition forces — with about 95 percent of those deaths caused by bombs or fire from helicopter gunships.
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>Violent deaths — defined as those brought about by the intentional act of others — were reported in 15 of the 33 clusters. The chances of a violent death were 58 times higher after the invasion than before it, the researchers said.
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>Twelve of the 73 violent deaths were not attributed to coalition forces. The researchers said 28 children were killed by coalition forces in the survey households. Infant mortality rose from 29 deaths per 1,000 live births before the war to 57 deaths per 1,000 afterward.
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>The researchers estimated the nationwide death toll due to the conflict by subtracting the preinvasion death rate from the post-invasion death rate and multiplying that number by the estimated population of Iraq — 24.4 million at the start of the war. Then that number was converted to a total number of deaths by dividing by 1,000 and adjusting for the 18 months since the invasion.
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>"We estimate that there were 98,000 extra deaths during the postwar period in the 97 percent of Iraq represented by all the clusters except Fallujah," the researchers said in the journal.
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>"This isn't about individual soldiers doing bad things. This appears to be a problem with the approach to occupation in Iraq," Roberts said.
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>The researchers called for further confirmation by an independent body such as the International Committee of the Red Cross, or the World Health Organization.
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>The study was funded by the Center for International Emergency Disaster and Refugee Studies at Johns Hopkins University and by the Small Arms Survey in Geneva, Switzerland, a research project based at the Graduate Institute of International Studies in Geneva.
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>© Copyright 2004 Bell Globemedia Inc.



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