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The great* Iraq death toll debate: Putting war on the global health agenda

Editor’s note: *meaning not so great

It would look pretty odd – or outrageous – if medical research organizations, public health scientists, health advocacy organizations and others devoted to saving lives and preventing death decided not to try to determine how many people get killed every year from a select cause like, say, AIDS or heart disease or traffic accidents or drug abuse or any particular leading cause of death and disability.

Iraq Death Tollchart

Yet that is the standard approach when it comes to warfare.

Officially, the U.S. government and leading research organizations like the National Institutes of Health do not support studies aimed at determining how many people we kill – or can be predicted to die – when we enter into a military conflict.

“You’d think we’d want to know that, wouldn’t you?” said Amy Hagopian, a global health professor at the University of Washington.

Hagopian is lead author of a report this week in the scientific journal PLOS Medicine (Public Libarary of Science) that, through a number of analytical methods, estimated that nearly half a million Iraqis – men, women and children – died between 2003 and 2011 as a result of the war and its broader corrosive effects on infrastructure.

Other researchers at the UW, such as the number-crunchers at the Institute for Health Metrics and Evaluation, Johns Hopkins University, Simon Fraser University and Mustansiriya University in Baghdad, contributed to the study – which Hagopian noted could not get funding from any of the typical government research funding agencies.

The report that half a million Iraqis died – as opposed to the American public’s belief that the death toll was in the tens of thousands – prompted fairly widespread media coverage this week such as these stories by the LA Times and NBC, but the news isn’t really that new.

In 2006, Johns Hopkins scientists Les Roberts and Gil Burnham (a co-author with Hagopian for this week’s article as well) reported 655,000 ‘excess’ deaths in Iraq due to the direct and non-direct consequences of the war. For their efforts in doing this study in Iraq (which put some of the researchers’ lives at risk), Roberts and Burnham were lambasted, their findings eventually shrugged off as ‘debatable.’ And the debate has gone on.

Now, seven years later, we have a new report that essentially confirms the gist of what Roberts and Burnham found back in 2006 – but with improved statistical and survey methods aimed at perhaps satisfying the critics of the earlier study. But the real issue here shouldn’t just be about refining the numbers, Hagopian said. The big issue, she said, is the official policy we have to not count war dead.

Amy Hagopian“We think it is high time for the global health community to view war as a serious threat to public health and to push for accurate measurement of its impact on the populations at risk,” Hagopian said. “We couldn’t get one scientific agency or government organization to fund this study. The public health community needs to stop shying away from the politics of all this.”

For the PLOS study published Tuesday, Hagopian and her colleagues worked with Iraqi researchers to conduct detailed surveys of some 2,000 households across the country, asking residents to describe all the deaths and causes of death of family members between 2003 and 2011.

They determined that there were 461,000 ‘excess deaths’ of men, women and children in Iraq directly or non-directly caused by the war. Most of them, 60 percent, were due to direct violence. But a significant proportion of the deaths, 40 percent, were due to ‘indirect’ effects of the war on people’s lives – such as lack of medical care, food, clean water and the like. Of the deaths due to violence, the researchers attributed 35 percent to U.S. and coalition forces, 32% to sectarian clashes and 11% due to criminal activities.

Not surprisingly, other experts already have challenged, or expressed lack of confidence, in the accuracy of this latest study of the death toll due to the war in Iraq.

The LA Times, for example, quoted one expert:

“The main problem with this survey, and with others, is the underlying denominator: the total population,” said Dr. Prabhat Jha, director of the Center for Global Health Research in Toronto. “That’s the tricky part of war zone situations. People not only get killed, but they move out of the country and rarely move in.”


About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at] or follow him on Twitter @tompaulson.