Death in Iraq

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I suppose that
data on mortality rates is never uplifting, but some data made available
online last Thursday seems especially sober. Researchers at the
Johns Hopkins Bloomberg School of Public Health, in collaboration
with a researcher at Al Mustansiriya University in Iraq, estimate
that 655,000 Iraqis have died as a consequence of our invasion (Burnham,
G, et al, Lancet (2006)
). The research was published
in the well-regarded medical journal, Lancet. It was led
by Les Roberts, who also led a survey of deaths in Iraq published
in October 2004 (Roberts,
L, et al, Lancet (2004)
) that was largely ignored.

The timeliness
of the publications is, in all likelihood, not a coincidence — both
the 2004 and last week’s articles came out weeks before a national
election. Dr. Roberts is a distinguished member of academia and,
therefore, is statistically expected to be a critic of the Bush
administration. Naturally, this timing is an easy and obvious weakness
in terms of the neutrality of the authors and the credibility of
the study. These are, after all, epidemiological studies — there
are many places for human bias to enter into the data collection
either intentionally or not. On the flip side, one can criticize
the authors (as Tom
Engelhardt and Judith Coburn did
) for putting the data out at
a time when it can get overshadowed by trivial election distractions.
Why fabricate data if your strategy for timely publication can backfire
(twice)?

With all of
this potential bias on the part of the researchers, it is interesting
to note that this study was funded by MIT and Johns Hopkins, not
by the typical source of research funding in America: the US government.
If it were funded by the state, there would be no chance of bias,
right? Come to think of it, why isn’t the government funding
an accurate casualty count in Iraq?

There was some
scholarly discussion of the 2004 article, in the form of letters
to the editor of Lancet (Volume
365, page 1133–4
). The authors were criticized for their
survey method, known as cluster sampling, and for various areas
where researcher bias could have been introduced as well as a specific
design flaw that could introduce false overestimates of death. As
the authors point out in their response, the cluster sampling method
they used is recommended by UN and US agencies. Since then, a team
of researchers has shown that the cluster sampling method, when
done properly, is as reliable as another leading survey technique
(Rose,
AMC, et al, Bulletin of the World Health Organization.
(2006)
). In my opinion, the authors address the other potential
biases and design flaws specifically in the original article, although
they could be lying. I have no reason to believe that they are
lying, but the possibility must always be acknowledged.

These criticisms
centered around the validity of the statistics. Statistics says
that if you roll one die six times, you will roll each number once.
However, if you have played a board game, you know this is not what
really happens most of the time. What statistics really says is
that if you roll one die six hundred times, you will roll
each number close to 100 times. If you really wanted to do this,
the actual number of times that you got each number would in fact
be very close to 100. So the estimate that there are an extra 655,000
Iraqis dead because of the invasion is simply that: an estimate.
An error on this estimate can also be calculated, which can be used
as a guide of how accurate that original estimate is likely to be.
If the study is done properly, the errors will be small and the
estimate will be accurate.

While there
may be flaws with the study, the overarching conclusion will not
change: many more people have died in Iraq since its occupation
than would otherwise be expected. There is one set of raw numbers
that backs this up: 547 people died between March, 2003 and June,
2006 in areas where 82 people died between January, 2002 and March,
2003. The post-invasion period of 39 months is about two and three-quarters
times as long as the pre-invasion period of 14 months, but 547 is
over six and one-half times as many people as 82. If our invasion
had no effect in these areas, the number of people dead would be
directly proportional to the amount of time that passed, but it
is not even close to proportional.

The authors
estimate that 19.8 deaths per 1000 people occurred between June
2005 and June 2006. This is almost 2 deaths per 100 people. Since
this study was based on interviews of households, there was a standard
cross-section of ages and sex that you would find in any family.
Are you related to 100 people? Have 2 of your relatives died every
year? Between my husband and myself, I can say I know just about
100 of our relatives. Great Uncle Mike passed away last spring,
which is the only family death in five years. The annual rate of
death in our family is a little lower than what families in Iraq
were experiencing before March, 2003 (0.2% in our family versus
0.55% estimated in Iraq).

The post-invasion
mortality rate was 7.9 deaths annually per 1000 people in the 2004
study. If Dr. Roberts and his colleagues had somehow affected the
politicians of this nation with his last article, and inspired a
de-occupation of Iraq, would there be an extra 500,000 people dead?
If we do not leave Iraq in 2006, what will the Iraqi mortality rate
be in 2008? As you consider whether it is the moral obligation of
the US to leave Iraq soil, keep in mind that, of the 547 post-invasion
deaths recorded by the researchers, 13 were children under the age
of 15 killed by coalition air strikes.

October
18, 2006

Kathryn
Muratore [send her mail]
has a PhD in biology from UC Berkeley and is currently a postdoctoral
fellow at Johns Hopkins.

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