Editor of Lancet, Richard Horton, Comments on Report of Deaths in Iraq

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This terrible misadventure has killed one in 40 Iraqis

The government will do all it can to discredit the latest estimate of civilian casualties since the invasion: 650,000

Richard Horton
Thursday October 12, 2006
The Guardian

http://www.guardian.co.uk/comment/story/0,,1919977,00.html

Many people refused to believe the Lancet report in 2004 from a group of American and Iraqi public-health scientists who surveyed homes across the country and found that about 100,000 additional Iraqi deaths had taken place since the coalition invasion in March 2003. Several government ministers were deployed to destroy the credibility of the findings and, in large part, they succeeded. But now their denials have come back to haunt them, for the figures from Iraq have been confirmed by a further study.

The same team from Johns Hopkins University worked with Iraqi doctors to visit over 1,800 homes in Iraq, selected randomly to make sure that no bias could creep in to their calculations.
They identified more than 12,000 family members and tracked those who had died over an interval that spanned both pre- and post-invasion periods. The Iraqi interviewers spoke fluent English as well as Arabic, and they were well trained to collect the information they were seeking. They asked permission from every family to use the data they wanted. And they chased down death certificates in over four out of five cases to make sure that they had a double check on the numbers and causes of death given to them by family members.

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The total figure of 650,000 is truly staggering. It represents 2.5% of the entire Iraqi population. In 2004 The Lancet was criticised for publishing a number that seemed to have a high degree of uncertainty. The best estimate then was 98,000 deaths. But the uncertainty meant that it could have been as low as 8,000 or as high as 194,000.

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Why is this Lancet estimate so much higher than the figures put out by President Bush or the Iraq Body Count website? They put the number of casualties in the tens of thousands, not the hundreds of thousands. To be fair, Iraq Body Count does not claim to publish accurate absolute numbers of deaths. Instead, their figures are valuable for measuring trends. But the reason for the discrepancy between these lower estimates and the new figure of 650,000 deaths lies in the way the number is sought. Passive surveillance, the most common method used to estimate numbers of civilian deaths, will always underestimate the total number of casualties. We know this from past wars and conflict zones, where the estimates have been too low by a factor of 10 or even 20.

· Richard Horton is the editor of the Lancet

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