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A scientific study calculating Iraqi deaths for almost the complete period of the US-led war and subsequent occupation published in PLOS Medicine this week reports that close to half a million Iraqi deaths are directly or indirectly attributable to the conflict. A team of researchers from Iraq and the US led by Amy Hagopian, of the University of Washington, conducted a survey in 2000 households across Iraq and used the data to estimate death rates for the two year-period before the war began in March 2003 and the subsequent years until mid-2011.
Estimates that extrapolate from a small number of reported deaths to the entire population are associated with considerable uncertainty, and based on statistical methods attempting to account for this, the researchers say that they are 95% confident that the true number of excess deaths lies between 48,000 and 751,000.
A number of previous estimates had covered different periods up to 2006 and come up with widely different results, several of them considerably higher than those of the current study. All of them had been controversial and their methodologies had been criticized by scientists and politicians. Improving their methods to overcome some of the shortcomings of the earlier studies, Hagopian and colleagues found that the wartime crude death rate in Iraq was more than 50% higher than the death rate during the two-year period preceding the war.
Based on those rates, the researchers estimate the total excess Iraqi deaths attributable to the war through mid-2011 to be about 405,000. They also estimated that an additional 56,000 deaths were not counted due to migration. Including this number, their final estimate is that close to half a million people died in Iraq as a result of the war and subsequent occupation from March 2003 to June 2011.
The risk of death at the peak of the conflict in 2006 almost tripled for men and rose by 70% for women. Violent deaths were attributed primarily to coalition forces (35%) and militia (32%). The majority (63%) of violent deaths were from gunshots. Car bombs accounted for 12%.
While war-related deaths peaked in 2006, as discussed in an accompanying Perspective article by Salman Rawaf (uninvolved in the study) of The WHO Collaborating Centre at Imperial College London, post-war Iraq has limited capacity to re-establish and maintain its battered public health and safety infrastructure. Rawaf argues that living in Iraq today is no longer about how many died but how future deaths should be prevented as the country copes with ongoing conflict.
Looking beyond Iraq, Hagopian and colleagues say "Opportunities exist to further refine methods for studying the health effects of other armed conflicts, and science funding agencies should consider investing in research to address this large public health problem." Rawaf agrees but states that "while as scientists we want an accurate war tally that we can use to argue against future wars, people also want to live without fear of becoming a counted body by epidemiologists. In a region with escalating violence, sadly, this may be a distant dream."
Funding: Support for this study came from pooled internal resources by the American and Canadian researchers without external funding. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Hagopian A, Flaxman AD, Takaro TK, Esa Al Shatari SA, Rajaratnam J, et al. (2013) Mortality in Iraq Associated with the 2003–2011 War and Occupation: Findings from a National Cluster Sample Survey by the University Collaborative Iraq Mortality Study . PLoS Med 10(10): e1001533. doi:10.1371/journal.pmed.1001533
Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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