Special Reports

The invasion of Iraq in March 2003 by coalition forces has lead to the death of at least 100,000 civilians, reveals the first scientific study to examine the issue.

The majority of these deaths, which are in addition those normally expected from natural causes, illness and accidents, have been among women and children, finds the study, released early by The Lancet on Thursday.

The most common cause of death is as a direct result of violence, mostly caused by coalition air strikes, reveals the study of almost 1000 households scattered across Iraq. And the risk of violent death just after the invasion was 58 times greater than before the war. The overall risk of death was 1.5 times more after the invasion than before.

The figure of 100,000 – estimated by extrapolating the surveyed households’ death toll to the whole population - is based on "conservative assumptions", notes Les Roberts at Johns Hopkins Bloomberg School of Public Health, Baltimore, US, who led the study.

That estimate excludes Falluja, a hotspot for violence. If the data from this town is included, the study points to about 200,000 excess deaths since the outbreak of war.

Body count

“The invasion of Iraq, the displacement of a cruel dictator, and the attempt to impose a liberal democracy by force have, by themselves, been insufficient to bring peace and security to the civilian population. Democratic imperialism has led to more deaths, not fewer,” writes Richard Horton, the editor of The Lancet in a commentary accompanying the paper.

He also praises the “courageous team of scientists” for their efforts, and notes the study’s limitations.

Jack Straw, the UK government’s foreign minister says the government will "examine with very great care" the results of the study.

"It is, however, an estimate that is based on very different methodology from standard methodology for assessing causalities, namely on the number of people reported to have been killed at the time," he told the BBC.

One major project, www.iraqbodycount.net, estimates up to 16,300 deaths in Iraq due to coalition forces. But this collects data on deaths reported in the press only. “We've always maintained that the actual count must be much higher," says Scott Lipscomb, at Northwestern University, Illinois, US, who works on the project. "I am emotionally shocked but I have no trouble in believing that this many people have been killed," he told The New York Times.

GPS sampling

The team of US and Iraqi scientists recorded mortality during the 15 months before the invasion and the 18 months afterwards. They carried out the survey of 988 Iraqi households in 33 different areas across Iraq in September 2004.

Using a GPS (global positioning system) unit, the interviewers randomly selected towns within governates. They then visited the nearest 30 houses to the GPS point randomly selected.

Families living under one roof were asked about deaths in their household before and after the war. “Confirmation was sought to ensure that a large fraction of the reported deaths were not fabrications,” write the team. The interviewers did ask for death certificates, but only in two cases for each cluster of houses. This was because of concerns that implying the families were lying could trigger violence.

But the team believes that lying about deaths is unlikely and, if anything, “it is possible that deaths were not reported” because families might want to conceal them.

Horton acknowledges the potential for recall bias among those interviewed and also the relatively small sample size. “The research was completed under the most testing of circumstances - an ongoing war. And therefore certain limitations were inevitable and need to be acknowledged right away,” he says.

But he also calls for an “urgent political and military response”.

Journal reference: The Lancet (early online publication)