What has been the cost of the Iraq War? In strictly American terms, 4,486 U.S. military personnel died there (plus another 318 from Coalition allies); the dollar tab for the war is reckoned in the trillions. And in Iraq—how many people died as a result of the American-led invasion? That’s a harder question than it might seem.
A new study with a controversial back story attempts to provide a good answer. Writing today in the journal PLOS Medicine, the University of Washington’s Amy Hagopian and 11 co-authors estimate that roughly 461,000 Iraqis died as either a direct or indirect cause of the war and subsequent military occupation. But reflecting the tortured effort both of getting good numbers from a war zone and the history of controversial past counts, by the time all their calculations had settled the researchers put their “confidence interval” for possible excess deaths between March 2003 and June 2011 at between 48,000 and 751,000.
For the survey, Iraqi medical doctors questioned members of 2,000 randomly selected households throughout the country, asking about any births or deaths in the household since 2001. Interviewers also asked if any of their siblings had died over the same period. When a household responded with a death they identified as related to the war, they were then asked how it occurred (gun, bomb, air strike) and who they thought the perpetrator was. As a check, the surveyors also asked to see any death certificates at the end of their interview sessions.
A better idea of the death toll going into a conflict might dissuade the participants from taking the ugly actions that make a count necessary.
Gathering these figures, the team extrapolated to reflect the whole population, then compared that figure to the number of deaths that would be expected without a war. (By including the two-year period before the war started, the researchers could set a baseline on expected death rates.) They arrived at 405,000 dead. That left out Iraq’s vast refugee population, which had its own deaths to report, so using outside sources they estimated 56,000 additional deaths. Remember, these figures include both those who died from violent acts and those whose deaths occurred because society was falling apart around them.
IEDs featured prominently in Allied coverage of the war, but especially between 2003 and 2008, the hottest years of the conflict, guns were far and away the most common killing machine. Firearms were responsible for 63 percent of violent deaths, while bombs were responsible for 21 percent. That gibes with other studies that identified gunshots—whether fired in combat or during impromptu executions—as the most common method of killing. Looking at non-violent exits, cardiovascular disease accounted for almost half, 47 percent, of those deaths.
Among perpetrators, coalition forces accounted for 35 percent of violent deaths, and militias for 32 percent.
All told, the Iraqi death rate was 50 percent higher during wartime. Adult men were three times more likely to die violently than before the war, adult women 70 percent more likely to. Looking just at Iraqis between the ages of 15 and 60, researchers estimate 132,000 died directly from war-related violence. That estimate falls in line with other efforts to count Iraq’s dead. The non-profit Iraq Body Count, whose ongoing mission is to count individual civilian deaths (as opposed to using a statistical approximations), estimates, for example, that there have been about 157,000 violent deaths in the same period.
These new figures using “cluster sampling” methodology are a dramatic recalculation of numbers published in 2006 in The Lancet, a paper that used similar methodology and an author, Johns Hopkins epidemiologist Gilbert Burnham, with the PLOS Medicine study. The Lancet paper arrived at a figure of 601,000 violent deaths for just the first three years of the war. Red-faced Coalition politicians squawked at that finding, but so did observers like IBC and the American Association for Public Opinion Research, who individually and jointly criticized the methodology, the smell-test-failing outcome, and the researchers’ lack of transparency. The resulting controversy even gets its own Wikipedia listing.
“This paper really seems to fix most of the methodological flaws of the 2006 paper,” said Michael Spagat, an economist at London’s Royal Holloway, University of London, “with a consequence being that the numbers plummet dramatically, probably by more than a factor of four.” Spagat, who has worked with Iraq Body Count (and written for PSmag.com), is a longtime critic of “mismeasures” of the conflict deaths in Iraq and of the 2006 Lancet paper in particular. He sees this paper as both a repudiation and a corrective to that past paper—and an endorsement of best practices.
“This is very interesting from a scientific or research point of view. There’s a lot written in, let’s say, somewhat obscure literature about survey methodology and best practices and surveys. This would seem to suggest that that stuff really matters. If you’re really sloppy with the methodology your estimates can be just hugely off.
“From a scientific view, there’s really a lot of meat in there,” he added, although he finds that huge confidence interval from the headline number a little off-putting. “Unfortunately, we don’t have, and it wouldn’t be possible to have, some sort of controlled experiment. In an ideal universe you’d like to do the survey 20 different times and change one of the methodological points each time and see how that moves the estimate. ... Here you get all of the changes all at once, but the cumulative effect of all them is really huge.”
You might think “the authorities” would be putting these figures together. As Syria demonstrates now, that’s really difficult to do in a battle zone, especially one without clear-cut front lines. Iraq's Human Rights Ministry has tracked violent deaths; the U.S. did not—officially. In a passage that also shows how fraught it can be to try and count individual deaths, Hagopian notes the U.S. sometimes did count civilian deaths:
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 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. 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.”
Ultimately, do body counts matter? I tried to answer that once, and I’ll quote myself:
But modern warfare also brings concern for, or at least lip service to, the fate of noncombatants, civilians hurt through privation, collateral damage or atrocity. Here, if there is a bag, no side wants to be the one left holding it.
Beyond the obvious concern in states where citizens are actually dying, the fate of innocents killed in warfare can have a powerful effect elsewhere, particularly in countries with free or free-ish media — as the United States and its NATO allies can attest in regard to the former Yugoslavia, Iraq and now Afghanistan and Pakistan. Oddly enough, while it's the individual mangled bodies on this morning's news that drive public opinion, it's the actual body count that often drives policy. As a result, these counts — of civilians and soldiers alike — are often suspect and determined more by political considerations than actual corpses.
And so, perhaps knowing what’s gone before can spare us a little of what’s coming up, Stalin and Westmoreland be damned. A better idea of the death toll going into a conflict might dissuade the participants from taking the ugly actions that make a count necessary. In Iraq, casualty estimates made before the war—such as this intentionally alarmist one from MedAct—were generally lower than what actually occurred. (MedAct’s estimates came with the now-quaint caveat that if Iraq used its weapons of mass destruction the toll could reach almost four million.)
In a perspective appearing alongside Hagopian’s paper in PLOS Medicine, the World Health Organization's Salman Rawaf makes that point, then let’s real life rudely intrude:
The findings of Amy Hagopian and colleagues may help some families feel that their loss has at least been recognised, but continued sectarian bombings and targeted killings are deepening the sense of insecurity that continues to gnaw away at Iraq. As a scientific community, yes, we want an accurate war tally that can be used as evidence against waging future wars, but people also want to live without fear of becoming a body counted by epidemiologists. In a region with escalating violence, sadly, this may be a distant dream.