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The World Health Organization has now published an article in the prestigious New England Journal of Medicine new study on deaths in Iraq, and the study has gotten the official stamp of approval from the Washington Post. Here's their lead:

A new survey estimates that 151,000 Iraqis died of violence in the three years following the U.S.-led invasion of the country. Roughly nine of 10 of those deaths were a consequence of U.S. military operations, insurgent attacks and sectarian warfare.

The survey, conducted by the Iraqi government and the World Health Organization, also found a 60 percent increase in nonviolent deaths -- everything from childhood infections to kidney failure -- during the period.

I haven't had time to do a complete analysis, but right off the bat you can see some problems. First, note that both the news articles and the report itself quantify only the 151,000 deaths from "violence." This does make it clear how inaccurate the methodology of Iraq Body Count (its much lower numbers relying on published media reports, and counting "civilians" only) is, but it's very misleading with respect to the earlier Johns Hopkins studies. Why? Because the Johns Hopkins study was a study of "excess deaths," not deaths by violence only. Unfortunately, although the WHO study says they "found a 60 percent increase in nonviolent deaths," they don't quantify how many that amounts to, so comparing its 151,000 total to the Johns Hopkins study is difficult indeed.

Also, note the March 2006 end date. Nothing wrong with that, the study had to end sometime, but there's no attempt, either in the press or in the study itself, to project from that number or even to mention it. 21 months have passed since March 2006, and a lot more Iraqis have died (indeed, official numbers have said that last year saw an even higher Iraqi death toll than the ones that preceded it). Clearly, then, the "151,000" number, which is now going to assume the role of gospel, is starting out incorrect, even if it was correct as of March 2006.

But the biggest problem is the non-violent death problem. There seems to be an idea that only violent deaths "count," as if people dying from poor public health conditions, poor nutrition, or poor health care are somehow less dead, or as if the increase in their numbers is any less attributable to the invasion. Consider Table 3 from the study. For all ages, subtracting out the violent component gives 3.07 deaths per 1000 person-years from disease and other non-violent causes before the invasion, and 4.92 after, a 60% increase. Violent deaths went from 0.1 to 1.09. I'm no statistician, but even though that's a 10-fold increase, the absolute increase of 1.85 deaths per 1000 person-years from non-violent causes would seem to be 70% larger. So if there were 151,000 additional violent deaths by March 2006, my crude calculation (which I am very willing to have corrected by a real statistician) gives 256,000 deaths from non-violent causes, for a total of 407,000 Iraqis dead as a result of the invasion by March 2006. That's three years of data, which means it's 11,300/month. Add an another 21 months and that's another 238,000 people, for a grand total of 645,000, more than four times higher than the number you're now going to be hearing bandied about in the corporate media.

One hell of a lot of people. Or, to be blunt about it, former people. They're dead now.

P.S.: Shall we start a poll as to when the first time a reporter will ask George Bush about these numbers? I'll place my bet on "never."

Update: First misinterpretation: Democracy Now! this morning reports that "a new study shows that 151,000 Iraqis have died." No, the new study shows that 151,000 Iraqis have been killed by violent means through March 2006.

Second misinterpretation, from The New York Times: "W.H.O. Says Iraq Civilian Death Toll Higher Than Cited." No, the WHO study has nothing to do with "civilians," it has to do with "Iraqis." The only appearance of the word "civilians" in the NEJM paper is in conjunction with mentions of Iraq Body Count, which does count only "civilians." The Times further confuses deaths with violent deaths, reporting that "The World Health Organization said its study...indicated with a 95 percent degree of statistical certainty that between 104,000 and 223,000 civilians had died." It did no such thing. It indicated that many Iraqis had died from violence. Quite a different thing.

Small correction: Just caught myself in one math error. Somehow I thought that the study ended in March, 2006; it actually ended in June, 2006. That means I added in three too many more months of deaths. I should have added in 18 months, for a total of 610,000 deaths, not 645,000.

Another update: I just checked the Democracy Now website, and it's worse than I wrote above. Like the NY Times, they report (inaccurately on three counts!): "A new study of the civilian death toll since the U.S. invasion of Iraq has put the number of Iraqi deaths at 151,000." Not "civilians," not the "death toll," and not "since the invasion". This from the most progressive news organization with reasonably mass distribution in the entire country.


Reprinted from Left I on the News

Originally posted to Left I on the News on Wed Jan 09, 2008 at 09:11 PM PST.

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Comment Preferences

  •  Tip jar (13+ / 0-)

    Eli Stephens
    Left I on the News

    "Philosophers only interpret the world, the point remains to change it." - Karl Marx

    by elishastephens on Wed Jan 09, 2008 at 09:11:50 PM PST

  •  Plus who knows how many have died... (2+ / 0-)
    Recommended by:
    Nihilvor, jlms qkw

    ...because of lack of doctors, hospitals, hunger, suicide.

    Lancet's 2006 estimate of 655,000 excess deaths still rings true to me and is probably conservative now.

    Dailykos.com; an oasis of truth. Truth that leads to action -1.75 -7.23

    by Shockwave on Wed Jan 09, 2008 at 09:19:43 PM PST

  •  The NEJM has a different analysis (1+ / 0-)
    Recommended by:
    jlms qkw

    The analysts there write about violent deaths.

    The results of this survey are most striking in comparison with those in two other reports: the Iraq Body Count Project2 and a 2006 study by Burnham et al.3 The IFHS authors note that their estimate is much lower than that reported in the study by Burnham et al., which yielded a point estimate of 601,027 violent deaths between 2003 and 2006. Since the latter tally was much publicized, the first response to the IFHS results may be disbelief; some will no doubt suggest that the findings are flawed. However, the Iraq Body Count arrived at an even lower total — 47,668 (see graph).

    I am not a biostatistician or epidemiologist but the NEJM has them.

    See my diary below.

    "It's the planet, stupid."

    by FishOutofWater on Wed Jan 09, 2008 at 09:26:53 PM PST

    •  Please read more carefully (4+ / 0-)
      Recommended by:
      Shockwave, shock, FishOutofWater, jlms qkw

      This post is precisely about the WHO study published in the NEJM (which is a WHO study, just as the other one is the "Johns Hopkins" study, not the "Lancet" study as people erroneously refer to it; neither "Lancet" nor "NEJM" does studies). Anyway, the whole point of this diary is that, while the authors of the study and the news coverage hone in on violent deaths, as if they are "more important" than others, the other data is very much present in their study.

      Eli Stephens
      Left I on the News

      "Philosophers only interpret the world, the point remains to change it." - Karl Marx

      by elishastephens on Wed Jan 09, 2008 at 09:29:11 PM PST

      [ Parent ]

      •  No. It counts deaths resulting from violence, (1+ / 0-)
        Recommended by:
        jlms qkw

        not deaths by violence.

        There was a wording ambiguity in the abstract of the original article that caused this confusion.

        Results Interviewers visited 89.4% of 1086 household clusters during the study period; the household response rate was 96.2%. From January 2002 through June 2006, there were 1325 reported deaths. After adjustment for missing clusters, the overall rate of death per 1000 person-years was 5.31 (95% confidence interval [CI], 4.89 to 5.77); the estimated rate of violence-related death was 1.09 (95% CI, 0.81 to 1.50). When underreporting was taken into account, the rate of violence-related death was estimated to be 1.67 (95% uncertainty range, 1.24 to 2.30). This rate translates into an estimated number of violent deaths of 151,000 (95% uncertainty range, 104,000 to 223,000) from March 2003 through June 2006.

        The term "violent deaths" actually meant deaths related to violence in Iraq, not deaths by violence in Iraq.

        The new study was similar, but had a much larger sample.

        Meanwhile, there is ongoing discussion4 about the validity of the study by Burnham et al. The survey methods have been scrutinized, and observers have put forward convincing arguments both that it does and that it does not overestimate mortality. One of the issues under debate is whether the clusters that were surveyed were nonrandomly distributed owing to "main-street bias" (an oversampling of highly trafficked areas). What cannot be debated is that it was a much smaller study (1849 households in 47 clusters) than that conducted by the IFHS (9345 households in 1086 clusters).

        We are both on the same side of this horror. I think this study underestimated the number of deaths because the investigators didn't go to the most dangerous areas for fear of adding to the numbers.

        "It's the planet, stupid."

        by FishOutofWater on Thu Jan 10, 2008 at 05:25:00 AM PST

        [ Parent ]

        •  Underestimate (1+ / 0-)
          Recommended by:
          jlms qkw

          I think this study underestimated the number of deaths because the investigators didn't go to the most dangerous areas for fear of adding to the numbers.

          They openly acknowledge that and attempted to correct for it. Of course assumptions are very much involved any time you attempt such corrections.

          But the main "underestimate" remains the one I point to - the fact that the authors, and the press, seem to think that "violent" deaths are the only ones that count, and that they are free not to give us the total of the "regular" deaths which were also caused by the invasion, thanks to the serious degradation of living conditions in Iraq.

          Eli Stephens
          Left I on the News

          "Philosophers only interpret the world, the point remains to change it." - Karl Marx

          by elishastephens on Thu Jan 10, 2008 at 06:46:03 AM PST

          [ Parent ]

          •  Thanks. Correct, they ignored "regular" deaths (1+ / 0-)
            Recommended by:
            jlms qkw

            The NPR story is clear. They talked to the author.

            "They don't include car accidents and they don't include unintentional injuries," says Boerma. "They just include intentional injuries and armed conflict. In fact, the armed conflict deaths are more than 80 percent of the deaths we got reported."

            You got it right. I'm sorry.

            "It's the planet, stupid."

            by FishOutofWater on Thu Jan 10, 2008 at 01:29:03 PM PST

            [ Parent ]

          •  Definition of violent death? (0+ / 0-)

            Weren't there some discussions a few years ago about how to classify U.S. soldiers who were wounded or killed 'indirectly'?  I seem to remember, back in Rumsfeld's days, that the Pentagon was trying to mess with the definition of 'battle-related injuries' so as to minimize the bad news coming out of Iraq, and also to minimize the VA burden.  Without a very explicit definition of 'violence-related deaths,' I can imagine someone sympathetic to the war making claims such as, "Well, she died from blood loss when she was in the hospital, so it doesn't really count as a battle-related injury, and therefore isn't really violence-related."  After the first Johns Hopkins study, I don't trust anyone who puts a number like 151k in the title of a research article.  

            Any death that was "in excess" because of the war -- even if it was from a hospital infection that was not treated simply because of lack of supplies -- should be counted as "violence-related," because without the war it arguably would not have happened.  

  •  Some perspective (6+ / 0-)

    A combined 517,226 total people voted in this week's New Hampshire primary (that is, combining the totals from both parties).

    This is about 108,000 people:

    Social advance depends as much upon the process through which it is secured as upon the result itself. --Jane Addams

    by shock on Wed Jan 09, 2008 at 10:28:05 PM PST

  •  Errors in new study discussion (5+ / 0-)

    There are some errors in the Iraqi Government/WHO (IFHS) report's discussions which are worth pointing out.

    The most glaring is that they misrepresent the John Hopkins "Lancet"(Burnham et al) report:

    During the same period, the Iraq Body Count registered 47,668 civilian deaths from violence. A much smaller mortality survey (1849 households in 47 clusters) by Burnham et al. came up with a best estimate of 601,027 violent deaths

    Burnham et al reported not on violent deaths but the excess deaths which includes those as a result of the damage caused by the war eg public hygene as well as those caused by violence.

    The Iraqi government's report thus seem to be intended to discredit the Burnham et al report by this deliberate error. It cannot be anything else at the discussion goes on to point out how much higher the violent deaths would be. It is worth comparing the ranges given by the two studies.

    IFHS    104,000 - 223,000 violent deaths

    Burnham 393,000 - 943,000 excess deaths

    Adding in your guesstimate of 250,000 non-violent excess deaths shown in the IFHS study will up their range to

            354,000 - 473,000

    While the Burnham result may well have factors that exaggerate the total, the IFHS admits to downward errors. Both studies therefore "appear to point to an excess death figure for the period in excess of 400,000" which may be the best way of expressing the result from the IFHS.

    It really needs an in depth study comparing the two results but crudely reading the two together, they appear to be consistent with each other.

    •  No. The new study measured (1+ / 0-)
      Recommended by:
      jlms qkw

      the same thing as the older, smaller study.

      See my comment above.

      The NEJM is not politically motivated here and the reviewers wouldn't allow the kind of deliberate cover up you are suggesting. The NEJM is a first-rank professional journal. It makes mistakes occasionally, of course. However, there is very little chance that your hypothesis is correct.

      "It's the planet, stupid."

      by FishOutofWater on Thu Jan 10, 2008 at 05:29:12 AM PST

      [ Parent ]

      •  Correction: This diary is basically correct (2+ / 0-)
        Recommended by:
        Eikyu Saha, jlms qkw

        NPR had a discussion including an author of the new study and an author of the JHU study. In the discussion it became clear that this new study didn't include excess deaths caused by deteriorating health care and other factors not directly related to violence. Moreover, it measured a much lower rate of violent death than the JHU study.

        I apologize for any confusion I may have caused.

        It's pretty clear that the new study significantly undercounts the number of deaths. It's pretty clear they got a lower rate of violent death because they didn't count in the most violent areas. It's completely clear that they didn't include non-violent deaths related to deteriorating conditions.

        "It's the planet, stupid."

        by FishOutofWater on Thu Jan 10, 2008 at 01:19:33 PM PST

        [ Parent ]

  •  Thanks for the analysis elishastephens (2+ / 0-)
    Recommended by:
    Eikyu Saha, jlms qkw

    Study puts Iraqi death toll at 151000
    Baltimore Sun, United States - 41 minutes ago
    By Jonathan Bor | Sun reporter January 10, 2008 The Iraq government and World Health Organization estimate that 151000 Iraqis died violent deaths during the ...

    WHO Says Iraq Civilian Death Toll Higher Than Cited New York Times

    WHO Study Finds More Than 150000 Violent Iraqi Deaths Voice of America

    UN survey puts 3-year Iraqi toll at 151000 Los Angeles Times

    WHO Estimates Iraqi Death Toll at 151000
    NPR - 9 hours ago
    by Brenda Wilson All Things Considered, January 9, 2008 · A study conducted by the World Health Organization and the Iraq Health Ministry estimates that ...

    Google News of World Health Organization shows 4 of the top 5 headlines using the 151,000 Iraqi death toll figure. COM has decided almost 500,000 additional dead don't matter.

    History is going to look back at this era (error) and conclude we were monsters.

    Image Hosted by ImageShack.us
    image - RubDMC

    Creationism will be big in the future because people will deny they evolved from us.

    by exNYinTX on Thu Jan 10, 2008 at 02:41:23 AM PST

  •  congrats on being rescued (0+ / 0-)

    maybe a next diary on all the studiest, longitudinally ?  

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