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A Controversial Report From Johns Hopkins Researchers Estimates Iraq Civilian Death Toll

Frank Klein
BRINGING OUT THE DEAD: (from left) Johns Hopkins' Blomberg School of Public Health's Gilbert Burnham and Les Roberts say the casualties of the Iraq War are higher than experts claim.

By Edward Ericson Jr. | Posted 11/17/2004

On the Friday before the election, Oct. 29, a startling claim hit the pages of mainstream newspapers like The Washington Post and The Sun, only to be dismissed out of hand and, apparently, forgotten.

The Lancet, a respected British medical journal, printed the results of the first and only scientific canvassing of Iraqis to determine how many had died as a result of the U.S. invasion and occupation. The conclusion: 100,000. At least.

The study, designed and led by a pair of researchers from the Johns Hopkins Bloomberg School of Public Health in Baltimore, estimated the Iraqi death toll to be at least six times the tally published by Iraqi Body Count, the Britain-based nonprofit that compiles news reports of civilian casualties. The Lancet figures were so high that a Brookings Institution analyst, quoted in The Sun, deemed them “preposterous.”

“These numbers seem to be inflated,” Marc E. Garlasco, an expert with Human Rights Watch, told the Post.

With both the liberal Brookings Institution and the anti-war Human Rights Watch apparently dismissing the Lancet study as incredible, most observers felt no need to read the study itself. “When Human Rights Watch says you’re crazy, then you really must be crazy,” a spokesman at the federal Centers for Disease Control and Prevention told City Paper. He asked not to be quoted by name.

Other mainstream American news organizations fell in line, either repeating the incredulity of the first experts quoted or, like The New York Times did, suggesting that The Lancet and perhaps the report’s authors aimed to sway the election against President Bush.

Few reporters, apparently, understood what the study actually said. Fewer still called Garlasco after he himself had time to read it. “I hate the interview I did for The Washington Post,” he says. “I was on the train, I hadn’t read the report yet [when the Post’s reporter called for comment]. In general, I’m not as negative as that [Post] report made me seem. This is raising issues that are not heard of much in the U.S.”

Garlasco, who previously performed bomb-damage assessments for the Pentagon, was by then taking numerous calls from the press for comment on the Lancet study. But 90 percent of those calls came from foreign reporters, he says, and so the issue of just how many Iraqis have died because of the U.S. invasion remains a taboo subject here. The Pentagon has pointedly refused to count the dead (despite international law that requires any occupying military force to count its victims and pay reparations). Conservative commentators regard all efforts to assess noncombatant deaths in Iraq as propaganda for the insurgency; the New York Post called the Lancet study, and CBS News’ airing of it on Oct. 28, “a politically timed hatchet job from a blatantly partisan source.”

Report researchers Les Roberts and Gilbert Burnham, both from Hopkins’ Bloomberg School of Public Health, say their aim was to count the dead—and to alert the public about their count—in order serve the Iraqi people. Rushing their study into print before the U.S. election meant it would stand a better chance of making news, Roberts says, but he also admits to an ulterior political motive: protecting the life of his co-researcher, Dr. Riyadh Lafta of Al-Mustansiriya University in Baghdad.

“Baghdad is an absurdly political place,” Roberts says. “The chief of police will not allow his name to be known” because insurgents would kill him. If the study were held from the press until after the U.S. election, then, Lafta “would have been perceived to have been a tool of the Americans,” Roberts says, and he likely would be dead today. “There were political considerations here, but they were all related to the health of people in Iraq.”

The study, which was carried out over four weeks by a team of seven medical researchers in Iraq, did not say that U.S. soldiers killed 100,000 noncombatants. It said that 100,000 excess deaths occurred since the start of the ground war. That counts the people shot or buried under rubble—and it also counts the people who died of malnutrition or starvation, who became sick and died from drinking polluted water, and people who died from all other causes directly and indirectly related to the war, including the skyrocketing crime rate.

The study was done by teams of interviewers who fanned out across Iraq, visiting 33 neighborhoods in 11 cities, knocking on doors and interviewing the occupants of 990 households. The researchers asked the families if anyone who had lived in the house had died in the preceding years, covering a period both before and after the U.S.-led invasion. By comparing the death rate before and after the military attack, the research team calculated the number of “excess deaths” attributable to the war.

This is the same methodology Roberts used in 2000 to estimate that the civil war in the Democratic Republic of the Congo claimed at least 1.7 million lives. That estimate made the front page of The New York Times, without caveats about Roberts’ political beliefs.

Despite the criticism, the Iraq count was “less susceptible to bias” than the Congo study, Roberts says, because the researchers had access to the entire country and not just a section of it, as was the case in the Congo. “Every Iraqi had an equal chance that we would knock on their door,” Roberts says.

When the researchers entered Fallujah, the city now under attack by coalition forces, they found more deaths than in the other 32 places combined. So many civilian deaths were reported in Fallujah that the researchers threw out the data, reasoning that the tremendous mortality rate in that city could not be extrapolated to the rest of Iraq. If the Fallujah data were included, the group’s estimate of Iraqi casualties would have tripled, to 300,000. (Again, the data includes Iraqis who may have been fighting as insurgents.)

Some critics have seized on this and other caveats in the study to claim it is imprecise. Roberts and Burnham say that at every point where they had a choice they went with the most conservative assumptions. They say they were surprised by their own data—particularly the increasing death rate over the past summer and the amount of death attributable to violence.

“We assumed that most of the deaths were going to be from typhoid” or other disease, Burnham says. Instead, more than half the reported deaths were from violence, particularly coalition air strikes.

“We’ve dropped in the neighborhood of 50,000 bombs in a very densely populated area where the enemy is hiding among civilians,” Roberts notes. High casualties should come as no surprise, he says.

Garlasco, the Human Rights Watch worker who used to conduct bomb-damage assessments, says he found that cluster bombs launched from land-based rockets caused the most civilian casualties, while helicopter gunships were more precise. He cited his own study of the civilian casualties in Iraq, “Off Target,” as an example of precision counting combined with an understanding of military reality. “One issue I have with the [Lancet] report is that most of the combat takes place in very specific areas, so I don’t know how valuable it is to propagate overall death numbers throughout the country,” Garlasco says. “My bottom line is that whether the number is 10,000 or 20,000 or 100,000, more Iraqi civilians have been killed than people realize. It’s avoidable.”

Roberts says he respects Garlasco’s work, “but Marc didn’t really have any notion about how to get at the broader civilian death rate.”

There have been at least a dozen private efforts to count the dead in Iraq, including an ongoing project by a group called CIVIC—the Campaign for Innocent Victims in Conflict—to pay reparations to victims of the U.S. military. That effort is funded by $10 million from Congress.

At least one scientific study counting Iraqi civilian deaths was published by the U.S. military in the New England Journal of Medicine in July, although that study was not designed as a casualty count. That study, called “Combat Duty in Iraq and Afghanistan: Mental Health Problems, and Barriers to Care,” surveyed U.S. soldiers returning from active duty about their combat experience, in order to correlate battle experience to mental-health issues. Surveying them anonymously, the researchers asked if the soldiers had been ambushed, shot at, handled dead bodies, been wounded, etc.

Of 1,650 or so soldiers and Marines in Iraq surveyed, more than 900 claimed kills of at least one “enemy combatant.” Remarkably, more than 330 reported that they had been “responsible for the death of a noncombatant.”

Writing for The Nation magazine, reporter Jefferson Morely extrapolated those numbers to the ground-combat units in Iraq, concluding that ground-combat troops alone would have been responsible for at least 13,881 civilian deaths so far.

The study’s lead researcher, Dr. Charles Hoge of the Walter Reed Army Institute of Research, did not answer an e-mail seeking comment for this story.

The Hopkins researchers say they had not seen Hoge’s study. “That will be interesting to look at,” Roberts allows, adding, “I don’t think you could validate one [study] by another, just like you can’t necessarily validate the Iraq Body Count numbers” using The Lancet.

Roberts and Burnham don’t plan to return to Iraq soon, but if more data becomes available, estimating Iraq’s casualties with “a lot more statistical power” will be more likely, Burnham says. The job, according to these researchers, is essential to creating a free Iraq.

“I think the whole concept of civilization is increasing your spheres of empathy,” Roberts says. “Some argue that not being able to count births and deaths is a marker for a failed state.”

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