The Lancet, the world's
oldest medical journal, has turned its hand to something
quite new in medical research — the first attempt
to use epidemiological methods to estimate civilian casualties
in the invasion and occupation of Iraq. The research,
published in the journal's October 9 issue, gives an alarmingly
high figure for excess mortality since the April 2003
invasion: 100,000 civilians are dead who would otherwise
be alive today.
So why on earth would a medical
journal want to step into this particular political
minefield? The Lancet's editor, Dr Richard Horton,
thinks it's about time science got its hands a bit dirty.
"One should openly acknowledge science is political
and not be afraid to get stuck into the debate," he
told British newspaper The Observer recently.
"To me that's one of the failures of science. It sees
itself as being very apolitical, and that's just nonsense."
Many editorialists and bloggers have noted that it's
unlikely pre-publishing the article online just before
the US election would be mistaken for an apolitical
act.
CREDIBILITY
CASUALTY
The journal hasn't emerged unscathed from its political
experiment. The article drew a sharp response from both
the US and British governments. "We believe there are
no accurate estimates of civilian casualties in Iraq,"
said Britain's Ministry of Defence. The Pentagon went
a step further, arguing that accurate estimates are
impossible — American General Tommy Franks has
famously declared, "We don't do body counts."
This view doesn't wash with Dr
Neil Arya, past president of the Canadian group Physicians
for Global Survival. He retorts that the Coalition has
not only failed to count civilian casualties themselves,
but has also pressured the Iraqi Health Ministry to
stop hospitals compiling such figures. "They are on
very thin ice when they talk about precision warfare
or minimizing civilian casualties," he says, "because
they have never studied the actual results of their
actions."
HARD
FACTS
The figures in the report are certainly hard to ignore.
Some of the 100,000 deaths are due to the collapse of
Iraqi infrastructure. Infectious diseases such as typhoid
and hepatitis E are increasingly rampant in the new
Iraq, infant mortality is up, drugs are scarce and access
to medical care is frequently interrupted.
But the main cause of death in
Iraq is violence, which has killed more civilians in
the past 18 months than top killer cardiovascular disease,
say the researchers from Johns Hopkins Bloomberg School
of Public Health, Columbia University School of Nursing
and doctors affiliated with Al-Mustansiriya University
in Baghdad. And the leading perpetrators of deadly violence,
by a wide margin, are the US-led occupying forces.
Violence hot spot Fallujah was
excluded because of its disproportionately high death
toll; the researchers speculate the real numbers would
be even higher if towns like Fallujah were factored
in.
HUMAN
COST
In his accompanying editorial, Lancet editor
Dr Horton brought the message back to medicine: "From
a purely public health perspective it is clear that
whatever planning did take place was grievously in error,"
he wrote.
As for the authors of the study,
they say they're as surprised by the media frenzy as
they were by the results themselves. Study author Professor
Richard Garfield of Columbia University also noted,
in an interview with radio show CounterSpin, that the
US military has also expressed an interest in their
findings because the safety of their mission is directly
pertinent to the health and welfare of their troops.
He defended the study, saying "There are of course costs
to wars, but these have to be in the public arena if
we're supposed to support the war."
Judge for yourself: The Lancet
article, "Mortality before and after the 2003 invasion
of Iraq: cluster sample survey," is available free at
www.thelancet.com.
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