Iraq: the Human Cost


Policy Implications of High Mortality

The large scale of mortality during the Iraq war has implications for how the war is being conducted by the United States. While not within the scope of the survey itself, it is worth raising a few points and questions relevant to political and military policies, strategy, and tactics.

  • The overall scale of death from the beginning of the war, and the constant rise in mortality, clearly demonstrates that the United States and other legitimate armed forces are not adequately providing security, and indeed that everyday insecurity is increasing for most Iraqis.
  • Large numbers of noncombatants are dying as a direct consequence of the violence.
  • The health care system is showing signs of weakening.
  • The sharp rise in the respondents’ attribution of violent deaths to forces other than those of the U.S.-led coalition clearly tracks with reports of growing sectarian and ethnic violence, as does the steady rise in deaths by gunshots.
  • The violence and insecurity throughout the period of the survey could be creating a feedback loop in which greater insecurity leads to greater violence. Insurgents may believe they are acting to protect their families and communities, for example. The American application of force may be a stimulant to more insurgency; recent doctrinal changes in the army reportedly recognize this.
  • The overall scale of violence and the large representation of young men in the mortality figures may indicate a much larger insurgency and/or membership in militias than is widely estimated.
  • The political arrangements, such as the constitution of Iraq, which may lead to divisions along ethnic and sectarian lines reinforce the distrust and fear that can spur more violence.
  • The growth in violence and the primary use of guns in that deadly violence indicate a continuing rise in the numbers participating in violent activities.
  • Quite a significant portion of violence is occurring outside Baghdad, even though the capital is the focal point of attention for U.S. security strategy.
  • An apparently high prevalence of assassinations, and their growth, underscores how little is known about the militias and insurgencies, and what strategies or tactics could be put into place to reduce this violence.
  • The high mortality for young men raises questions about social viability and future reconstruction efforts for Sunni Arab regions in particular.
  • Recent opinion polls in Iraq, published by the Washington Post (Sept. 26-27), indicate very large majorities of Iraqis believe that the application of U.S. military force is responsible for the widespread violence in their country, and believe that withdrawing U.S. troops will reduce violence.
  • It cannot be predicted, based on the mortality figures and trends, how a rapid withdrawal of U.S. forces would affect security for Iraqis.

References in Appendices

  1. Les Roberts et al., Mortality in eastern Democratic Republic of Congo. International Rescue Committee, New York: 2001.
  2. Ascherio A, Chase R, Cote T, et al. Effect of the Gulf War on infant and child mortality in Iraq. NEJM. 1992; 327: 931-6.
  3. Spiegel PB, Salama P.War and mortality in Kosovo, 1998-99: an epidemiological testimony. Lancet 2000; 355: 2204-09.
  4. Depoortere E, et al. Violence and mortality in West Darfur, Sudan (2003-04). Lancet. 2004 Oct 9-15; 364(9442):1315-20.
  5. Sapir DG, Gomez VT. Angola: The Human Impact of War. Brussels: Université catholique de Louvain, 2006.
  8. Al-Rubeyi BI. Mortality before and after the invasion of Iraq in 2003: Commentary. Lancet 2004; 364: 1834-5.
  9. UNDP, Iraq Living Conditions Survey, %20English.pdf (accessed 4 Oct 2006).
  10. Carl Bialik, “Counting the Civilian Dead in Iraq,” Wall Street Journal (Aug. 5, 2005), article/SB112309371679604061-EAfVPB24lX6gSz3wkK_gg0HtRvU_20060804.html?mod=tff_main_tff_top (accessed 4 Oct 2006).
  11. “Measuring Stability and Security in Iraq,” August 2006, pp. 31-34;, (accessed 4 Oct 2006).
  12. John Daly, “Iraqi Civilian Casualties,” July 12, 2005. (accessed 04 Oct 2006).
  13. Chambers LW, Green DJ, et al. The experience of the US Marine Corps’ Surgical Shock Trauma Platoon with 417 operative combat casualties during a 12 month period of operation Iraqi Freedom. J Trauma. 2006; 60(6): 1155-64.
  14. O’Hanlon ME, Kamons A. Iraq Index: Tracking Variables of Reconstruction and Security in Post-Saddam Iraq. 2006. Brookings Institution. 1-67.
  15. Thompson, M. “The Wounded Come Home” Time. 3 Nov 2003.
  16. Ricctiello R. Casualty of War. (accessed 20 Sept 2006).
  17. Wounded. (accessed 22 Sept 2006).
  18. Weisskopf, M. Blood Brothers: Among the Soldiers of Ward 57. New York: Henry Holt & Company, 2006.
  19. Hoge CW, Auchterlonie JL, Milliken CS. Mental Health problems, Use of Mental Health Services, and Attrition from Military Services After Returning from Deployment to Iraq or Afghanistan. JAMA. 2006; 295: 1023-1032.
  20. Hoge CW, Castro CA, et al. Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care. New Eng J Med. 2004; 351: 13-22.
  21. Friedman MJ, Posttraumatic Stress Disorder Among Military returnees from Afghanistan and Iraq. Am J Psych. 2006; 163(4): 586-593.
  22. Ascherio A, Chase R, Cote T, et al. Effect of the Gulf War on infants and child mortality in Iraq. New Eng J Med. 1992; 327: 931-936.
  23. 2 Zaidi S, Fawzi MS. Health of Baghdad’s children. The Lancet. 1995; 346:1485.
  24. UNICEF. At a glance: Iraq-The big picture. (accessed Sept 10, 2006).
  25. Department of Defense. Measuring Stability and Security in Iraq: report to Congress. August, 2006. p. 17
  26. UN World Food Program. Baseline food security analysis in Iraq, Rome:World Food Program, 2004.
  27. Hirschfield, R. An Arab-American Priest, Depleted Uranium, and Iraq. The Washington Report on Middle Eastern Affairs. 2005. 24(8): 29-30.
  28. 28 USAID, 2004. Internal report.
  29. MedAct. Enduring effects of War: Health in Iraq. London: 2004.
  30. O’Hanlon, ME, Kamons A. Iraq Index, Brookings Institution August 2006. (accessed 13 August 2006).
  31. This Appendix and Appendix G were written by John Tirman.
  32. Dexter Filkins of the New York Times, one of the longest serving American reporters during the war, says that “98% of Iraq, and even most of Baghdad, has now become ‘off-limits’ for Western journalists.” Editor & Publisher (Sept. 16, 2006); (accessed 4 Oct 2006).
  33., (accessed 22 Sept 2006).
  34. In 2006, according to Central Command and Air Force Link web sites, these sorties were averaging about 1,200 or more monthly.
  35. On rules of engagement, several journalistic accounts have taken this up, including Thomas E. Ricks, Fiasco: The American Military Adventure in Iraq (Penguin, 2006), interalia; see also Juan Cole’s report on this, which includes a link to the official documents, (accessed 24 Sept 2006).
  36. A Khakee and H Wulf, “Following the Trail: Production, Arsenals, and Transfers of Small Arms, HGF Review, Spring 2005, 26-30.
  37. Both polls were reported in the Washington Post, Sept. 26-27, 2006, and are available online. The PIPA results are available on line at