Post by Admin on Oct 18, 2013 7:09:52 GMT
Figure 1. Raw number of household deaths by year and cause, 2001–2011, reported by the University Collaborative Iraq Mortality Study. Counts of deaths reported by respondents to the household mortality questionnaire, by year and cause. The survey concluded July 2, 2011, so the final bar reflects data for only half of the year.
United Nations sources estimate that about 1.7 million Iraqis have migrated abroad since the start of the war [56], while other estimates put the number at closer to 2 million [57] or even 2.4 million [58]. In addition, more than 1.3 million persons have been displaced within Iraq, most fleeing after 2006 [59],[60]. In a 2010 national population survey, one in six households had reportedly moved in the previous 5 y, with “escaping violence” the most common reason [61]. Refugee and internally displaced persons estimates are probably low, as a portion of refugees do not register with the United Nations High Commissioner for Refugees or the International Organization for Migration [46]. Given an average household size of 5.34—as found in the current study (compared with 6.9 in a previous 2006 study [30])—and an emigrant population of 2 million, this would yield 374,532 external refugee households. One study in Syria estimated that 14.9% of Iraqi refugee households had experienced at least one death [46]. Conservatively, assuming that only 15% of the emigrant households experienced a death, our migration adjustment would add more than 55,000 deaths to the total generated by our household survey (calculation: 2 million migrants/5.34 per household = 374,532 households; those household×0.149 experiencing deaths = 55,805 total deaths attributable to external migrants). Our household survey produced death rates that, when multiplied by the population count for each year, produced an estimate of 405,000 total deaths. Our migration adjustment would add an additional 55,805 deaths to that total. Our total excess death estimate for the wartime period, then, is 461,000, just under half a million people.
Figure 2. Estimates of numbers of deaths per week in Iraq for 2-y intervals, 2001–2011, by cause as reported by households in the University Collaborative Iraq Mortality Study.National estimate of deaths in Iraq between 2001 and 2011. Crude death rates were estimated separately within 2-y blocks (the first two time intervals are not strictly 2 y long, in order to align the first interval dividing point with the start of the war in March 2003; the survey concluded July 2, 2011, so the final bar reflects only half of the year). The counterfactual (had there been no war) estimate shows the predicted death counts if crude death rates had remained at their average level from 2001–2002 during the war and occupation (in gray). War-related, but not violent, deaths above the normal baseline are in the salmon-colored area. War-related violent deaths are portrayed in red.
We estimate about half a million excess deaths occurred in Iraq following the US-led invasion and occupation (March 2003–2011). This estimate is derived from reports of deaths by respondents in our nationally representative survey of 2,000 households in 100 clusters, and adds a correction for deaths that would have been reported by households that emigrated. Our household data indicate that the wartime crude death rate in Iraq was 4.6 per 1,000 PY, more than 0.5 times higher than the death rate during the 26-mo period preceding the war. We were also able to estimate the risk of death among adults, both before and during the war, by asking all adults in the household about the deaths of their siblings, and learned that the risk of death rose 0.7 times higher for women and 2.9 times higher for men between the pre-war period and the peak of the war. There were an estimated 766 excess (war-related) adult deaths per week when the war was taking its highest casualties, with about 70% of these attributable to war-related violence.
Most excess deaths (above pre-war rates) were attributable directly to violence, primarily from gunshots, car bombs, and explosions. Cardiovascular conditions were the principal cause of about half of nonviolent deaths. War-induced excess deaths not caused by violence would include those caused by diversion of the health system to a focus on crisis care, interruption of distribution networks for crucial supplies, and the collapse of infrastructure that protects clean water, nutrition, transportation, waste management, and energy. Further, war contributes to a climate of fear, humiliation, and interruption of livelihoods that undermines health [65]–[68].
The pattern of mortality we observed with both our household and sibling methods correlates with media accounts of how the violence rose and ebbed over the years of the war. Deaths increased to twice expected levels at the onset of the war, plateaued briefly at the end of 2003, then rose again to a new peak in 2006. Thereafter, deaths dropped until 2008, when they leveled off, and then rose again slightly just before the time of our data collection in 2011. The number of events recorded by the households we visited was relatively small, yet it generated rates that appear large when magnified to the national population; that is the nature of this method. On the other hand, we did not adjust for world secular trends of declining mortality, therefore probably understating the number of excess deaths over this long conflict.
Figure 7. Density of civilian deaths in Baghdad, with the cluster locations of the University Collaborative Iraq Mortality Study as well as 2006 cluster locations of a previous study [30]. The density map was generated using a kernel density estimation of civilian deaths from the Wikileaks Iraq War Logs release [55]. The kernel density estimation provides a smoothed surface from a point pattern that represents spatial variation in the density of events, in this case civilian deaths. This allows for a crude visual analysis of the variation of events across space in Baghdad as well as the relation of 2006 and 2011 cluster locations to the density of civilian deaths. Analysis is based on geolocated data of all civilian deaths by any means reported in the Wikileaks Iraq War Logs data from 2004 to 2009.
Although the US military initially denied tracking civilian deaths, 2011 Wikileaks documents revealed that coalition forces did track some noncombatant deaths. The emergence of the Wikileaks “Iraq War Logs” reports in October 2010 [69] prompted the Iraq Body Count team to add to its count, but a recent comparison of recorded incidents between the two databases revealed that the Iraq Body Count captured fewer than one in four of the Iraq War Logs deaths [70]. One important reason for the discrepancy is that small incidents are often missed in press reports. For example, when asked why the assassination of a medical school dean in Baghdad did not merit reporting, Tim Arango (of the New York Times) stated in personal correspondence to AH in April 2011, “Unfortunately there are numerous assassinations every day, and we cannot cover them all.”
The deaths of citizens swept up in the conflict are seldom commemorated [71], and yet memorializing and reconciling these casualties has been found to be important for creating a peaceful post-conflict society [72]–[74]. Those who attempted to predict the mortality consequences of an impending invasion of Iraq in 2002 under-projected the death count [75], because methods for this type of assessment remain too crude. Estimates of mortality in the final stages of this protracted war suffer from methodological problems as well, because of complex population shifts [54]. Our contribution has been to use one nationally representative sample to collect both household and adult sibling mortality data. Researchers should continue to refine methods to count the mortality effects of conflicts.
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