APPENDIX C
Other Accounts of Mortality in Iraq
There are several other efforts to account for the dead as a result of the Iraq war.
Iraq Body Count (IBC) has been the most widely cited source for ongoing civilian casualties in Iraq since the 2003 invasion (www.ibc.org). This independent UK-based project accounts for deaths through comprehensive and thorough surveys of news media sources around the world. After independent review by at least two members of the project team, the maximum and minimum values are compiled onto a website that is updated daily. These figures are derived from a comprehensive survey of online media reports and eyewitness accounts.
The founders of IBC believe that each civilian death is a tragedy, and that it is a moral and humanitarian duty for each death to be recorded and compiled. The website cites a quote by General Tommy Franks stating that, “We don’t do body counts” and thus, a primary motivation of this project is to take on the duty they believe is the responsibility of American and British citizens.
The IBC uses passive surveillance techniques, which depend upon available reports from the news media, in contrast to an active search for dead bodies. This brings about the possibility of gross underestimations. A significant number of deaths are not reported by the media, especially ones that occur in less populated or well known areas. In addition, the IBC methodology is conservative and excludes data that do not meet their set standards. Marc Herold, an economist on the IBC team, believed that the count is likely too low because thousands of deaths may go unreported due to lack of media coverage.8
In the absence of active surveillance measures, passive surveillance is a useful and necessary tool to gather information, but it is important that the information is taken in the correct context. Unfortunately the careful and conservative numbers recorded by IBC are often taken out of context and cited as the true body count, thus lulling people into thinking that the human consequence of the war is far less than it really is. IBC has played a highly commendable role in making people aware of the upward spiral of deaths in Iraq.
Working for the U.N. Development Program, the highly regarded Norwegian researcher Jon Pederson led a survey that recorded between 18,000 and 29,000 violent deaths during the first year of occupation. The survey9 was not focused on deaths, but asked about them over the course of lengthy interviews that focused on access to services.While this was more than twice the rate recorded by IBC at the time, Pederson expressed concern for the completeness and quality of the data in a newspaper interview last year.10 The surveys reported in The Lancet were focused solely on recording deaths and count about two and a half times as many excess deaths from all causes over the same period.
The U.S. Department of Defense, using passive surveillance techniques, has begun to account for casualties in a broadly defined way, including numbers of attacks, without estimating totals but showing trends lines that are almost identical to IBC and The Lancet accounts.11
There is also a widely circulated UPI report of a count by ‘Iraqiyun, a humanitarian organization, totaling 128,000 dead over the first 27 months of the war.12 The methods of this organization—reported to be direct accounts from relatives of those killed—could not be confirmed.
The Ministry of Health in Iraq has published some numbers from time to time, but these are generally considered to be unreliable. The registration of deaths in Iraq has been an organized process for many years. Death certificates have traditionally been obtained for the deaths of all adults and older children. Death certificates are required for insurance claims, compensation, payment of benefits, and for burial. Cemeteries do not take bodies for burial without certificates. If deaths occurred outside of hospital, the bodies would be transported to the general hospital for the certificate to be issued. If there were doubts about the cause of death, a post-mortem examination would be carried out before issuing a certificate. Copies of the death certificates would go to the national offices managing vital registration.
This process has continued through the current conflict, with death certificates being required for burial, and with information from certificates being duly recorded. However, the tabulation of data from registration of deaths in Iraq has suffered from the chaos of the current conflict. Beyond this, there is also a suspicion that records of death, particularly related to violent deaths, is being manipulated and only partially being released for various political reasons.
Even with the death certificate system, only about one-third of deaths were captured by the government’s surveillance system in the years before the current war, according to informed sources in Iraq. At a death rate of 5/1,000/year, in a population of 24 million, the government should have reported 120,000 deaths annually. In 2002, the government documented less than 40,000 from all sources. The ministry’s numbers are not likely to be more complete or accurate today.
The figure below shows trend lines from three different accounts—our mortality survey, Iraq Body count, and the Department of Defense report. Although the numbers we estimate through population-based methods are substantially greater than the numbers of deaths counted by the other two, the figure shows that over time the trends are almost identical. This is clear evidence that the three studies have measured the same events, and further reinforces the results of the population based data. This difference in numbers but similarity in trends is typical of the differences between active and passive public health surveillance seen in many conditions.
Figure 5. Trend lines of different mortality accounts. The reference axis for Iraq Body Count and the Department of Defense reports are on the left. For this study, the reference axis is on the right.