Another bleeding blog posting on the Lancet report on post-invasion mortality in Iraq?

Yes, and if you're sick of repeatedly arguing with the bookless, innumerate cohort who reject the findings of the Lancet report on post-invasion mortality in Iraq, turn away now. I guarantee you there are more interesting things on the Grand Distractometre about which you could be reading, such as Pete Doherty's recent break-up with Kate Moss or his release from prison, or how the Bremen zoo is trying to de-gay its penguins.

From 'Ivan', a decidedly persistent pro-war commenter on a previous posting of mine, as well as from other critics of the Lancet report, I have been able to ferret out seven key criticisms:

1. The report was produced by a cabal of godless, baby-eating homo-Communists.

2. The methodology is inappropriate, with, in particular, the spread of the confidence interval between 8,000 and 194,000 possible excess deaths, coming under attack.

3. The sample is unrepresentative, as Falluja was an admittedly bloody episode, but not representative of the conflict as a whole.

4. There is too great a disparity between the numbers offered by Iraq Body Count and those of the Lancet.

5. Even accepting the Lancet report, there are actually only 60,000 excess deaths attributable to Coalition forces, not 100,000.

6. Many of the deaths could have been caused by the insurgents

7. Many of the deaths could have been insurgents.

While, as I shall show, each of these arguments are weaker than my basketball dribbling ability, it is useful to explore whether 'Blair and Bush: butchers of 100,000 Iraqis' is a legitimate slogan to paint on a placard. Are we in fact playing fast and loose with the figure?

First off, what does the Lancet report actually say?

'We estimate that 98 000 more deaths than expected (8000–194 000) happened after the invasion outside of Falluja and far more if the outlier Falluja cluster is included. The major causes of death before the invasion were myocardial infarction, cerebrovascular accidents, and other chronic disorders whereas after the invasion violence was the primary cause of death. Violent deaths were widespread, reported in 15 of 33 clusters, and were mainly attributed to coalition forces.

'Most individuals reportedly killed by coalition forces were women and children.

'Making conservative assumptions, we think that about 100 000 excess deaths, or more have happened since the 2003 invasion of Iraq.

'Violence accounted for most of the excess deaths and air strikes from coalition forces accounted for most violent deaths.' (Roberts et al pg 1)

Now let's deal with each argument in turn.

1. The report was produced by a cabal of godless, baby-eating homo-Communists.

No it wasn't. The study, published in the leading British medical journal The Lancet, was approved by the Johns Hopkins Bloomberg School of Public Health Committee on Human Research.

2. The methodology is inappropriate, with, in particular, the spread of the confidence interval between 8,000 and 194,000 possible excess deaths, coming under attack.

In the UK, the Prime Minister's Official Spokesperson (PMOS) dismissed the study and its methodology immediately following its publication:

'Asked if the Prime Minister was concerned about a survey published today suggesting that 100,000 Iraqi civilians had died as a result of the war in Iraq, the PMOS said that it was important to treat the figures with caution because there were a number of concerns and doubts about the methodology that had been used. Firstly, the survey appeared to be based on an extrapolation technique rather than a detailed body count…'

Well, let's look at the methodology. From the report:

'We designed the cross-sectional survey as a cohort study, with every cluster of households essentially matched to itself before and after the invasion of March, 2003. Assuming a crude mortality rate of ten per 1000 people per year, 95 per cent confidence, and 80 per cent power to detect a 65 per cent increase in mortality, we derived a target sample size of 4300 individuals. We assumed that every household had seven individuals, and a sample of 30 clusters of 30 households each (n=6300) was chosen to provide a safety margin. We selected 33 clusters in anticipation that ten per cent of selected clusters would be too insecure to visit.

'We assigned 33 clusters to Governorates via systematic equal-step sampling from a randomly selected start. By this design, every cluster represents about 1/33 of the country, or 739 000 people, and is exchangeable with the others for analysis. Most communities visited consisted of fewer than 739 000 people. Thus, when referring to a specific cluster by name, this group of 30 households is representing 1/33 or three per cent of the country, which may extend beyond the confines of that village or city.'

Now, The Economist, which is hardly a photo-copied zine by some Portland anarchist anti-imperialist knitting circle, accepts the methodology:

'Statistically, 33 [regions are] a relatively small sample (though it is the best that could be obtained by a small number of investigators in a country at war). That is the reason for the large range around the central value of 98,000, and is one reason why that figure might be wrong. (Though if this is the case, the true value is as likely to be larger than 98,000 as it is to be smaller.) It does not, however, mean, as some commentators have argued in response to this study, that figures of 8,000 or 194,000 are as likely as one of 98,000. Quite the contrary. The farther one goes from 98,000, the less likely the figure is.'

The magazine also produces a pair of professors who approve of the methodology: 'Nan Laird, a professor of biostatistics at the Harvard School of Public Health, who was not involved with the study, says that she believes both the analysis and the data-gathering techniques used by [lead investigator in the Lancet study] Dr Roberts to be sound…[and] Arthur Dempster, also a professor of statistics at Harvard, though in a different department from Dr Laird, agrees that the methodology in both design and analysis is at the standard professional level.'

The Economist also reminds us that 'clustered sampling is the rule rather than the exception in public-health studies,' and even defends the extrapolatory methodology of the Lancet study over passive-surveillance techniques such as that used by Iraq Body Count: '…when [Dr. Roberts} was head of health policy for the International Rescue Committee in the Congo, in 2001, he found that only seven per cent of meningitis deaths in an outbreak were recorded by the IRC's passive system.'

3. The sample is unrepresentative, as Falluja was an admittedly bloody episode, but not representative of the conflict as a whole.

The PMOS also homed in on Falluja in order to discount the survey [from the same press statement]:

'Our worries centred on the fact that the technique in question appeared to treat Iraq as if every area was one and the same. In terms of the level of conflict, that was definitely not the case. Secondly, the survey appeared to assume that bombing had taken place throughout Iraq. Again, that was not true. It had been focussed primarily on areas such as Fallujah. Consequently, we did not believe that extrapolation was an appropriate technique to use.'

This is such horseshit.

The authors of the study note both in the précis and further on in the text that they immediately discounted data from Falluja:

'More than a third of reported post-attack deaths (n=53), and two thirds of violent deaths (n=52) happened in the Falluja cluster. This extreme statistical outlier has created a very broad confidence estimate around the mortality measure and is cause for concern about the precision of the overall finding.' (Roberts et al pg 4)

So it was excluded.

In fact, 'in the random selection process, other heavily damaged cities such as Ramadi, Najaf, and Tallafar were not selected. Moreover, the cluster in Thaura (Sadr City), the site of the most intense fighting in Baghdad, by random chance was in an unscathed neighbourhood with no reported deaths from the months of recent clashes.'

Thus, far from what the critics suggest, the 100,000 figure if anything has a considerable likelihood of being an underestimate.

Indeed, as the folks from the Cambridge Solidarity with Iraq (CASI) group note in their own response to the Prime Ministers' porky pies, 'Had the Fallujah sample been included, the survey's estimate would have been of an excess of about 298,000 deaths, with 200,000 concentrated in the three per cent of Iraq around Fallujah.' (Roberts et al p.5).

4. There is too great a disparity between the numbers offered by Iraq Body Count and those of the Lancet.

The Lancet report itself notes the discrepancy:

'Passive surveillance systems often have low sensitivity, and the fact that the estimate of coalition casualties from http://www.iraqbodycount.net is a third to a tenth the estimate reported in this survey should be of little surprise. What is particularly revealing about the Iraqbodycount.net system is that, as a monitor of trends, it closely parallels the results found in this survey…However, it should be used as a monitor of trends rather than as a count estimator.' (Roberts et al pg. 7)

There is a difference between a body count and the total number of deaths. The latter will always be higher, given the number of deaths that go unreported. In a war zone, the likelihood of such underreporting is keen. (Although, to be fair, the confusion and disorganization of a war zone is also likely to produce a duplication in such statistics.)

Iraq Body Count's response to the Lancet report in any case was to support the Lancet surveyors, but to distinguish between a precise body count and an estimate of total deaths:

'Iraq Body Count does not include casualty estimates or projections in its database. It only includes individual or cumulative deaths as directly reported by the media or tallied by official bodies (for instance, by hospitals, morgues and, in a few cases so far, NGOs), and subsequently reported in the media. In other words, each entry in the Iraq Body Count data base represents deaths which have actually been recorded by appropriate witnesses'
…

' We have always been quite explicit that our own total is certain to be an underestimate of the true position, because of gaps in reporting or recording'

This in itself is interesting because no similar study has been performed in Afghanistan, and so there is likely a comparable disparity between the Afghan conflict's body count (performed by the same people behind Iraq Body Count) and such an estimate of total deaths.

Since the report's publication, critics and even the Foreign Office have begun to hold up the IBC numbers as the more accurate sum. Now, Jack Straw should be careful clinging to such a liferaft - these numbers are fairly damning in themselves. Indeed, the government is more than aware of this, as shown by a response by a Ministry of Defence spokesperson to a question about Iraq Body Count. Again from the CASI response:

'We would caution against taking the numbers quoted in media reports and else where at face value. No source or combination of sources can produce a reliable figure.' (BBC Online 22 September 2004)

So we see that even just days before the publication of the Lancet report, the MoD was poo-pooing the Iraq Body Count figures, but now that they look so much better they become gospel?

5. Even accepting the Lancet report, there are actually only 60,000 excess deaths attributable to Coalition forces, not 100,000.

I have to say I am appalled that anyone would consider this to be a reasonable defence of the occupation or attack on the Lancet report. As if, even if this interpretation of the numbers were legitimate, for these moral eunuchs, some 60,000 deaths is just okaaaaay. Just fine. An acceptable figure. Troubling, perhaps, but, in the end, worth it, as Madeleine Abright once said about the half a million Iraqis who had died as a result of the UN sanctions.

The source used by Ivan, and, presumably other critics, to situate the 'true number' of those killed by the coalition forces at 60,000 is Epic, the Education for Peace in Iraq Center, an American NGO that was opposed to the war and attacks the Americans' support for Saddam Hussein in the 1980s, but supports the occupation due to the usual sort of wet 'pottery barn rule' arguments.

Although the site takes the Lancet report to be accurate, Epic distinguishes between violent deaths directly attributable to the coalition forces and excess deaths caused by chronic disease, infectious disease and accidents.

However, as we all know, someone who kills someone in a car accident that is a result of drunk driving is no less guilty of murder than if he had shot the victim. There is still someone dead, even if the death is unintended. It is the predictable result of such actions, just as these excess deaths not attributable directly to violence were.

Remember; these are not deaths due to chronic disease, etc., but excess deaths due to chronic disease, etc., i.e., those deaths that would not have occurred had there not been an invasion and occupation.

Attempting to distinguish the two forms of death, or to say that the occupiers were responsible for the deaths of but didn't 'kill' the other 40,000 is to free the occupation forces from norms of responsibility that in non-war situations are regularly applied to drunk drivers, negligent corporations, and drug traffickers. This is akin to saying cigarette manufacturers 'were responsible for cigarette-related deaths, but they didn't kill anyone.'

The Lancet report itself mentions some events that undermine this most Jesuitical of arguments that if someone hasn't actually had a bomb dropped on him or a gun put to his head, he wasn't killed by the occupation forces: '…the January, 2002, to March, 2003, rate applied to the 366 births recorded in the interview households post-invasion would project 10·4 infant deaths, whereas we noted 21 to have happened. Of these, three were attributed to coalition bombings and three to births at home when security concerns prevented travel to hospital for delivery.' The restriction in travel that is a product of the occupation (checkpoints, bombs, etc.) is thus also a cause of death no less lethal than a bomb or a gun, just as it is in occupied Palestine.

6. Many of the deaths could have been caused by the insurgents.

Well, let's go back to the start of the report again and see what the investigators had to say about this possibility:

'Violence accounted for most of the excess deaths and air strikes from coalition forces accounted for most violent deaths.' (Roberts et al pg 1)

In fact, what we find when we parse the report is that of the total excess deaths in the sample, '12 violent deaths [were] not attributed to coalition forces, including 11 men and one woman. Of these, two were attributed to anti-coalition forces, two were of unknown origin, seven were criminal murders, and one was from the previous regime during the invasion.' (Roberts et al pg. 5)

So two - two - out of the 142 deaths in the sample are attributable to the insurgents. You do the math.

7. Many of the deaths could have been insurgents.

Ivan and others cling to one line in the report that, taken out of context seems to support this idea, based on the fact that many of those killed were men:

'Many of the Iraqis reportedly killed by US forces could have been combatants. 28 of 61 killings (46 per cent) attributed to US forces involved men age 15–60 years' (Roberts et al pg 7)

However, the surveyors themselves warn against such an interpretation in the same paragraph, saying the disproportionate presence of males amongst those killed could be a result of the prominence of men in public, in the street, in Islamic societies: '…men are more often in public and more likely to be exposed to danger. For example, seven of 12 (58 per cent) vehicle accident-related fatalities involved men between 15 and 60 years of age.'

Furthermore, as the surveyors point out at the beginning, 'more than half the deaths reportedly caused by the occupying forces were women and children.'

This does not mean that many of the men killed were in fact not insurgents, but it is slim straw indeed to which these critics are clutching.

In any case, under international law, the inhabitants of an occupied country have the right to resist with arms. The insurgents when they attack Coalition forces are entirely within their rights to do so, thus while killing insurgents is obviously not a crime on the scale of the killing of civilians, it remains illegal when the occupiers kill them in the course of their resisting the occupation (although, arguably, not when the insurgents are off blowing up polling booths and Christian shopkeepers that sell Jack Daniels).
…

Q.E.D., I would think.