Iraq Family Health Survey - Reactions and Criticisms

Reactions and Criticisms

An accompanying commentary appeared in the editorial 'Perspectives' section of the New England Journal of Medicine issue that contained the study. The authors commend the IFHS study group for its attempt to capture the highest-quality results, but also discuss "substantial limitations" of the IFHS and more generally of the use of household surveys to estimate mortality in circumstances such as Iraq, saying:

The sampling frame was based on a 2004 count, but the population has been changing rapidly and dramatically because of sectarian violence, the flight of refugees, and overall population migration. Another source of bias in household surveys is underreporting due to the dissolution of some households after a death, so that no one remains to tell the former inhabitants' story. Mortality estimates that are derived from surveying deaths of siblings were also calculated, but this method may also be subject to such underreporting. ... Under the current conditions in Iraq, it is difficult to envision a study that would not have substantial limitations. The circumstances that are required to produce high-quality public health statistics contrast starkly with those under which the IFHS study group worked. Indeed, it must be mentioned that one of the authors of the survey was shot and killed on his way to work.

Paul Spiegel, a medical epidemiologist at the United Nations High Commission on Refugees in Geneva, commented, "Overall, this is a very good study," adding that "this does seem more believable to me" than the earlier Lancet survey, which estimated 601,000 deaths from violence over the same period.

Officials in the Iraqi government had differing reactions to the report. The Iraqi Health Minister Saleh al-Hasnawi described the survey as "very sound" and said the survey indicated "a massive death toll since the beginning of the conflict," and "I believe in these numbers". However, a senior official in the Iraq Health Ministry's inspector general's office cast doubt on the findings, saying 151,000 was far too high because the numbers cited by the study were much larger than figures tracked by the ministry. On the other hand, Jalil Hadi al-Shimmari, who oversees the western Baghdad health department, said the 151,000 total seems roughly accurate but is probably a "modest" one and that "the real number might be bigger than this."

Many criticisms leveled at the IFHS estimate have originated from authors of the Lancet survey or others associated with that survey. Some of these criticisms relate to an idea that respondents would have a fear of giving information about violence-related deaths to government interviewers who represented "one side of the conflict" and the reliance on Iraq Body Count's data in dangerous areas (Anbar and Nineveh provinces and parts of Baghdad).

In a January 11, 2008 article Les Roberts, co-author of the Lancet study, is quoted as saying:

They roughly found a steady rate of violence from 2003 to 2006. Baghdad morgue data, Najaf burial data, Pentagon attack data, and our data all show a dramatic increase over 2005 and 2006.

On February 24, 2009 Morning Edition discussed what a Baghdad central morgue statistics office worker reported to them:

the number of deaths the morgue registers never corresponds with numbers from the Ministry of Health or the Ministry of Interior. "They do it on purpose," he says. "I would go home and look at the news. The ministry would say 10 people got killed all over Iraq, while I had received in that day more than 50 dead bodies just in Baghdad. It's always been like that — they would say one thing but the reality was much worse."