mortaliy study

[claudia westermann]

http://www.thelancet.com/journal/vol364/iss9445/full/llan.364.9445.early_online_publication.31137.1

Mortality before and after the 2003 invasion of Iraq: cluster sample survey

Les Roberts, Riyadh Lafta, Richard Garfield, Jamal Khudhairi, Gilbert Burnham

Summary

Background In March, 2003, military forces, 
mainly from the USA and the UK, invaded Iraq. We 
did a survey to compare mortality during the 
period of 14·6 months before the invasion with 
the 17·8 months after it.

Methods A cluster sample survey was undertaken 
throughout Iraq during September, 2004. 33 
clusters of 30 households each were interviewed 
about household composition, births, and deaths 
since January, 2002. In those households 
reporting deaths, the date, cause, and 
circumstances of violent deaths were recorded. We 
assessed the relative risk of death associated 
with the 2003 invasion and occupation by 
comparing mortality in the 17·8 months after the 
invasion with the 14·6-month period preceding it.

Findings The risk of death was estimated to be 
2·5-fold (95% CI 1·6-4·2) higher after the 
invasion when compared with the preinvasion 
period. Two-thirds of all violent deaths were 
reported in one cluster in the city of Falluja. 
If we exclude the Falluja data, the risk of death 
is 1·5-fold (1·1-2·3) higher after the invasion. 
We estimate that 98000 more deaths than expected 
(8000-194000) happened after the invasion outside 
of Falluja and far more if the outlier Falluja 
cluster is included. The major causes of death 
before the invasion were myocardial infarction, 
cerebrovascular accidents, and other chronic 
disorders whereas after the invasion violence was 
the primary cause of death. Violent deaths were 
widespread, reported in 15 of 33 clusters, and 
were mainly attributed to coalition forces. Most 
individuals reportedly killed by coalition forces 
were women and children. The risk of death from 
violence in the period after the invasion was 58 
times higher (95% CI 8·1-419) than in the period 
before the war.

Interpretation Making conservative assumptions, 
we think that about 100000 excess deaths, or more 
have happened since the 2003 invasion of Iraq. 
Violence accounted for most of the excess deaths 
and air strikes from coalition forces accounted 
for most violent deaths. We have shown that 
collection of public-health information is 
possible even during periods of extreme violence. 
Our results need further verification and should 
lead to changes to reduce non-combatant deaths 
from air strikes.

See Comment