Lancet Surveys of Iraq War Casualties - The Second Study (2006)

The Second Study (2006)

A second study by some of the same authors was published in October, 2006, in The Lancet.

"We estimate that between March 18, 2003, and June, 2006, an additional 654,965 (392,979–942,636) Iraqis have died above what would have been expected on the basis of the pre-invasion crude mortality rate as a consequence of the coalition invasion. Of these deaths, we estimate that 601,027 (426,369–793,663) were due to violence."

If accurate, these figures would imply the death of an average 500 people per day, or 2.5% of Iraq's population during the period.

An October 11, 2006 Washington Post article reports:

"The survey was conducted between May 20 and July 10 by eight Iraqi physicians organized through Mustansiriya University in Baghdad. They visited 1,849 randomly selected households that had an average of seven members each. One person in each household was asked about deaths in the 14 months before the invasion and in the period after. The interviewers asked for death certificates 87 percent of the time; when they did, more than 90 percent of households produced certificates."

Lancet: "Only 47 of the sought 50 clusters were included in this analysis. On two occasions, miscommunication resulted in clusters not being visited in Muthanna and Dahuk, and instead being included in other Governorates. In Wassit, insecurity caused the team to choose the next nearest population area, in accordance with the study protocol. Later it was discovered that this second site was actually across the boundary in Baghdad Governorate. These three misattributed clusters were therefore excluded, leaving a final sample of 1849 households in 47 randomly selected clusters."

The Lancet authors based their calculations on an overall, post-invasion, excess mortality rate of 7.8/1000/year. "Pre-invasion mortality rates were 5.5 per 1000 people per year (95% CI 4.3–7.1), compared with 13.3 per 1000 people per year (10.9–16.1) in the 40 months post-invasion." See Table 3 in the Lancet article. The population number used in the calculation is reported in the Lancet supplement: "Mortality projections were applied to the 2004 mid-year population estimates (26,112,353) of the surveyed areas (which exclude the governorates of Muthanna and Dahuk, which had been omitted through misattribution) to establish the mortality projections."

Of 629 deaths verified and recorded among a sample of 1,849 households incorporating some 12,801 people at the time of the survey, 13% took place in the 14 months before the invasion and 87% in the 40 months afterwards. "The study population at the beginning of the recall period (January 1, 2002) was calculated to be 11 956, and a total of 1474 births and 629 deaths were reported during the study period."

The study concluded that the mortality rate per 1,000 population per year in the pre-invasion period was 5.5 (range of 4.3-7.1, using a 95% CI, confidence interval) and in the post-invasion period was 13.3 (95% CI, 10.9-16.1). Excess mortality rate over the pre-invasion period was therefore 7.8 per 1,000 population per year, with violent death accounting for 92% of the increased mortality rate.

Washington Post: "Gunshot wounds caused 56 percent of violent deaths, with car bombs and other explosions causing 14 percent, according to the survey results. Of the violent deaths that occurred after the invasion, 31 percent were caused by coalition forces or airstrikes, the respondents said."

The study results show an increasing mortality rate throughout the post-invasion periods, with the excess mortality rate for June 2005-June 2006 of 14.2 (95% CI, 8.6-21.5) being nearly 5.5 times the excess mortality rate for March 2003-April 2004 of 2.6 (95% CI, 0.6-4.7). The 2006 study also provides an estimate for the 18-month period following the invasion (March 2003 through September 2004) of 112,000 deaths (95% CI, 69,000-155,000). The authors conclude, "Thus, the data presented here validates our 2004 study, which conservatively estimated an excess mortality of nearly 100,000 as of September, 2004."

The authors described the fact that their estimate is over ten times higher than other estimates, such as the Iraq Body Count project (IBC) estimate and U.S. Department of Defence estimates, as "not unexpected", stating that this is a common occurrence in conflict situations. They stated, "Aside from Bosnia, we can find no conflict situation where passive surveillance recorded more than 20% of the deaths measured by population-based methods. In several outbreaks, disease and death recorded by facility-based methods underestimated events by a factor of ten or more when compared with population-based estimates. Between 1960 and 1990, newspaper accounts of political deaths in Guatemala correctly reported over 50% of deaths in years of low violence but less than 5% in years of highest violence."