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Friday, October 29, 2004

100,000 Killed by Iraq War?

According to a new study by Roberts et al published in the prestigious medical journal The Lancet, the Iraq War has resulted in about 100,000 "excess deaths," mainly due to violence.

If the Iraq War has truly resulted in an additional 100,000 deaths over a year and a half, that would greatly undermine what I had thought was an important justification for the war. Specifically, I had hoped that the war would allow us to end the sanctions that were killing 50,000 Iraqi children a year, according to an earlier study in The Lancet (by Ali & Shah).

The Roberts et al study finds that the death rate increased from a pre-war 5.0 to 7.9 per thousand after the invasion (excluding Falluja). Roberts et al exclude Falluja from most of their results because the extremely high death rate there is estimated very imprecisely with their methods. Given Iraq's population of 24 million, this increase in the death rate amounts to an additional 70,000 deaths per year, or 105,000 over the 18 months between the invasion and the study.

Roberts et al Estimates of Mortality in Iraq (Lancet 2004)

Pre- Post-
Conflict Conflict
Death Rate
(per 1000) 5.0 12.3

Death Rate
Excluding Falluja 7.9

Infant Mortality
(per 1000) 29 57

I doubt these estimates are correct.

The problem is that the pre-conflict figures are not consistent with other, better, studies. Ali & Shah's 2000 study of infant mortality in Iraq interviewed a sample 40 times larger. The World Health Organization and US Census Bureau have also published estimates of pre-war mortality in Iraq. These other studies show much higher pre-conflict death rates.

Roberts et al's a post-war death rate of 7.9 per 1000 is only slightly higher than the WHO's pre-war estimate of 7.6 or the Census Bureau's estimate of 6.4. These differences are within the margin of error, suggesting that any change has been too small to measure with the 1000-household Roberts et al survey.

The closest that Roberts et al come to discussing other pre-war estimates is when they state:
The preconflict infant mortality rate (29 deaths per 1000 livebirths) we recorded is similar to estimates from neighbouring countries. [20]
This is true enough. An infant mortality rate of 29 per 1000 is in line with the levels found in places like Egypt, Jordan, and Iran. But it's hardly relevant, since pre-war Iraq was in much worse shape than these other countries. In fact, if you go to the web page cited in the Roberts et al footnote, you find Iraq's pre-war infant mortality rate listed as 107! They make no mention of this.

The Roberts et al post-war infant mortality rate of 57 is in fact much lower than the pre-war rate of 108 estimated by Ali & Shah (although it's not much different from the rate of 62 estimated by the WHO and Census Bureau). If we believe the Ali & Shah figure, which is the basis for the claim that sanctions were killing 50,000 Iraqi children a year, it turns out that most of these deaths have been eliminated. The war, by ending the sanctions, has resulting in about 40,000 fewer Iraqi children dieing each year.
Alternate Estimates of Pre-Conflict Mortality in Iraq

Ali & Shah WHO US Census
1994-99 2000 2000
Death Rate
(per 1000) -- 7.6 6.4

Infant Mortality
(per 1000) 108 62 62

Infant Mortality
in Autonomous Areas
(Northern Iraq) 59 --

Source: Ali & Shaw, Lancet, 2000. WHO. U.S. Census Bureau.


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