Thursday, October 12, 2006

Iraq: Death By the Numbers

I've now had an opportunity to read the article and accompanying documentation in The Lancet on the controversial new study that concludes nearly 655,000 Iraqis have died because of the war. My initial skepticism has been replaced by, well . . . non-skeptical anger.

Over the years I've been involved in a fair amount of cluster sampling such as that used in the study by the Johns Hopkins Bloomberg School of Public Health, and the resulting mortality numbers seem pretty solid to me, if mind blowing.

For me, keys to the accuracy of the numbers are:
The pro-active nature of the sampling. Virtually all previous surveys on civilian deaths have been passive; that is, statistics were gleaned from secondary sources. With the Hopkins survey, the numbers were compiled in the field through interviews with the families of the victims.

Who did the sampling.
Four-member teams of medical doctors fluent in English and Arabic led by supervisors did the interviews. Death certificates and other documents were examined to determine exact cause of death.

How the numbers were crunched. The statistics were derived from 50 population clusters determined by size of area. Heavily populated Baghdad had 12 clusters while Kerbala and four other sparsely populated areas had one each.
Most surveys on Iraqi civilian war deaths have been passive in the extreme. This is because most have been based on news media reports. The consensus conclusion of these surveys has been that between 40,000 and 50,000 Iraqis have died since the U.S.-led invasion in March 2003.

This survey method has two big problems:
* The media has concentrated on the carnage in Baghdad, where the city's Central Morgue and the Ministry of Health have kept seemingly accurate mortality tallies which are grim in their own right.

But beyond those figures media accounts are typically anecdotal since there seldom is any follow-up reporting to validate their accuracy.

* There has been no reliable way to tally deaths in the outlying provinces, which increases the Baghdad-centric bias of these media account-driven surveys.

I have long suspected that deaths outside the capital have been higher on a per capita basis than in the capital, in part because of the absence of news media representatives and because deaths in villages and rural areas tend to go unnoticed by all but immediate families and tribal members anyway. The Hopkins study confirms that is indeed the case.
My confidence level in the study also was raised because efforts were made to iron out problems in a 2004 study that might have skewed the results or made accurate results more difficult to obtain.

An example: Survey sites were determined by random numbers applied to streets or blocks rather than with global positioning units as had been the case two years ago. The random approach is less skewed and therefore more accurate. GPS units also were ditched because people using them might be viewed with suspicion and be put at risk in a country far more violent than in 2004.

Some other nuggets from the article on the survey:
* The civilian death rate has increased every year since the war began.

* Two out of three victims have been males, typically ranging in age from adolescence to middle age.

* Non-violent deaths during the same time period included cardiovascular conditions (37 percent), cancer (14), chronic illness (13), infant deaths (12), accidents (11) and old age (8).

* The Department of Defense keeps records of Iraqi deaths. The most recent accounting is in a classified 2006 report called the Measuring Stability and Security in Iraq. When the Pentagon says it doesn't know how many Iraqis have been killed, it's lying. If and when the report is released, expect the DoD's numbers to be dramatically lower than the Hopkins survey.
The survey team was candid about possible biases that might skew the results in one direciton or another.

These included the large-scale migration out of Iraq which has decreased population size, households not available on an initial visit were not called back because of security concerns, and there were instances when entire families were killed and there was no one to interview. (Don't you hate when that happens?)

The article's conclusion is chilling:
"In the Vietnam war, 3 million civilians die; in the Democratic Republic of Congo, conflict has been responsible for 3.8 million deaths; and an estimated 200,000 of a total population of 800,000 died in conflict in East Timor . . . We estimate that almost 655,000 people -- 2.5% of the population in the study area -- have died in Iraq. Although such death rates might be common in times of war, the combination of a long duration and tens of millions of people affected has made this the deadliest international conflict of the 21st century and should be of grave concern to everyone."
There are plenty of people who are skeptical -- if not downright angry -- about the study's conclusions.

They range from Omar Fadil at Iraq the Model to Chicago Tribune blogger Frank James., who writes that:
"Skepticism is probably healthy whenever a study with such an eye-popping result comes out. It doesn't mean the study's wrong. It just means more questions about how it was done need to be answered. . . .

"The study is a retrospective, backwards-looking one. Those are less reliable than prospective studies that select a sample of people, then follow them into the future, recording deaths as they happen."

I was stopped cold when President Bush had this to say about Iraq during his Rose Garden press conference on Wednesday:
"I'm amazed that this is a society which so wants to be free that they’re willing to — you know, that there’s a level of violence that they tolerate."

Says Will Bunch at Attytood:

"Honestly, I'm amazed too -- by the arrogance of that statement. Frankly, there's something to parse in every word, but let's start with the president's most 'amazing' notion, that people in Iraq are 'tolerating' a situation where you can be shot dead at a traffic light -- like Knight Ridder journalist Yaser Salihee was -- or just going to the local market, a situation where anywhere from 50,000 (the very lowball estimate) to 600,000 (new high-end estimate) have been killed, not just by violence but by often unspeakable violence -- shot in the head or decapitated, hands bound, with severed penises or other mutilation, often just dumped in the river like so much raw sewage.

"Who is 'tolerating' that? Bush is -- from the comfort of his treadmill in the White House gym -- and Cheney and Rumsfeld, maybe. But do you honestly think that any mother trying to raise a family on the streets of Baghdad tolerates it? And the evidence is overwhelming that they don't tolerate it one bit. Why do you think that a whopping 71 percent of Iraqis want America to leave in the next year?

"What's 'amazing here' is the level of cluelessness -- and deception -- packed into one sentence. Iraqis do want to choose their own leaders, like most people, but the White House is trying to cast what has really happened there -- an unprovoked invasion by the world's most powerful military, followed by a three-year carnival of killing -- as some type of 'popular uprising,' a 'society that so wants to be free.' The overwhelming evidence is that they're merely a society that so wants to be left alone -- by us.

"But it's amazing what people can tolerate, when it's 11,000 miles away and it's happening to somebody else."

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